Vaginal infections: taking care of your flora

A story of flora and pH

Lactobacilli are microorganisms that grow and multiply naturally in the vagina. They constitute 90% of the composition of the vaginal flora, also called Döderlein flora . This physiological composition allows the maintenance of an adequate vaginal flora. They are, in a way, good bacteria whose vocation is to defend and maintain a healthy female genital area . The vaginal flora results from an adequate proportion between the protective lactobacilli and other bacteria whose presence is natural and harmless when it remains in low proportion (for example Gardnerella vaginalis).

In the same way as for the intestine, the composition of the vaginal microbiota must remain predominantly in lactobacilli. Indeed, it is the latter which contribute to the maintenance of an optimal vaginal pH by producing lactic acid . Under normal physiological conditions, the vaginal pH is acidic and should be acidic and be between 3.5 and 4.5.

When there is a disorder, whatever the origin, the number of lactobacilli can decrease. No longer playing their role effectively, the balance is broken and the acidity of the vagina becomes less. The natural defense system is somehow weakened and makes this area more vulnerable to the invasion of pathogens . Bacterial vaginosis and vulvovaginal candidiasis are the most common vaginal infections.

bacterial vaginosis

It is the most common bacterial vaginal infection and the leading cause of vaginal symptoms in women of childbearing age.
When the balance within the vaginal ecosystem is weakened, potentially pathogenic bacteria proliferate and cause an infection. It is not, strictly speaking, a sexually transmitted disease. On the other hand, the presence of bacterial vaginosis exposes you to a much higher risk of sexually transmitted infections. Thus, their association is relatively common with chlamydial infection, gonorrhea and HIV) (1).
This vaginosis sometimes goes unnoticed and is then qualified as asymptomatic. However, in many cases, it is manifested by unpleasant symptoms such as heavy and smelly vaginal discharge . It is also sometimes associated with vaginitis which corresponds to an inflammation of the mucous membrane. This results in itching, local redness, irritation that can go as far as bleeding with burning sensations. There may be an impact on sexual intercourse which becomes painful.

Vulvovaginal candidiasis

More commonly called mycosis , vulvovaginal candidiasis is due to the colonization of fungi (most often a Candida albicans ) permitted by the poverty or inefficiency of the local flora.

Again, distressing symptoms suggest this diagnosis. It may also be itching and burning inside the vagina and at the level of the vulva, local irritation, whitish discharge resembling curdled milk and urinary signs with cravings more compelling.

Well-identified contributing factors to the weakening of the vaginal flora

Hormonal changes

Menstruation represents a period of greatest fragility of the vaginal flora. Sometimes, the simple physiological variations of estrogen levels during the menstrual cycle contribute to the imbalance.

Pregnancy also experiences a greater frequency of bacterial infections, but especially fungal infections due to hormonal upheavals, more frequent constipation and, moreover, a decrease in local immunity during this period.

The atrophy and vaginal dryness that accompany the period of menopause are also particularly conducive to the alteration of the local flora.

Inadequate intimate hygiene

Thinking well, some women carry out a too invasive intimate toilet (vaginal douching). This practice can have the consequence of destroying the physiological vaginal flora which nevertheless plays a role of barrier vis-à-vis foreign organisms such as bacteria and fungi. The use of unsuitable hygiene products also constitutes a risk of disturbance of the vaginal flora.

Other factors involved

Other factors are known to be harmful in disrupting the vaginal microbiota. This is the case with tobacco , but also with stressful situations or even diabetes .

Propose effective treatments

Treat the cause

The treatment of bacterial vaginosis is based on general antibiotic treatment (or rather local in pregnant women). This treatment is not systematic and it is customary practice to treat only women with symptoms. The classes of antibiotics that work best are metronidazole and clindamycin. Nevertheless, studies on the subject testify to a high risk of recurrence , including in the event of good compliance with treatment. This probably testifies to the relative effectiveness of antibiotic treatments (2) and progress remains to be made.

Moreover, as mentioned above, the risk of association with sexually transmitted infections regularly raises the question of treating asymptomatic women due to a context of transmission of these diseases by contamination during unprotected sexual intercourse.

In the case of mycosis, or vaginal candidiasis , the treatment consists of an antifungal drug since it is a form of fungus.

take probiotics

Taking probiotics helps on the one hand to relieve uncomfortable symptoms, on the other hand to restore the vaginal flora which is lacking (3). Specific lactobacilli are used intravaginally or orally , as a cure, with an attack phase to recolonize the failing flora. Then, it is possible to consider regular maintenance cures to continue the restoration of balance and prevent recurrences , which are particularly frequent in the case of vaginosis.

Several strains of lactobacilli , present in the same probiotic, make it possible to vary its composition and act in synergy on the vaginal ecosystem. The advantage of this treatment lies in the absence of side effects .

Note that when taken orally, this type of probiotic has also proven its effectiveness on the vaginal microbiota (4). Indeed, it is now known that lactobacilli taken orally pass through the digestive microbiota before migrating to the vaginal microbiota.

Repair the vaginal mucosa

Vaginal infections damage the local mucosa. In addition to other therapies, the addition of a tissue protector and repairer contributes to the return of a healthy physiological ecosystem.

These adjuvants can be applied in the form of vaginal capsules or gel and are often composed of soothing active ingredients with plant extracts such as aloe vera or calendula, among others.

Ensuring gentle intimate hygiene

Whether during an infection, or in daily practice, intimate hygiene rules must be respected. First of all, it is advisable to choose a mild soap adapted to this region , that is to say with a neutral pH, without antiseptics and as natural as possible.
One personal wash a day is enough. Excessive frequency is harmful. If you nevertheless wish to wash more often, the hygiene of this zone must be done with clear water.

Douching , as well as the use of stripping products, are to be avoided . The same goes for the use of wipes, the composition of which is often laced with chemicals likely to destabilize the vaginal flora.

Wear adequate clothing and underwear

Beyond being changed daily, cotton underwear is preferable to synthetic underwear. Clothes that are too tight (trousers, tights, etc.) are also not recommended because they promote local heat and potentially increase the proliferation of germs.

The vaginal flora represents a defense barrier against potentially pathogenic external organisms. Several periods of a woman's life can weaken this physiological armor. Also, taking care of your female health involves, among other things, ensuring that you maintain or restore a strong vaginal flora that is ready to deal with an attack.

Bibliographic references:

1. Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 13 Feb 2016;3:4.
2. Bradshaw CS, Sobel JD. Current Treatment of Bacterial Vaginosis—Limitations and Need for Innovation. J Infect Dis. 2016 Aug 15;214(Suppl 1):S14‑20.
3. Homayouni A, Bastani P, Ziyadi S, Mohammad-Alizadeh-Charandabi S, Ghalibaf M, Mortazavian AM, et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis. 2014 Jan;18(1):79‑86.
4. Vujic G, Jajac Knez A, Despot Stefanovic V, Kuzmic Vrbanovic V. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):75-9.