Any sort of disbalance in nature is considered to be catastrophic! Similar is the case when it is the environment in the vagina. Most women complain of odor or many other issues related to the vagina, and this affects not only the sexual health and life, but the overall health and hygiene of a person.
There are certain reasons for it, and let us delve into an understanding about this. In a female body,the vagina inhabits abundant flora, most common being lactobacillus. These vaginal microbiota in right numbers helps in maintaining appropriate vaginal pH or acidity. This delicate balance in vaginal pH is a must to prevent its invasion by pathogens like bacteria and fungus. Lactobacilli produce lactic acid and hydrogen peroxide which are natural microbicides, most common species being lactobacillus crispatus. Typical or physiological discharge from vagina is white and odorless and may increase at the time of ovulation and pre-menstruation.
Vaginal Microbiome is altered by many environmental factors, which range from the hygiene to other reasons. One of the most important and often ignored factor is the type of water supply in a particular locality. Yes, bizarre as it may sound, it definitely has an impact on the vaginal health. The other reason is poor personal hygiene. Most of the women are unaware about cleanliness of the private parts. They don’t know whether water is to be used every time they use the washroom after passing urine, or if it is better to keep it dry with toilet paper. This in the long run has a major impact on the vaginal health. The other reasons are low socioeconomic status, where again accessibility to neatness, a clean washroom, and habits become a major obstruction. Another prominent reason for this is unprotected sexual intercourse and having multiple sexual partners.
A few other reasons are use of long-term antibiotics, uncontrolled diabetes mellitus, pregnancy and HIV infection. Urogenital infections i.e., infections involving vulva, vagina, cervix, pelvic organs and urinary tract. Billions of women are affected each year leading to morbidity and even mortality in developing countries. These infections are usually ascending infections. The pathogens reside in vaginal cells and invade them causing their persistence, growth and symptoms. Various types of vaginitis are bacterial vaginosis, trichomonas vaginitis and vulvovaginal candidiasis. Affected women may have complaints of abnormal vaginal discharge which is profuse in amount and foul smelling.There can be vulval pruritis, dyspareunia, dysuria and post-coital bleeding. Vaginal infection can ascend to present itself as pelvic inflammatory disease as well.
All these reasons have started affecting the fertility of the females now. The female partner is affected as it affects the tubes and uterus as well and even altered vaginal pH can act as spermicidal.Vaginal dysbiosis have been found to be associated with failed IVF cycles by effecting implantation of embryos. Even during pregnancy, vaginal infections can cause complications like pre-term premature rupture of membranes and preterm labour pains which increases risks of fetal morbidity and mortality.
Physical examination of vulva, vagina and cervix by your gynecologist followed by certain tests may help in identifying the specific infection in order to start treatment. Most important advice along with treatment is refrainment from sexual intercourse till treatment is complete.
BACTERIAL VAGINOSIS is the most common among all types of vaginal infection. It is basically a shift in vaginal flora from lactobacillus to anaerobes i.e., Gardnerella vaginalis, mycoplasma hominis,bacteriodes species. Many women may be asymptomatic whereas others may present with profuse ,malodorous discharge and pruritis. The organisms form a biofilm over the vaginal mucosa and so protect themselves from antimicrobial therapies. This is the predominant reason for increased recurrence rates. It is seen the infection recurs in 15-30% women in 3 months period and in 50% within 1 year.
Oral or local specific antibiotic is required for the treatment. Most commonly, tablet metronidazole is prescribed 500 mg twice daily for 7 days.
Second most common type of vaginal dysbiosis is Vulvo-Vaginal Candidiasis (VVC). The causative organism is fungal organism, most common being candida albicans. More than 40% of affected women may have two or more episodes of VVC in their life time. This infection is characterized by specific curdy white discharge and requires antifungals.
Single dose of tablet fluconazole 150 mg along with local antifungal creams for 3-6 nights.
It is caused by protozoa, trichomonas. It is characterized by greenish-frothy discharge along with other mentioned symptoms.
Tablet metronidazole is prescribed 500 mg twice daily for 7 days.
Urinary tract infections are also associated with vaginal dysbiosis. Most common pathogen causing urinary tract infection is Escherichia coli. There occurs colonization of uropathogens in vaginal mucosa surrounding peri-urethral region followed by ascending infections i.e., to urethra, bladder and to kidneys which can be catastrophic. Antibiotics are required in symptomatic cases and even in asymptomatic pregnant women.
With the increase in UTI’s, the worrisome issue is rampant use of antibiotics in all above mentioned conditions and many times these are over-the-counter drugs that people tend to take without the prescription of a medico. Readers are requested not to fall trap of such practices and take proper advice of gynecologist or urologist. Increased antibiotic use can lead to development of resistance of the pathogens which further can lead to harmful mutations to become more ferocious.Also,widespread antibiotic use can lead to alteration in vaginal flora with suppression of good bacteria. So, use of probiotics can be a good substitute along with antibiotics. Various studies have been done on the benefit of using probiotics in urogenital infection and have been found to be effective. They act by colonizing the host i.e.,the vaginal mucosa with good bacteria, lactobacillus. They help in producing lactic acid, hydrogen peroxide, bacteriocin production and also compete for adherence to vaginal cells with pathogens. In a study by Vujik G et al, 1 oral probiotics were found to be effective and free from side effects in addition to antibiotics. Oral probiotic preparations are now available in India as well and should be prescribed along with antibiotics in order to decrease possibility of recurrence and ensure complete relief.
1) Vujic G, Jajac Knez A, Despot Stefanovic V et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a doudle blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol.2013; 168(1): 759.
Dr. Kanika Chopra (MBBS, MS Obstetrics and Gynecology) is working as an Assistant Professor in Lady Hardinge Medical College, New DELHI. She has also worked as an Associate consultant in Sir Ganga Ram Hospital, New Delhi in the minimally invasive surgery unit. A dynamic and diligent doctor, she was awarded the BEST POST-GRADUATE AWARD in her residency period and has received many prizes for her work. An avid writer and researcher, she has authored over 30 articles in both National and International Journals, and wellness magazines.
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