Treatment of dysbiosis in women. Detailed explanation of smear analysis for flora in women

The health of the entire body as a whole is determined by the balance of the various microorganisms that live in it. The health of the genital organs also depends on this. Probably, many of you have more than once encountered such a concept as microflora of the genital organs– a set of microorganisms inhabiting the organs of the human genitourinary system. Sexual health remains normal as long as beneficial bacteria dominate over harmful ones. If this balance is disturbed, then a person begins to be bothered by various symptoms of infectious and inflammatory diseases of the genital organs.

The structure of the female internal genital organs

Normal vaginal microflora

Functions of normal vaginal microflora

• Evolutionary – an acidic environment tends to destroy sperm, as a result of which only the healthiest sperm can overcome the acid barrier;
• Protective – an acidic environment destroys all pathogenic microorganisms.

Based on the composition of the microflora, the following degrees of cleanliness of the vagina of healthy women are distinguished:
1st degree: acidic reaction of the environment, high level of lactobacilli ( representatives of the genus of lactic acid bacteria), there are very few other microorganisms;
2nd degree: slightly acidic reaction of the environment, a small number of lactobacilli, staphylococci, leukocytes and streptococci are observed;
3rd degree: slightly alkaline or neutral reaction of the environment, single lactobacilli, a large number of cocci and leukocytes;
4th degree: alkaline reaction of the environment, lactobacilli are not observed, a large number of leukocytes, cocci and bacteroids;

Grades 3 and 4 indicate the presence of an inflammatory process.

Violation of vaginal microflora or dysbiosis

• whitish-yellowish vaginal discharge;
• unpleasant odor;
• feeling of discomfort in the genital area.

Causes of development of vaginal dysbiosis

• climate change;
• frequent stress;
• disturbances or changes in hormonal levels;
• infectious and inflammatory pathologies of the pelvic organs;
• promiscuous sex life;
• irrational use of antibiotic drugs;
• intestinal pathologies;
• sexually transmitted infections;
• hypothermia of the body;
• improper use of tampons during menstruation;
• decreased immunity.

Possible complications of vaginal dysbiosis

Diagnosis of vaginal dysbiosis

• General flora smear – allows you to determine the general condition of the vaginal flora and vaginal wall;
• PCR ( polymerase chain reaction) - a method for detecting pathogens of sexually transmitted diseases by identifying their DNA ( deoxyribonucleic acid) in the material under study

How to restore vaginal microflora?

1. Suppression of pathogenic bacteria:
For this purpose, local antiseptics, antibacterial suppositories or antibiotic drugs are used. As for antibiotics, their list includes sumamed, trichopolum, amoxiclav, doxycycline and others. Tops the list of antiseptics Miramistin. Among the variety of antibacterial candles, experts usually choose gyno-pevarile and Terzhinans.

2. Restoring normal flora:
In this case, probiotics are used ( products that restore the balance of microorganisms), which includes lactobacilli. You can’t do without fermented milk products.

3. Restoring the immune system of the vaginal wall:
To restore the immunity of the vaginal wall, patients are prescribed local and general immunomodulators such as vaginal tampons if they have at least once caused the development of an allergic reaction.

Microflora of male genital organs

Urethritis is one of the consequences of a violation of the microflora of the male genital organs

Flora smear analysis is one of the most important diagnostic methods in gynecology. A smear is taken from the mucous membrane of the vagina, cervix or urethra. This analysis allows you to assess the state of the microflora of the genitourinary system and identify the presence of pathogenic microorganisms.

A smear test for flora in women is performed during a preventive examination by a gynecologist and in the presence of complaints from the genitourinary system. These include: painful sensations in the lower abdomen, itching, burning in the vagina, discharge, indicating a possible inflammatory process. It is also advisable to do this analysis at the end of a course of antibiotic therapy to prevent thrush and when planning pregnancy.

Why is this analysis prescribed?

Usually a vaginal smear is part of a woman's routine medical check-up. It is performed by a specialist during a gynecological examination. Biological material is also collected from the urethra and cervix.

This diagnosis allows you to detect possible problems with women's health, such as an inflammatory process or a disease caused by an infection. In medical terminology, such a study has another name - bacterioscopy.

A gynecological smear is taken if the following diseases are suspected:

• or vaginitis;

Specialists can prescribe a smear if the patient has the following complaints:

• Pain during sexual intercourse.
• Unpleasant-smelling copious discharge with discoloration.

A smear is taken when planning pregnancy and after antibiotic therapy. In addition, the smear allows you to monitor the effectiveness of therapy in the treatment of gynecological diseases.

Advantages of the method:

• Painless procedure.
• Simple rules for preparing for a smear test.
• Monitoring the effectiveness of treatment of female diseases.
• Possibility of identifying many diseases of the genitourinary system.

For preventive purposes, women periodically need to undergo this diagnosis. This will help prevent possible undesirable consequences.

Preparation for delivery

Some doctors say that this test does not require special preparation, however, this is not true. To ensure the reliability of the results, the patient is advised not to go to the toilet for 2-3 hours, since urine can wash away all pathogenic bacteria and infections, making it difficult for the attending physician to determine the causes of your pathological condition.

Douching, vaginal suppositories and antibacterial soap also contribute to unreliable indicators. Women must undergo this test after the end of menstruation, and in addition, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.

How is it surrendered?

The analysis is most often taken by a doctor when you come to him for a regular appointment at the clinic or when you simply go to a paid laboratory, where obstetricians and medical staff take biomaterial from you.

The gynecologist, obstetrician or any other medical professional lightly runs a special disposable stick-shaped spatula over three points - the vagina, urethra and cervical canal.

In men, a urologist or another doctor inserts a special disposable probe into the urethra, turns it around its axis several times and takes an analysis. It is believed that the examination does not cause pain, however, this does not exclude the carelessness of the doctor, as well as individual sensitivity or the presence of a particular disease, which can cause discomfort.

The meaning of the letters on the analysis form

Doctors do not use full names, but abbreviations - the first letters of each of the analysis parameters. To understand the normal microflora of the vagina, knowledge of the letter designations will be very helpful.

So, what are these letters:

1. abbreviations of the zones from which the material is taken are designated by the letters V (vagina), C (cervical area of ​​the cervix) and U (urethra or urinary canal);
2. L - leukocytes, the value of which may not be the same in normal conditions and in pathology;
3. Ep - epithelium or Pl.Ep - squamous epithelium;
4. GN - gonococcus (the “culprit” of gonorrhea);
5. Trich - Trichomonas (causative agents of trichomoniasis).

In the smear, mucus may be detected, indicating a normal internal environment (PH), beneficial Doderlein bacilli (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.

Some laboratories make it a rule to mark the content of a specific type of bacteria. For example, somewhere they use the “+” sign for this. It is put into 4 categories, where one plus is an insignificant content, and the maximum value (4 pluses) corresponds to their abundance.

If there is no flora in the smear, the abbreviation “abs” is indicated (Latin, this type of flora does not exist).

What doctors don't see with microscopy?

Using this analysis, the following conditions or diseases of the body cannot be determined:

1) Cancer of the uterus and cervix. To diagnose malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus during separate diagnostic curettage.

2) . To determine it, a smear is not needed and it does not matter what result it shows. It is necessary to take a blood test for hCG, undergo a gynecological examination by a doctor, or do an ultrasound of the uterus. It is possible to detect human chorionic gonadotropin in urine, but not in genital discharge!

3) CC and other pathologies (leukoplakia, koilocytosis, HPV lesions, atypical cells, etc.) are diagnosed based on the results of a cytological examination. This analysis is taken directly from the cervix, from the transformation zone, using a certain method with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

4) Does not show infections (STDs) such as:

• (chlamydia);
• (mycoplasmosis);
• (ureaplasmosis);

The first four infections are diagnosed using the PCR method. And it is impossible to determine the presence of the immunodeficiency virus from a smear with high accuracy. You need to take a blood test.

Smear standards for flora

After receiving test results, it can sometimes be very difficult to understand the numbers and letters written by the doctor. It's actually not that complicated. In order to understand whether you have gynecological diseases, you need to know the normal indicators when deciphering the smear analysis for flora. There are not many of them.

In smear tests in an adult woman, the normal indicators are as follows:

1. – must be present, but only in small quantities.
2. (L) – The presence of these cells is allowed because they help fight infection. The normal number of leukocytes in the vagina and urethra is no more than ten, and in the cervical area - up to thirty.
3. (pl.ep.) – normally its quantity should be within fifteen cells in the field of view. If the number is higher, then this is evidence of inflammatory diseases. If less is a sign of hormonal disorders.
4. Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.

The presence of Candida fungi, small rods, gram(-) cocci, Trichomonas, gonococci and other microorganisms in the analysis results indicates the presence of a disease and requires a more in-depth study and treatment.

Table for deciphering the normal smear in women (flora)

A breakdown of the results of a smear analysis for flora in women is presented in the table below:

Degrees of purity based on flora smear

Depending on the results of the smear, there are 4 degrees of vaginal cleanliness. The degree of purity reflects the state of the vaginal microflora.

1. First degree of purity: The number of leukocytes is normal. Most of the vaginal microflora is represented by lactobacilli (Doderlein bacilli, lactomorphotypes). The amount of epithelium is moderate. Mucus - moderate. The first degree of purity means that everything is normal for you: the microflora is fine, your immunity is good and you are not in danger of inflammation.
2. Second degree of purity: The number of leukocytes is normal. The vaginal microflora is represented by beneficial lactobacilli along with coccal flora or yeast fungi. The amount of epithelium is moderate. The amount of mucus is moderate. The second degree of vaginal cleanliness is also normal. However, the composition of the microflora is no longer ideal, which means that local immunity is reduced and there is a higher risk of inflammation in the future.
3. Third degree of purity: The number of leukocytes is higher than normal. The main part of the microflora is represented by pathogenic bacteria (cocci, yeast fungi), the number of lactobacilli is minimal. There is a lot of epithelium and mucus. The third degree of purity is already inflammation that needs to be treated.
4. Fourth degree of purity: The number of leukocytes is very large (the entire field of view, completely). A large number of pathogenic bacteria, the absence of lactobacilli. There is a lot of epithelium and mucus. The fourth degree of purity indicates severe inflammation that requires immediate treatment.

The first and second degrees of purity are normal and do not require treatment. At these degrees, gynecological manipulations are allowed (cervical biopsy, uterine curettage, hymen restoration, hysterosalpingography, various operations, etc.)

The third and fourth degrees of purity are inflammation. At these degrees, any gynecological manipulations are contraindicated. You need to first treat the inflammation and then take the smear test again.

What is coccal flora in a smear?

Cocci are bacteria that have a spherical shape. They can occur both normally and in various inflammatory diseases. Normally, single cocci are detected in the smear. If immune defense decreases, the amount of coccobacillary flora in the smear increases. Cocci can be positive (gr+) or negative (gr-). What is the difference between gr+ and gr- cocci?

To describe bacteria in detail, microbiologists, in addition to indicating their shape, size and other characteristics, stain the preparation using a special method called “Gram staining”. Microorganisms that remain colored after washing the smear are considered “gram-positive” or gr+, and those that become discolored when washed are “gram-negative” or gr-. Gram-positive bacteria include, for example, streptococci, staphylococci, enterococci, and lactobacilli. Gram-negative cocci include gonococci, Escherichia coli, and Proteus.

What are Doderlein sticks?

Doderlein bacilli, or, as they are also called, lactobacilli and lactobacilli, are microorganisms that protect the vagina from pathogenic infections by producing lactic acid, which helps maintain an acidic environment and destroy pathogenic flora.

A decrease in the number of lactobacilli indicates a disturbed acid-base balance of microflora in the vagina and a shift towards the alkaline side, which often occurs in women who are sexually active. The pH of the vagina is significantly influenced by both pathogenic microorganisms and opportunistic microorganisms (which are sometimes found in the vagina normally).

Flora smear during pregnancy

The microflora of each woman is strictly individual, and normally consists of 95% lactobacilli, which produce lactic acid and maintain a constant pH of the internal environment. But opportunistic flora is also normally present in the vagina. It got its name because it becomes pathogenic only under certain conditions.

This means that as long as there is an acidic environment in the vagina, opportunistic flora does not cause any inconvenience and does not actively multiply. These include yeast-like fungi, which under certain conditions can cause vaginal candidiasis, as well as gardnerella, staphylococci, streptococci, which under other conditions can cause bacterial vaginosis (inflammatory process) in a woman.

A woman's flora can change for a variety of reasons - with decreased immunity, taking antibiotics, common infectious diseases and diabetes. One of these factors that can change the microflora is a change in hormonal levels. Thus, a pregnant woman produces virtually no estrogen until the end of pregnancy, but produces the hormone progesterone in large quantities. This hormonal background allows Doderlein's rods to increase 10 times, so the body tries to protect the fetus from possible infection during pregnancy. Therefore, it is very important to undergo an examination before a planned pregnancy to determine the degree of cleanliness of the vagina. If this is not done, then during pregnancy the opportunistic flora can be activated and cause various diseases of the vagina.

Candidiasis, bacterial vaginosis, gardnerellosis, gonorrhea, trichomoniasis - this is not a complete list of diseases that weaken and loosen the walls of the vagina. This is dangerous because ruptures may occur during childbirth, which might not have happened if the vagina was clean and healthy. Diseases such as mycoplasmosis, chlamydia and ureaplasmosis are not detected by smear analysis, and these pathogenic microorganisms can only be detected by blood analysis using the PCR (polymerase chain reaction) method, using special markers.

A smear test is taken from a pregnant woman during registration, and then for monitoring at 30 and 38 weeks. Usually, to assess the state of the vaginal microflora, doctors talk about the so-called degrees of vaginal cleanliness, which a woman should know and ensure that the required degree is maintained during pregnancy.

Depositphotos/imagepointfr

According to statistics, every second woman has at least once encountered a disruption in the coordinated work of microbiota, which serve as beneficial microorganisms that make up the microflora of the vaginal environment. This disease is called vaginal dysbiosis.

The insidious disease does not cause obvious anxiety in the patient and does not have pronounced symptoms. Without showing any signs, dysbiosis can cause serious disruptions in the functioning of the entire reproductive system. Studying the causes of the occurrence, based on clinical signs, will help you choose the appropriate method for treating vaginal microflora.

Causes of flora disturbance in women

There can be many causes of dysbacteriosis in gynecology. These include:

• a decrease in the body’s general immunity as a result of freezing has a detrimental effect on the vaginal flora;
• sexually transmitted infections;
• a sharp change in climate often serves as a factor in the acute phase of dysbiosis;
• prolonged or uncontrolled use of antibiotics;
• non-compliance with the rules for using tampons during menstruation, their careless insertion and unsystematic replacement create a favorable environment for anaerobic dysbiosis in women;
• diseases of the gastrointestinal tract;
• disruptions in the hormonal sphere due to irregular sexual activity or irregularities in the menstrual cycle, any trimester of gestation and postpartum recovery, termination of pregnancy, menopause;
• various infectious and inflammatory processes in the pelvis;
• antibiotic therapy;
• violations of personal hygiene rules.

All these factors are not always identified as the root cause of dysbiosis of the genital organs. In the case when the immune system has strong antiviral characteristics, the health of the microflora is not threatened, and as soon as any deviations from the norm appear, the strength of a strong organism freely leads to the normalization of the condition. But when a woman is constantly exposed to the factors described above (freezing or does not treat the intestines), then the vaginal flora can be destroyed and a new problem arises: how to restore the vaginal microflora.

Signs of vaginal dysbiosis

Asymptomatic dysbacteriosis is the norm. But still, there are obvious indicators that are worth paying attention to, for example, a change in the amount or composition of secretions released from the vagina. Often women do not pay special attention to this indicator, which is their mistake. Here are some more signs that should alert you and prompt a woman to visit a doctor:

• there is an unpleasant odor in the discharge;
• a significant increase in the quantitative indicator of vaginal secretion and a pronounced yellow color;
• increased dryness, which manifests itself as unpleasant sensations during urination or during sexual intercourse.

This disease is not characterized by other obvious indicators. In the case when additional symptoms are added to the above set, this indicates the beginning of an inflammatory or infectious process. These include:

• burning in the perineal area;
• problems with urination;
• itching of the external genital area and vagina;
• increased vaginal dryness.

Failure to treat an ongoing clinical disease leads to the following serious consequences:

• endometritis, which begins as a result of infection of the uterine body;
• urethritis and cystitis are a projection of a malfunction of the genitourinary system;
• adnexitis, provoked by infection of the uterine appendages - tubes and ovaries.

It is better to seek help from a specialist at the first symptoms than to reap the bitter fruits of an irresponsible attitude towards women's health.

How to normalize microflora in women

The topic of how to restore the vaginal microflora is quite relevant, because the female flora is easily susceptible to imbalance, which leads to this kind of consequences. A special recovery program has been developed, which consists of three stages:

1. Getting rid of painful microbiota that caused vaginal dysbiosis.
2. Regeneration of the microflora of the vaginal mucosa.
3. Raising the level of immune protection of the vaginal walls to further maintain healthy microflora.

Now in more detail about all the stages. Treatment of the disease directly depends on eliminating the root cause that provoked such a pathological process. We have already talked about possible reasons.

First of all, it is necessary to undergo tests, and both partners must undergo a clinical study. This is one of the necessary measures to identify the main cause of dysbiosis. If the main factor is a sexually transmitted disease, both infected partners will be subject to treatment.

The infection, which has become a decisive factor, must be eliminated, and as a result, dysbiosis will recede. Most likely, a course of antibiotic therapy will be prescribed. The following drugs are considered the most effective: Flagyl, Amoxicillin, Summed, Unidox Solutab, etc.

If a sexually transmitted infection is not detected, taking antibiotics is not a necessary measure; a short five-day course can be chosen.

Afterwards, the doctor prescribes topical procedures that are most effective. At home, medicinal tampons are introduced and special baths are made. Such an integrated approach will help not only suppress the pathogenic focus in the microflora, but also restore its health by boosting immunity. In this case, it would be appropriate to use antiseptic drugs.

After identifying and eliminating the cause of dysfunction of the vaginal microflora, the time comes to regenerate the natural flora.

How to restore vaginal microflora

First of all, it is worth understanding that this stage consists exclusively of immunomodulatory medications. The consequence of the resulting disruptions in flora indicators is an underestimation of the immunity of the mucous walls of the vagina. It is this part of the woman’s reproductive system that is responsible for regulating the vaginal microflora. It turns out that the regenerative reconstruction of the immune characteristics of the vaginal walls has one of the most significant roles in all therapy.

Ailments that do not have complications are easily treated with immunomodulatory drugs. The launched version requires a complex arrangement of various circuits. In most cases, the therapeutic course starts with taking immunostimulants, and then antibacterial therapy is added.

Restoring microflora after thrush is also not an easy task. This disease, in most of the diagnosed cases, is a consequence of taking strong antibiotics, including uncontrolled or frequent use of such drugs. After thrush, you will also have to undergo a course of antibiotics, then treatment for their consequences and, finally, rehabilitation therapy.

The course of treatment lasts from 3 to 4 weeks. Then the patient is examined and control laboratory tests are done to ensure correct treatment. Good results provide a reason to stop treatment. It remains to follow preventive measures to maintain a healthy balance of microflora.

Preparations for normalizing vaginal microflora

The pharmacy market is filled with many high-quality drugs that are used in the treatment of this problem. It is worth remembering one thing that only a specialist will be able to select the necessary therapy, because the treatment of this disease is not limited to taking one drug, and it is unlikely that you will be able to create a comprehensive medicinal approach on your own.

Suppositories for improving vaginal microflora that contain lactobacilli have proven their effectiveness. The thing is that the infection affects the surface cells of the epithelium of the vaginal mucosa, as a result of which they die and are rejected, so there is simply nothing for the beneficial microbiota to cling to, and after a week they die. Standard probiotics will not give the expected results. Double-acting drugs are used here. They build up the epithelial layer and at the same time populate it with vital bacteria. In this way, the microflora is restored.

The most effective are the following tablet preparations: Ecomfemin Floravag, Folio, Gynoflor E. After completing the course, 7 days are expected and if the symptoms do not recur, then the doctor prescribes Bifidumbacterin suppositories. They will help balance the pH of the vaginal environment, which is an integral part of the restoration process of healthy microflora. Duration of use - 10 days.

The drug “Tantum rose” also showed good results. It is produced in powder form. A solution for vaginal use is prepared on its basis.

Oral medications may also be prescribed, for example, Normoflorin-B and L. For one month, sachets are taken morning and evening.

A prerequisite for treatment is adherence to a diet. Fatty and smoked foods, as well as sweets and carbonated drinks are excluded from the diet. Fermented milk products are introduced; they enhance the effect of suppositories and probiotics.

The results of bacteriological culture can provide reliable information about the correctness of the treatment.

Traditional medicine

There are also alternative medicine methods that are also designed to restore vaginal flora. But you should not make a decision on your own; consult your doctor first. The doctor will be able to advise on the effectiveness or, conversely, the uselessness of the measures used. Some of the most popular methods that traditional medicine offers:

1. Tampons with sea buckthorn oil. A tampon soaked in oil is inserted at night and removed in the morning. This method is very effective, because sea buckthorn concentrate has a pronounced bactericidal and wound-healing effect. The treatment course lasts at least 10 days.
2. Cotton swabs with an acidic medium and honey panacea. After melting 1 tbsp. honey, moisten a cotton-gauze swab in the prepared solution. The next day, a tampon with kefir liquid is inserted. The method is suitable only for people who do not have allergic reactions to honey. The course of treatment is 10 days.
3. Syringe from a decoction of string. Prepare the decoction of the string, filter and cool. Use it warm for daily douching. The course of treatment is unlimited - until all symptoms are eliminated.

Any traditional method can be repeated after a break of 7 days. Menstruation is a contraindication for procedures.

    performs a number of functions, but the most important of them is the protective function. During pregnancy, this function becomes especially important, so doctors closely monitor the ratio of beneficial and potentially dangerous bacteria. So why is special attention paid to the vaginal microflora and what does its imbalance mean?

   Experts have calculated that the vagina of the average healthy woman usually contains no more than 5 types of bacteria out of 100 usually found in this place.

   Among those bacteria that are present in the vagina, there are both beneficial and opportunistic microorganisms.

   For the peaceful coexistence of beneficial and opportunistic microorganisms, the number of these groups must be maintained in strict proportion. To be more precise, the vaginal microflora should consist of 90% lactobacilli, almost 10% bifidobacteria and less than 1% opportunistic microorganisms.

   Conditionally pathogenic microorganisms include bacteria, viruses and fungi, such as trichomonas, staphylococci, streptococci, gardnerella, mycoplasma, ureaplasma, candida fungi and many others. With normal microflora, they are present in the vagina only in small quantities. Therefore, no harm is caused.

   But when their numbers increase, opportunistic microorganisms begin active activity, which leads to disruption of the microflora or the development of inflammatory processes.

   However, this is not the only problem. The vagina is constantly exposed to pathogens from the external environment. They can penetrate intimate places, at least with sperm during sexual intercourse or in case of poor intimate hygiene. And some of them are no longer conditionally, but truly pathogenic (harmful under any conditions).

   In neutralizing external and internal harmful microorganisms, the most important role is played by the self-cleaning mechanism, which works in both cases, protecting the expectant mother from inflammation and infections.

Protection of vaginal microflora

   The main protector of the vaginal microflora is lactic acid. Thanks to lactic acid, an acidic environment is maintained in the vagina, in which harmful and opportunistic microorganisms die or are eliminated.

   Lactic acid is produced by lactic acid bacteria. The most important of these are lactobacilli, some species of which also produce hydrogen peroxide, which lowers the pH level in the vagina even more.

   These microorganisms produce lactic acid as a result of the breakdown of lactose or glycogen.

   Lactose is milk sugar, and glycogen is a polysaccharide found in the epithelium (the inner lining that lines the vagina).

   The concentration of glycogen directly depends on the level of estrogen: the more there are, the stronger the protective shell. Accordingly, the walls of the vagina are most protected from infections when the production of these hormones is high, that is, during ovulation in the middle of the menstrual cycle, and least of all when it is low, namely before puberty, after menopause and during pregnancy.

   Another most important task of an acidic environment is to increase local immunity. Normally, most women have a vaginal pH level of 4.0-4.5. Under such conditions, the synthesis of interferon (protective protein), immunoglobulins (antibodies that are directly involved in the formation of immunity) and macrophages (special cells that capture and destroy harmful bacteria) is enhanced.

   In addition, the acidic environment of the vagina takes part in the natural selection of sperm (most of the male germ cells in it simply die, and only one overcomes the obstacle and fertilizes the egg).

Factors causing disturbances in the vaginal microflora

   Despite its rather strong qualities, the vaginal microflora still remains vulnerable.

   All factors that can cause disturbances in the vaginal microflora can be divided into external and internal. And external factors are easier to control than internal ones.

   Harmful microbes can enter the vagina from the external environment during a gynecological examination if the instruments have not been thoroughly disinfected.

   The same can happen if a woman violates intimate hygiene. The use of soap for hygiene causes a change in pH level.

   Just like soap, sperm has alkalizing properties, but it can change the degree of acidity in the vagina only slightly and for a short time. However, sperm can be fraught with much more serious dangers: it can contain both pathogens that are sexually transmitted infections and bacteria that cause urological diseases in men.

   The latter are quite capable of triggering the occurrence of inflammatory processes in women. Since not all husbands remain faithful to their wives and admit their illnesses, obstetricians-gynecologists during pregnancy after 30 weeks do not recommend expectant mothers to have sex.

   Internal factors that can change the pH level include various diseases (for example, diabetes mellitus or gastrointestinal diseases), taking certain medications and disruption or changes in hormonal levels.

   Changes in hormonal levels quite often lead to the development of vaginal dysbiosis in pregnant women. And all this happens because after conception the concentration of estrogen and lactobacilli decreases, which is why the acidity level of the vaginal microflora changes automatically.

   But there is another reason for the violation of the vaginal microflora. During pregnancy, the expectant mother's immunity decreases and the body's protective functions weaken. Both processes are necessary and physiological, because this is the only way a woman’s body can accept a child, who at the molecular level is a foreign protein. However, they also increase the likelihood of developing infections in the vagina.

Undesirable consequences of vaginal microflora disturbance

   If the number of lactobacilli is reduced, then the environment in the vagina ceases to be acidic and changes to alkaline.

   Under such conditions, opportunistic microorganisms begin to multiply on a large scale, and then two courses of events are possible. When the balance between beneficial and opportunistic microorganisms is disturbed, bacterial vaginosis develops. Symptoms of the disease appear almost immediately: the discharge acquires a whitish-yellowish tint and an unpleasant odor, and itching is felt in the genital area.

   In the 1st trimester of pregnancy, many women face this problem.

   If the situation is not brought under control in time, opportunistic organisms begin to act actively. Quite often, this process threatens with inflammation of the vaginal walls, that is, specific or nonspecific colpitis.

   So, if the candida fungus is activated, then candidal colpitis (thrush) develops, if trichomonas - trichomonas, if staphylococci or streptococci - nonspecific, or banal.

   The discharge becomes abundant, and in the first case, also cheesy, in the second - greenish-yellow (in the third, it is simply light).

   For the occurrence of thrush during pregnancy, there are also additional factors: as the duration of pregnancy increases, the concentration of progesterone also increases. And this hormone promotes the deposition of sugars in epithelial cells. Sugars quickly become food for fungi, including those from the genus Candida, which explains the high incidence of candidal colpitis in expectant mothers.

   But sometimes it happens that the source of infection does not form in the vagina, but in the genitourinary system. This can happen, for example, when mycoplasma or ureaplasma is activated.

   During pregnancy, all these processes are especially undesirable. With any type of colpitis, bacteria from the vagina can move into the cervical canal, and from there reach the membranes. If this happens, there is a risk of premature rupture of amniotic fluid.

In the normal state of the genital organs of a healthy woman, an acidic environment is present in the vagina. Normally, the acidity level is pH 3.5-4.5.

The occurrence of an acid reaction is due to the following processes: the breakdown products of food entering the body are affected by the female sex hormones estrogens, as a result of which the formation of a specific substance glycogen occurs. As a result of desquamation and destruction of vaginal epithelial cells caused by one of the estrogens - progesterone, glycogen is released. Glycogen then breaks down into dextrose and maltose, which in turn act as food for lactobacilli (98% of normal vaginal microflora) and bifidumbacteria. As a result of the interaction of lactobacilli and glycogen, lactic acid is synthesized, which maintains the balance of the microbial flora of the vagina and gives it sufficient acidity.

WHAT FUNCTIONS DOES IT PERFORM?

The main function of the normal microbial flora of the vagina is to create a special acidic environment. It has two main functions:

* Destruction and creation of an unfavorable environment for the reproduction of pathogenic, including transient (temporarily present) opportunistic flora.

* A certain “evolutionary” function - as is known, an acid reaction is destructive for sperm, and only the healthiest and strongest sperm can break through the acid barrier and fertilize an egg

In addition, normally it stimulates the local immune defense of the body - activation of macrophages, production of interferon and secretory immunoglobulins and competes with transient (opportunistic) and pathogenic flora.

Composition of normal vaginal flora

The main components of the normal vaginal flora of a sexually mature, healthy woman are lactobacilli acidophilus. These mainly include:

• peroxide-forming lactobacilli (the majority);
• bifidumbacteria (up to 10%);
• peptostreptococci (up to 5%).

The total number of normal microorganisms in the flora of a woman’s vagina should not exceed 100 million per 1 gram of weight of the vaginal compartments. The main function performed by lactobacilli is the production of lactic acid. Lactobacilli also perform several other important protective functions, which include:

* production of hydrogen peroxide, lysozyme, as well as some other enzymes with antimicrobial properties;
* stimulation of local immune defense (activation of macrophages);
* stimulation of the production of interferon and secretory immunoglobulins.

CHANGES OVER LIFE

Throughout a woman's life, the composition of the normal vaginal flora changes repeatedly. This is due to the presence in the cells of the vagina of a special substance - glycogen, the exchange of which is regulated by estrogens (female sex hormones).

In the first weeks of a girl’s life, her blood contains a high percentage of estrogens received from the mother - therefore, the amount of glycogen is sufficient to support the life of lactobacilli introduced from the birth canal. The flora is represented by lactobacilli and bifidumbacteria, the vaginal environment is acidic. Further, the level of exogenous (external) estrogens falls, lactobacilli disappear and the vagina is populated by coccal flora - epidermal and saprophytic staphylococci. The vaginal environment becomes alkaline.

During puberty, increased production of estrogen begins, the amount of glycogen increases and the vagina is populated with lacto- and bifidum microflora. The vaginal environment becomes acidic.

With old age, due to a decrease in estrogen saturation, the level of lactobacilli decreases and the vagina is gradually repopulated with coccal flora.

Analyzes for vaginal flora are carried out using the following methods: smear, bacteriological culture, florocenosis study. These tests can be taken at our center every day. You can learn more about how various disorders of the vaginal microflora manifest themselves on the page “Vaginal discharge” in women.

ANALYSIS OF VAGINAL FLORA

WHERE YOU WILL BE HELPED IN MOSCOW | RESTORATION OF VAGINAL FLORA