This post is about vaginas

The human body is host to many different microbial micro-environments, and the vagina is no exception.  The healthy human vagina is quite acidic, with a pH less than 4.5, similar to that of grapes or orange juice.  This pH is maintained by a healthy population of Lactobacilli which produce lactic acid and hydrogen peroxide.  These products of Lactobacillus metabolism appear to keep in check populations of other vaginal bacteria, many of which are intolerant of hydrogen peroxide and of acidic environments.

http://commons.wikimedia.org/wiki/File:Vaginose-G15.jpg

Clue cells in bacterial vaginosis, from Wikimedia Commons

From time to time, this normal balance of bacteria is disrupted.  When this happens, the normally dominant Lactobacilli are outgrown by various anaerobic bacteria.  These bacteria break down proteins in the vagina and create various malodorous compounds that create a thin, grey discharge.  It is this symptom that normally drives a woman to the doctor where she is diagnosed with bacterial vaginosis (BV).
As the vaginal environment changes and the pH rises, Garnerella bacteria begin to stick to vaginal epithelial cells and are visible under the microscope as “clue cells” (the big blobs are squamous cells, the little dots are bacteria stuck to the surface).

BV is not a sexually transmitted disease, but it is strongly associated with sexual activity.  Sexual activity with men or women increases the risk of BV, as does douching.  Both sexual activity and douching can change the normal vaginal environment, and one of these activities can be safely and comfortably done away with.

Normally, BV is a benign condition, but in pregnant women it can increase the risk of premature delivery. It is also a risk factor for acquiring STIs such as HIV, chlamydia, and herpes, perhaps because the normal acidic and oxidizing environment is protective. Because of these risks, BV should be treated, and treatment is relatively easy, although relapse is common.

Because strains of Lactobacilli are present in many yogurts, yogurt has been touted as a possible prevention and treatment for BV, taken either orally or intravaginally, but there are many different species in this genus, and only some of them produce hydrogen peroxide, a trait thought to protect the vagina. One review found some evidence that yogurt can be helpful, but most of the studies out there don’t compare it to the gold standard antibiotic.

The vagina and its microflora do a pretty good job staying healthy, but certain human activities can create significant problems.  Douching is never necessary and can lead to BV.  It’s a bad idea.  While giving up douching should be pretty easy, I’m fairly certain people are still going to have sex.  When symptoms of BV develop, a simple gynecologic exam, including checking vaginal pH and looking at secretions under the microscope, leads to rapid diagnosis and treatment of an annoying and potentially harmful disorder.

10 Comments

  1. becca

     /  January 27, 2011

    “This post is about vaginas”
    *crowd goes wild*

  2. So, for those of us curious about alternative lifestyles, any papers out there on the related topic of douching other cavities? Is it pretty much a similar sort of risk, or not at all the same, given differing environments?

  3. A. Marina Fournier

     /  January 28, 2011

    Oddly enough, the only time I ever douched was with thinned plain yogurt with active lactobacillus cultures, in order to combat either a (perceived) yeast infection or vaginal irritation. Yogurt is cheaper and smells better than any of the medicated creams one is supposed to insert there, and it feels less creepy as it descends the channel.

    Never did understand why women were supposed to use a douche in modern days, save for some marketing campaign, of the kind that gave us vaginal deodorant and deodorized tampons and sanitary pads.

  4. brooksphd

     /  January 28, 2011

    I have a couple of friends who swear by vaginal douching with yoghurt. One of them goes to the step of dipping a tampon in the yoghurt and wearing it. Not sure that’s a good idea… thoughts? I’d like to be able to advise them on pros & cons (both are Comp/Alt health proponents)

  5. The idea of yoghurt (and this is probably going to sound funny…) is that it can’t be any flavoured stuff. Why? B/c many of these have a high suger content (jam/fruit etc)and while that is slightly inhibiting of bacterial growth in large enough concentrations, it is not at all discouraging for fungi growth… and one of the things women tend to get more often (and after BV) would be fungal infections since the pH is wacked up*.

    Where I grew up it was more mentioned to “smear yoghurt on the outside/slight inside” but start “douching yoghurt tampons on a regular basis” (a newer concept for me since we didn’t do that) seems unnecessary…. all in the sense of “if it ain’t broken, don’t fix”. Imho anyway. The yoghurt tampon might sooth from itching if you have an infection though, but again – make sure it’s non sugar, only plain and has the ‘right’ bacteria in them.

    Probably can point them to the “tampons with lactobacilli in them” – not completely scientific proven but those are for sure not making it worse though**.

    As for the sex part (or “cleaning”) – pee after sex have been one of these suggestions to help lower the pH in the vagina and reducing instances of at least fungi. As well as not sleeping in tight underwear (or rather any at all) but “let the lower parts air since that helps with keeping it all as should”.

    I see exactly how this can be read. Dear me 😉

    *fungi is sensitive to pH changes, just not as sensitive to sugar/salt concentrations as bacteria
    **did some studies on them in a microlab and we didn’t see too many benefits but no bad things what so ever. With perfumed pads and tampons there are some discomfort noted…

  6. Yay! Vaginas!

    Carry on…

  7. To answer the question of why anyone would have started douching in the first place. In the olden days when I was a young woman douching was considered a method of preventing sexually transmitted diseases. Also used for birth control One used apple cider vinegar mixed with water believed to be acidic enough to kill sperm. Needless to say I have two grown daughters and a bunch of grandkids and great grandkids.

  8. I wonder if specialized yogurts can be made by pharmaceutical companies to combat BV. That seems like a lot better of an idea that prescribing more antibiotics.

  9. Enkidu

     /  March 5, 2011

    This is a little OT, but I had two premature births (one 18 weeks, one 27 weeks) due to infection of the womb. The diagnosis afterwards was group B strep, which had hiked from the vagina (where it belongs) into the womb to infect placenta, amniotic fluid, and baby.

    After my first pregnancy, the docs told me there was nothing I could have done to prevent this from happening. And they had no clue why it did. Needless to say, with my second pregnancy, I went on pelvic rest as soon as I found out I was pregnant (5 weeks). Still, the same thing happened and at 27 weeks my water broke. Luckily, my daughter survived and with some antibiotics and a few months in the NICU, she was just fine.

    So, I guess I am asking, has anyone heard of this happening? And if so, any advice? I’m not planning on getting pregnant again, but I’d like to have as much knowledge on this phenomenon just in case. And the internet is getting me nowhere. 😦

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