How to restore lactobacilli in a smear. Normal vaginal biocenosis. Violation of intestinal microflora - the main causes

Every second woman suffers from dysbiosis, a disorder of the vaginal microflora. Often the disease is asymptomatic and eventually develops serious complications. What signs can be used to identify the disease and how to restore the vaginal microflora with medications.

Causes of dysbiosis

U healthy woman The vaginal flora is represented by 99% lactobacilli and bifidobacteria and only 1% by opportunistic microorganisms.

This percentage is considered normal, does not cause harm and does not provoke the development of any disease.

But the vulnerable and sensitive vaginal microflora is threatened by a large number of unfavorable external and internal factors. Under their influence, colonies of opportunistic microorganisms (fungi, gardnerella, streptococci, staphylococci, protea, E. coli, chlamydia) “displace” lactobacilli and bifidobacteria. A malfunction occurs and dysbiosis develops with inflammation of the vagina - vaginitis. IN certain period Every woman faces this disease sooner or later.

When does this happen and how does it manifest itself? It all depends on how strong the pathogenic pathogen is and how strong the woman’s immune defense is during this period. The development of dysbiosis can be provoked by:

1. Perestroika hormonal levels during pregnancy. A healthy woman may experience or increase discharge. They are accompanied by itching and burning, pain during sexual intercourse. Antibacterial and immunocorrective drugs to restore vaginal microflora are not prescribed during this period. Shown only local treatment and, if necessary, it is allowed to be carried out more than once.
2. General and sexually transmitted infectious diseases. Always accompanied by dysbiosis. Pathogenic microorganisms of sexually transmitted infections together with opportunistic microflora cause severe inflammation, which can be removed by special antibacterial drugs.
3. Restoring the vaginal microflora after treatment with antibiotics is necessary, because, in addition to pathogenic microorganisms, vaginal lacto- and bifidobacteria die. Treatment of common infectious diseases with antibiotics leads to the same result.
4. Gastrointestinal diseases with microflora imbalance. Anatomically, the walls of the rectum and vagina are located nearby. The proximity allows pathogenic microorganisms (Escherichia coli, enterococcus) to easily pass this barrier.

Dysbiosis can also develop from an unbalanced diet with big amount carbohydrate foods. Also, one of the common causes of dysbiosis is violation of basic rules of intimate hygiene.

Clinical picture

Vaginal dysbiosis occurs in three forms: sluggish, acute, chronic.

The disease does not show specific symptoms for a long time, and those women whose body could not cope on its own turn to the doctor. At first, a woman develops white or grayish liquid discharge. Afterwards they become intense yellow with a thick consistency. IN acute period a woman may complain of discomfort, moderate pain with itching and burning. If treatment is not carried out, the disease becomes chronic, and exacerbation alternates with remission. The death of lactobacilli and excessive growth of opportunistic flora lead to severe consequences– ascending infection of the uterus with appendages, urethritis, cystitis.

Symptoms that should not be ignored and should be a reason to contact a gynecologist:

• the amount of discharge has become more than usual;
• the discharge has acquired an intense yellow color;
• the vaginal walls have become “dry”, there is a feeling of constant discomfort during sexual intercourse;
• concerns about dryness, itching and burning of the external genitalia;
• The discharge has an unpleasant, specific odor.

To make a diagnosis, the doctor after the examination will prescribe pH-metry, microscopy and bacterial smear culture, and amine testing.

Therapeutic program

In modern gynecology, the program for normalizing the vaginal microflora goes through three stages:

1. Elimination of pathogenic bacterial flora(antibacterial treatment).
2. Restoration of vaginal flora.
3. Support healthy microflora.

Antibacterial drugs, if the disease has developed against the background of infections, are prescribed Sumamed, Trichopolum, Amoxiclav, Doxycycline, Metronidazole, Tibertal, Ornidazole.

Treatment includes tampons, baths, vaginal tablets, suppositories for restoring vaginal microflora. Target local procedures: suppress pathogenic microflora, normalize local immunity, enable recovery normal amount bifidobacteria and lactobacilli.

For treatment use:

• Dalatsin (in the form of cream and vaginal suppositories) - antibacterial drug with the main active ingredient clindamycin phosphate.
• Vaginal suppositories Flagyl with the main active ingredient metronidazole.
• Vaginal suppositories Hexicon (based on chlorhexidine).

At the second stage, to restore the flora, the local immunity of the vaginal walls is corrected. Immunal and Cycloferon tablets are prescribed.

To increase the amount of beneficial microflora of the vagina, drugs are prescribed with strains of live acidophilus lactobacilli: Normoflorin L, B, D (liquid concentrate), Acepol (capsules); suppositories Acylact, Lactonorm Kipferon, Bifidumbacterin.

One of the most popular and effective drugs for the treatment of vaginosis is Lactobacterin in tablets and powder for preparing a solution.

Intravaginal treatment lasts 10 days, starting on the 10th day of the cycle. If they start menstrual flow, drugs are not administered.

Normalization of vaginal microflora it will go faster, if the treatment includes a diet with a sufficient amount of fresh, “live” fermented milk products.

Candidiasis

If, with vaginal dysbiosis, the flora in the form of the Candida fungus predominates, this is thrush, the most common type of disease.

Symptoms of candidiasis are bright: strong curdled discharge, burning with itching, pain when urinating, discomfort during sexual intercourse.

Thrush can develop for many reasons: hormonal imbalances, hypothermia, unbalanced diet, specific treatment(immunosuppressants, chemotherapy drugs). But most often it becomes a consequence of treatment with antibiotics.

There are enough tools and techniques in gynecology, but restoring microflora after thrush is a rather difficult task for two reasons. First: vaginal candidiasis often recurs. Second: women who self-medicate, ignorance and the wrong choice of medication only aggravate the situation.

How to restore microflora after thrush correctly:

1. Normalize the functioning of the immune system.
2. Eliminate local manifestations.
3. To prevent relapses, use systemic therapy.

Candida fungus is one of the many representatives normal microflora person. Therefore, the task of treatment is not to kill, but to limit and control its reproduction.

Treatment of candidiasis

The restorative course of treatment includes local drugs(candles), systemic medicines(tablets, capsules). After severe candidiasis, injectable drugs are indicated.

How to restore flora after thrush:

• Antifungal therapy with drugs based on clotrimazole (Canesten), iconazole (Ginotragen), miconazole (Klion-D).
• Antimicrobial therapy with drugs containing natamycin, nystatin, levorin.

After treatment of thrush, suppositories, vaginal tablets, ointments and topical solutions are indicated to restore the microflora.

The local remedy should be used regularly, 1-2 times a day and for at least two weeks.

Each of local funds has its own characteristics:

• Livarol is effective for primary candidiasis. Quickly eliminates symptoms, with a minimum of contraindications and side effects.
• Ketoconazole is indicated for all types of fungal infections. Causes a number of adverse reactions.
• Nystatin is indicated for chronic candidiasis. With a minimum of side effects, does not suppress healthy microflora.
• Ginesol is used as a preventive and anti-relapse drug.
• At Betadine wide range actions: candidiasis, vaginal infections. Used for preoperative and postoperative obstetric treatment. The drug is approved for treatment during menstruation.
• Pimafucin is one of the few drugs that is approved during pregnancy and does not cause complications or adverse reactions.

So that drug treatment gives good result and the microflora of the mucous membranes has been restored, it is necessary to eliminate or reduce the influence of a number of factors: abandon bad habits, it is reasonable and according to medical prescription to use antibacterial and hormonal drugs, eat rationally, strictly observe hygiene.

Only if all conditions are met, treatment of dysbiosis will give a positive result and prevent relapse.

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 routine medical check women. It is performed by a specialist during a gynecological examination. Also a fence biological material carried out from the urethra and cervix.

This diagnostic 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 This study also 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 antibacterial 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 They take biomaterial from you.

Gynecologist, obstetrician or any other medical worker lightly passes a special disposable spatula in the shape of a stick 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 endometrium, histological material is required, 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. Can be determined 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 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 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 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 more deep research and treatment prescriptions.

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:

Index	Normal values
	Vagina (V)	Cervical canal (C)	Urethra (U)
Leukocytes	0-10	0-30	0-5
Epithelium	5-10	5-10	5-10
Slime	Moderately	Moderately
Gonococci(Gn)	No	No	No
Trichomonas	No	No	No
Key cells	No	No	No
Candida (yeast)	No	No	No
Microflora	A large number of Gram+ rods (Dederlein rods)	No	No

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 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 according to special method, which is called "Gram stain". 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 disorder acid-base balance microflora in the vagina and its shift to the alkaline side, which often occurs in women who are sexually active. Vaginal pH is significantly influenced by pathogenic microorganisms, and opportunistic (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).

A woman’s flora can change due to the most various reasons– with decreased immunity, taking antibiotics, general infectious diseases and diabetes mellitus. 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 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.

Vaginal dysbiosis This is a violation of normal microflora. The disease often manifests itself in women and is expressed in varying degrees. Sometimes it can lead to serious problems and inconveniences. Disturbance of the microflora in the vagina can be caused by external or internal reasons. This is often due to a seasonal decrease in immunity, neglect of personal hygiene, or a change in climate zone. Swimming in the pool, infections and other external factors have a negative impact on the microflora. Stress, especially chronic stress, can cause vaginal dysbiosis. Of course, these factors do not always affect the body. If it is weakened, especially chronic diseases, the disease will manifest itself much more often.

Disturbance of vaginal microflora

Let's find out more about vaginal microflora disorders. There can actually be quite a lot of reasons. Here are some factors that may influence this process:

Hypothermia of the body;

hormonal imbalances;

time zone change;

sexually transmitted infections;

antibiotic treatment;

improper use of tampons;

intestinal diseases;

infectious and inflammatory diseases of the pelvic organs.

The immune system maintains normal microflora, and helps microflora recover in case of minor disturbances. However, if irritating factors There are many and they occur frequently; in most cases, vaginal dysbiosis can occur.

Symptoms of vaginal dysbiosis

Normally, normal microflora develops in the vagina. It consists of approximately 90% lactobacilli (the so-called Dederlein rods), slightly less than 10% bifidobacteria, and less than 1% are gardnerella cells, mobiluncus, Candida fungi, leptothrix and some other bacteria. At normal operation the microflora is in balance, preventing the occurrence of infection and changes in the ratio of pathogens living in the vagina.

Immunity has no effect on the natural inhabitants of the vagina, but behaves aggressively towards any other infection. Exactly the immune system helps restore normal vaginal microflora in case of minor disturbances. But sometimes the immune system is not able to cope with this task.

When the vaginal microflora is disturbed, the balance between bacteria changes, the number of lacto- and bifidobacteria decreases and the number of some other pathogen increases. This pathogen can be one of the key cells (gardnerellosis, candidiasis develops), one of the sexually transmitted infections (trichomoniasis, chlamydia), or it can be any saprophytic pathogen (Escherichia coli, Proteus, streptococci, staphylococci).

Bacteria that lead to the development of dysbiosis can cause inflammation of the vagina - vaginitis When this happens depends on the quantity and pathogenicity of the pathogen on the one hand and the strength of the immune system of the vaginal wall on the other. As a rule, at first the immune system copes and does not allow either the progression of the disease or the development of its complications. Without treatment, the development of inflammation is inevitable.

Disturbance of vaginal microflora during pregnancy

Pregnancy may be a catalyst for the development of vaginal dysbiosis. The following symptoms may appear or worsen:

Discharge;

itching or burning of the genitals;

pain during sexual intercourse.

This is due to the fact that during pregnancy a woman’s body undergoes serious hormonal changes, which cannot but affect both the state of the immune system and the vaginal microflora. Treatment of vaginal dysbiosis during pregnancy is not possible, since it is associated with the use of antibiotics. Therefore, the doctor’s task during an exacerbation of vaginal dysbiosis in a pregnant woman is only to eliminate the symptoms and prepare the woman for childbirth.

Development of vaginal microflora disorders

Initially, a violation of the vaginal microflora does not manifest itself in anything special. As a rule, the nature of vaginal discharge changes slightly. Normally, a woman should either not have any vaginal discharge, or there may be a small amount of clear discharge without an unpleasant odor. There should be no cutting, burning, itching, pain in the genital area or discomfort and dryness during sexual intercourse. With the development of vaginal dysbiosis, the following signs are observed:

The amount of discharge increases;

acquire a whitish-yellow color;

an unpleasant odor appears.

Disturbance of the vaginal microflora in a woman does not cause discomfort in her sexual partner, even with regular sexual activity without the use of contraception. In some cases, when there is severe vaginal dysbiosis, a man may develop the phenomena of balanoposthitis and nonspecific urethritis. Treatment of the disease does not require mandatory treatment of the sexual partner, unless at least one of them is diagnosed with a sexually transmitted infection.

Violation of the vaginal microflora occurs in girls who have not begun sexual activity with the same frequency as in women who are sexually active. The disease is associated with several other factors, namely:

Hormonal instability;

formation of the cycle;

anatomical features structure of the hymen.

Dysbiosis rarely occurs heavy discharge, since the openings of the hymen usually do not allow them to be removed from the vagina in the quantities in which they are formed: the likelihood of developing inflammatory diseases higher for virgins.

Vaginal microflora disorders and sexually transmitted infections

Sexual infections may be associated with a violation of the vaginal microflora. The appearance of an STD pathogen in the vagina shifts the pH, causes an inflammatory reaction and further contributes to the progression of microflora disorders. Opportunistic microflora is taken into account in the treatment of sexually transmitted infections, since antibiotics can kill the STD pathogen, and the number of opportunistic infections will increase.

Treatment of STDs should end with a course of microflora restoration. It is possible to first carry out antibacterial therapy, and then begin to restore the vaginal microflora. It makes sense to do it first comprehensive diagnostics all urogenital microflora.

Vaginal dysbiosis is expressed in disruption of normal vaginal microflora. This disease occurs in most representatives of the fair sex. In most cases, this disease manifests itself to a minor extent, but can cause the development of a number of serious inflammatory diseases of the female genital area of ​​an infectious nature.

It is worth mentioning right away that several terms can be used to refer to vaginal dysbiosis. Vaginal dysbiosis or vaginal dysbiosis is considered the most accurate of the existing terms, since literally translated it means a violation of the vaginal microflora. But despite all this, this term is used extremely rarely. As a rule, this disease is called bacterial vaginosis, which also means a violation of the vaginal microflora. Meanwhile, many doctors define bacterial vaginosis as gardnerellosis, which is a special case of vaginal dysbiosis. As a result, when using this term it is not always possible to be sure what exactly vaginal dysbiosis means.

In addition, quite often any kind of manifestation of a violation of the vaginal microflora is considered “candidiasis” (thrush), which is completely unfounded. Candidiasis, or thrush, is a manifestation of one type of microflora disorder, expressed in an increase in the number of fungi of the genus Candida, which happens extremely rarely. As a rule, women and many doctors call any vaginal discharge thrush, often without understanding the nature of its occurrence.

Causes of vaginal microflora disturbances.
Various factors can provoke the development of vaginal dysbiosis. Let's name the most common of them:

• The predominance of fungi of the genus Candida in the vagina, and dysbiosis will be called thrush.
• This can be either a one-time severe or frequent hypothermia of the female body, which reduces general and local immunity, which, naturally, cannot but affect the vaginal microflora.
• Any hormonal changes or disruptions in the body, in particular: puberty, irregular sex life, pregnancy and childbirth, menstrual irregularities, abortion, premenopausal period, menopause, etc.
• Change of climate zone.
• Constant stress.
• Promiscuous sexual relations with different partners, neglect of contraceptives.
• Any diseases of the pelvic organs of an infectious-inflammatory nature.
• Sexual infections (ureaplasmosis, trichomoniasis, chlamydia).
• Long or frequent treatment using antibiotics.
• Intestinal diseases, constant problems with stool, intestinal dysbiosis.
• Incorrect use of tampons during menstruation. Not everyone knows that during menstrual bleeding, when using tampons, they should be changed every two hours, even at night. This is not only inconvenient, but promotes the development of excellent conditions in the vagina for growth various infections. Using sanitary pads will eliminate this problem.
• It could be Gardnerella. In this case, the disease will be called gardnerellosis (bacterial vaginosis). This type of disease most often develops asymptomatically. Only occasionally it can manifest itself as itching and profuse vaginal discharge with an unpleasant fishy odor.
• Any microorganisms with pathogenic activity.

Of course, these factors may not always immediately cause bacterial vaginal vaginosis, since the immune system is responsible for maintaining the microflora in a normal state, helping it recover in case of a minor disturbance. But since there are a lot of factors that provoke the occurrence of bacterial vaginosis and they occur quite often, and the immune system cannot always cope with its task, the development of the disease in women still occurs.

Mechanism of disease development.
Violation of the vaginal microflora occurs due to an imbalance of bacteria that live in the vagina. Normally, a woman's vagina contains about 90% beneficial lactobacilli(the so-called Dederlein rods), about 10% are bifidobacteria, and less than 1% are “key cells of the vagina” (leptothrix, gardnerella, fungi of the genus Candida, mobiluncus and some other representatives). It is one of the representatives of the key cells that can become the causative agent of dysbiosis. In addition, they can be one of the sexually transmitted infections or any saprophytic pathogen (streptococci, E. coli, Proteus, staphylococci, etc.). When the vaginal microflora is disrupted, there is a significant reduction in the number of beneficial bacteria and a predominance of pathogenic microflora.

The microorganisms that inhabit the vagina never behave hostilely towards the walls of the vagina; they do not allow a negative change in the ratio of beneficial organisms and pathogens. In this case, the immune system provides active support. It is the immune system that helps restore normal microflora in case of minor disturbances. But this does not always happen, unfortunately.

Any pathogen that leads to dysbacteriosis can provoke a serious complication in the form of vaginitis or colpitis (inflammation of the vagina). The occurrence of this complication occurs depending on the number and pathogenicity of the pathogen, as well as on how strong the immunity of the vaginal walls is. Initially, the protection copes with its task and prevents the progression of the disease and its complications. However, if you do not undertake timely and competent treatment, then inflammation in this situation is simply inevitable.

Symptoms of the development of the disease and its main complications.
As already noted, at first the disease is practically asymptomatic. The changes concern the nature of vaginal discharge, but, as a rule, women do not pay much attention to this. Normally, a woman may experience minor transparent discharge without an unpleasant odor, there should be no other kind of discharge, just as there should be no unpleasant sensations of dryness in the vagina during intimacy, pain, itching and burning in the vagina. As a rule, with vaginal dysbiosis, the amount of discharge increases sharply, and it may have a whitish or yellowish tint with an unpleasant odor, reminiscent of rotten fish. There are no other symptoms for this disease. Itching and burning, vaginal dryness indicate the duration of the disease and the lack of treatment, as a result of which complications have developed.

In general, this disease is chronic, accompanied by periods of exacerbations and remissions. With absence adequate therapy Constant infection of the uterus with bacteria from the vagina can lead to the development of inflammation of the uterine mucosa (endometritis) and its appendages (adnexitis). In addition, long-term non-treatment can contribute to the development of vaginitis or colpitis, in which the discharge becomes purulent, and painful sensations and pain in the genitals, and not rarely an increase in body temperature. Another complication of dysbacteriosis can be cervicitis - inflammation of the cervix, in which pain in the lower abdomen is observed, and intimacy becomes very painful. In addition, with this disease, constant infection of the urethra occurs, which ultimately leads to the development of cystitis, the main symptoms of which are pain and burning when urinating.

Bacterial vaginosis of the vagina during pregnancy.
Quite often, pregnancy causes an exacerbation of bacterial vaginosis. Because during this period female body undergoes enormous hormonal changes, immunity decreases, diet and lifestyle changes, then against this background, discharge, itching or burning in the genitals, pain during sexual intercourse, etc. may appear or intensify.

Since during pregnancy any kind of drug therapy, then it is not possible to receive full treatment. Any treatment of this disease, even if without the use of antibiotics, is always accompanied by immunocorrection, which is unacceptable during pregnancy. That is why local therapy is prescribed to eliminate the symptoms of this disease.

Taking antibiotics after childbirth can provoke dysbacteriosis, which also manifests itself in increased discharge, dryness, itching and burning, and pain. Treatment of this disease in women during breastfeeding is undesirable, therefore local therapy is prescribed, which reduces symptomatic treatment or, in other words, eliminating the manifestations of the disease. This includes vaginal sanitation and antibacterial suppositories. Then, at the end of breastfeeding, if necessary, treatment is repeated using other drugs.

Bacterial vaginosis and sexually transmitted infections.
In any case, sexually transmitted infections are associated with a violation of the vaginal microflora. The appearance of a sexually transmitted infection in the vagina shifts the pH, contributing to the occurrence of inflammatory reaction and even greater progression of the disease.

Sexual infection is always associated with opportunistic microflora, so this must be taken into account when treating STDs, since there may be a situation when antibiotic treatment completely kills the STD pathogen, while the number of opportunistic infections only increases.

The final stage of treatment for STDs in women should be restoration of the vaginal microflora. In case of serious infections or the presence of several STDs, antibacterial therapy should be carried out and only then restore the vaginal microflora. In simple cases, you can first carry out a comprehensive diagnosis of the entire urogenital microflora, and then begin to restore it while simultaneously eliminating sexually transmitted infections.

Bacterial vaginosis and intestinal diseases.
In the presence of severe intestinal dysbiosis, bacterial vaginosis should also be expected. This is due to the fact that the wall of the rectum is in close contact with the wall of the vagina, as a result of which bacteria can easily pass through it. As a rule, one of the intestinal infections- Escherichia coli, enterococci, etc.

In this case, treatment is complex nature, since there is a high probability of relapse. In this case, restoration of normal vaginal microflora is carried out with simultaneous treatment intestinal diseases.

Bacterial vaginosis of the vagina in girls.
This disease occurs very often in girls who are not yet sexually active, which is due to many factors: hormonal instability, the formation of the menstrual cycle, and the anatomical features of the structure of the hymen.

Bacterial vaginosis in girls only in in rare cases occurs with copious discharge, since the small opening of the hymen does not allow it to be completely removed from the vagina. Because of this, stagnation of vaginal discharge occurs, which sharply increases the risk of developing inflammatory diseases. Meanwhile, during the first intimate intimacy, a large number of bacteria are thrown from the vagina into bladder, which can trigger the so-called “honeymoon cystitis.”

Treatment of this disease in virgin girls is complicated by the structure of the hymen, which does not make it possible to treat the vagina with medicine as much as necessary. Therefore, sometimes doctors are forced to resort to artificial disruption of the integrity of the hymen (hymenectomy) in order to provide optimal treatment.

Bacterial vaginosis and sexual partner.
The disturbed microflora of a woman during intimate intimacy with a man does not affect his health in any way, even without the use of contraceptives. Very rarely, in cases of severe vaginal dysbiosis, a man may experience balanoposthitis and nonspecific urethritis. However, this happens if the man had a clear predisposition to these diseases. Absolutely healthy male body These inflammatory diseases are not scary. In full healthy body they will not develop.

It is worth noting that no diseases of the partner affect the microflora of a woman’s vagina, except venereal diseases. Treatment of disturbed microflora in a woman does not require mandatory treatment of the sexual partner, unless he has a sexually transmitted infection. Therefore, the sexual partner must also undergo examination.

Diagnosis of the disease.
For experienced specialist Diagnosing bacterial vaginosis will not be difficult. In addition to a visual examination, the diagnosis of this disease includes taking a general flora test, PCR diagnosis of sexually transmitted infections and culture of vaginal discharge or a special study of the vaginal microflora. A smear shows the state of the microflora of the vagina and vaginal wall, the degree of their disturbance and the severity of the inflammatory process, and the diagnosis of sexually transmitted infections and culture make it possible to identify the pathogens that caused the disturbance of the microflora and to identify the sensitivity of bacteria to antibiotics. The correct course of treatment cannot be determined from just one smear.

Treatment of bacterial vaginosis should be comprehensive and include three areas:

Suppression of bacteria.
If a violation of the microflora is associated with the presence of a sexually transmitted infection, then first treatment should be aimed at completely eliminating the causative agent of the infection. In this case, treatment consists of taking antibiotics while carrying out other measures. If there are no sexually transmitted infections, then antibiotic therapy is not necessary. In this situation, either a short course of antibacterial therapy is used, about three to five days, or local application antibiotics and antiseptics. Their action simultaneously fulfills all treatment objectives (suppression of pathogenic flora, population of normal inhabitants of the vagina and local immunocorrection). And the use of antiseptics generally eliminates the possibility of bacteria being immune to them. To suppress pathogenic bacteria, antibiotics (Amoxiclav, Sumamed, Doxacycline, Trichopolum, etc.), local antiseptics (Miramistin, Chlorhexidine), and antibacterial suppositories (Terzhinan, Ginopevaril, etc.) are most often prescribed.

Population of normal vaginal microflora.
This point is the main one in the treatment of dysbiosis. The remaining measures are aimed at creating conditions for the engraftment and growth of normal flora. However, in practice, most doctors neglect this stage of treatment. For the population of normal vaginal microflora, massive doses of eubiotics (preparations with live bacteria) of general and local action. But using only eubiotics to restore microflora without suppressing pathogens is simply useless.

Restoring the immunity of the vaginal walls.
Local immunocorrection should also be one of the stages in the treatment of dysbiosis, otherwise other measures taken will not have the expected effect. In simple situations for immunocorrection, as a rule, they are limited to the use of local immunomodulators (Polyoxidonium, Cycloferon, Genferon, Immunal), as well as taking any probiotics with lactobacilli (Lactobacterin, Linex, Narine, Normoflorin-b, etc. In addition, it is recommended to include add as many fermented milk products as possible to your diet.In cases where the disease is advanced, restoring the immunity of the vaginal walls will require the implementation of more complex measures.

According to traditional medicine, for the treatment of dysbiosis, douching with lemon juice diluted with water, lactic acid, as well as inserting tampons soaked in kefir into the vagina are effective. All this contributes to the creation of an acidic environment in the vagina, without which there can be no growth and activity of good lactobacilli bacteria.

Prevention of vaginal microflora disorders.
Those who have been treated for this disease should be examined every three months for a year. At the appointment, the patient talks about her condition, is examined and, if necessary, tests are taken. If a tendency to microflora disturbance is detected, a short preventive course of treatment is prescribed. Restoration of microflora on initial stage its violation is very easy.

If no serious problems arise during the year, then you can see a doctor once every six months. This allows you to assess and identify the presence of a tendency to relapse and prevent the disease from developing again.

Composition of the vaginal microflora, what functions does it perform? What is vaginal dysbiosis, why does it develop and what symptoms does it cause? Recovery methods local immunity.

The content of the article:

The vaginal microflora is a symbiosis of microorganisms that are constantly present and multiplying on the mucous membrane of this gynecological organ. The vaginal biocenosis contains lactobacilli - 95-97%, as well as opportunistic microorganisms - anaerobic and gram-positive bacilli, enterobacteria, cocci - 3-5%, respectively. Lactobacilli (Dederlein bacilli), producing lactic acid, normalize local immunity and suppress the activity of opportunistic bacteria.

Features of vaginal microflora disorders

Thanks to the symbiosis of beneficial and opportunistic microorganisms, stable acidity is maintained in the vagina, therefore pathogenic bacteria and fungi, introducing from the outside, are neutralized in an acidic environment. Due to physiological hormonal changes- monthly menstrual cycle- minor deviations in acidity occur.

Girls are born with a sterile vagina. But from the first second after birth, the skin and mucous membranes of the genital organs are colonized by bacteria that do not need oxygen, that is, cocci and anaerobes. Dederlein's rods are present in vaginal secretions, but in small quantities. Until menstruation begins, the acidity level remains neutral. As we get older, estrogen begins to be produced, the vaginal walls thicken, and the pH drops to normal due to increased activity.

The acidity (pH) of the vagina in girls during the prestrual period is 7.0. In the future, the indicator depends on the condition of the outer part of the mucous membrane of the reproductive organ.

Vaginal condition	Acidity, pH
Normal, lactobacilli	3,8-4,5
Cytolytic vaginosis	< 3,8
Candidal vaginitis	4,0-4,5
Trichomonas colpitis	5,0-6,0
Aerobic vaginitis	> 6,5
Atrophic vaginitis	6,0-6,5
Bacterial vaginosis, cocci and enterobacteria	4,5-5,3

An imbalance of microflora is called dysbiosis or vaginal dysbiosis. That is, the activity of lactobacilli is suppressed, due to which opportunistic or pathogenic microflora begins to multiply uncontrollably. Favorable conditions for development arise inflammatory processes reproductive organs.

A healthy adult woman has a variety of bacteria living in her vagina - more than 40 species. Most of them are Dederlein bacilli, beneficial microflora. The microecological system is responsible for the condition of the reproductive organs.

Pathogenic microorganisms themselves - causative agents of sexually transmitted diseases and fungi - are not the cause of dysbiosis. But they cause acute inflammatory processes, which provoke a decrease in local immunity.

The main causes of vaginal microflora disturbances

Dysbacteriosis can be considered not as a disease, but as a condition.

The reasons for the imbalance of beneficial and opportunistic microorganisms are:

• Hormonal changes - can be provoked by external factors or appear when organic metabolism is disrupted and diseases of the endocrine system. TO external factors include: growing up, pregnancy, abortion, entering menopause.
• Congenital anomalies of the reproductive system.
• Treatment with certain medications - antibiotics, corticosteroids, antidepressants.
• Intestinal dysbiosis caused by poor nutrition, malnutrition, and infectious diseases.
• Formation of neoplasms in the gynecological system - polyps, cysts, leiomyomas.
• Indiscriminate change of sexual partners, use of spermicides to prevent pregnancy, irregular sex life.
• Sexually transmitted diseases.
• Neglect of hygiene of the intimate area or frequent douching, use of detergents unsuitable for caring for the genitals.

Factors causing the development of dysbiosis: chronic stress and frequent hypothermia, emotional and physical fatigue, unbalanced nutrition, emotional overload.

General signs of vaginal dysbiosis

Manifestations of bacterial dysbiosis are purely individual.

Possible symptoms:

1. Qualitative and quantitative changes in secretions. The volume of vaginal secretion may increase or decrease, and the color, smell and consistency may change. The color becomes grayish, greenish, yellowish, the smell is ammonia, fishy, ​​sweetish. The consistency is too liquid or cheesy. A thick secretion sticks to the vaginal walls.
2. There may be itching, burning, painful sensations. The mucous membrane becomes thinner and hyperemic. For some women, signs of discomfort appear only during the menstrual cycle.
3. During coitus, unpleasant and sometimes painful sensations appear.
4. IN at a young age and during the transition to menopause, sticking of the labia minora occurs.
5. Burning and pain when urinating.

Signs of an inflammatory process when a woman’s vaginal microflora changes do not always appear. In some cases, bacterial vaginosis is detected when scheduled inspection, or when the patient consulted a doctor with complaints of frequent inflammatory processes, infertility, early termination of pregnancy.

How to restore vaginal microflora?

Vaginal dysbiosis is confirmed using a scraping smear from the cervical canal and the vagina itself. Complex treatment helps restore the balance of microflora and normalize local immunity. Treatment is carried out in 2 stages. Conditions are created to increase the activity of lactobacilli and restore immunity, and then use drugs that destroy pathogenic microflora and stop the proliferation of opportunistic microflora.

Hygienic measures to restore the balance of vaginal microflora

To restore local immunity, you need to pay attention to sanitary and hygienic measures and personal care. If, due to dysbacteriosis, an STD infection has not occurred or the doctor does not insist on douching, this type of washing should be completely abandoned.

For hygienic washing you need to use special means from pH to 5.5. Even regular baby soap has a pH of 7. When washing, you need to make sure that your hands or shower head move from front to back so as not to carry coli on the surface of the vulvar mucosa.

Underwear and towels should be changed every day, and bedding every 3-4 days. It is advisable to choose products only from hygroscopic natural fabrics that can be washed at high temperatures- 90-100°C to destroy pathogens.

It is necessary to exclude overheating and hypothermia, temporarily avoid baths, visiting a bathhouse, swimming pool, solarium, or swimming in open water.

Normalization of vaginal microflora through nutrition

It is necessary to normalize the diet, abandon strict diets, consumption of foods that contain easily digestible carbohydrates (sweets), high-calorie foods and fatty foods, canned food and alcohol.

Often vaginal dysbiosis develops against the background of intestinal dysbiosis. Therefore, you need to increase the amount of fermented milk products, fresh fruits and vegetables in your diet, with the exception of bananas and grapes. Food should not be overheated or overcooled; the temperature of the food should be at 25-50°C. Need to increase drinking regime due to pure or mineral water, compotes, fruit drinks and green teas - from currant leaves or fennel fruits.

It is advisable to avoid whole milk. Adults have practically no bacteria that are responsible for its absorption. The development of intestinal dysbiosis can aggravate the condition of the vaginal microflora.

Medicines to restore vaginal microflora

To treat dysbiosis, medications of different groups are used.

Antimicrobial and antibacterial agents

When prescribing medications of this type, preference is given to vaginal suppositories: Clindamycin and analogues - Metronidazole, Tinidazole, Ornidazole, Neo-Penotran. But antibiotics may also be prescribed. various types, taking into account additional symptoms and accompanying illnesses. The course of treatment with suppositories is 5-7 days.

Antifungal agents

When fungal flora is detected, agents that inhibit opportunistic organisms are prescribed. These include antifungal suppositories: Pimafucin, analogues of Clotrimazole, Nystatin.

Proven in the treatment of vaginal candidiasis high efficiency from use complex means- vaginal suppositories Terzhinan or an analogue of Polizhinaks in capsules. In addition to the antifungal component, dosage form includes a hormonal anti-inflammatory agent that accelerates mucosal regeneration.

Preparations to restore the balance of microflora

This group includes vaginal suppositories or tampons soaked in solutions made from dried bacterial cultures. Medicines used: Acylact, analogues Bifolact, Ginolact, Vaginorm or Bifidumbacterin. The multicomponent product Gynoflor is widely used. Contains lactobacilli acidophilus and estriol (synthesized estrogen hormone).

If bacterial vaginosis cannot be eliminated long time, use Solcotrichovac - a vaccine to stimulate the immune system. This remedy prevents relapses and can be used in for preventive purposes. The drug is administered only as prescribed by a doctor, accurately timing the injection. Administration three times, once every 2 weeks. A year after the first injection, revaccination may be required. Knowing how to restore the vaginal microflora after multiple relapses, you can avoid inflammatory processes in case of possible hypothermia or the need to be in unfavorable conditions for some time.

The therapeutic course is often supplemented with antihistamines. They try to use the latest generation medications, which are taken once a day.

Improving vaginal microflora with folk remedies

Traditional healers advise carrying out hygiene measures with the help of tar soap , which has antiseptic and antibacterial effects. It is enough to wash the genitals 2 times a week.

Manufacture tampons, wrapping the cotton wool in gauze. The ends should be left long enough so that the medical accessory can be easily removed. Tampons are soaked in honey sea ​​buckthorn oil, water decoctions of calendula, chamomile, whey. When preparing the infusion, 2 tbsp. l. Brew a glass of boiling water, be sure to boil for at least 1 minute, and filter.

Help restore microflora balance sitz baths. Use chamomile, calendula, oak bark, St. John's wort and sage. First, the decoctions are prepared according to the recipe described above, and then diluted in 2 liters boiled water. The procedure lasts 15-20 minutes.

If the gynecologist doesn't mind douching, use decoctions of the above-mentioned medicinal herbs or whey. A decoction that can be used to soak tampons and also be used for douching and sitz baths: mix equal amounts of chamomile, dried juniper berries, oak bark and leaves walnut. Brew 1 tbsp. l. 0.5 liters of boiling water.

To increase general immunity, medicines are prepared according to the following recipes:

• Rowan. Dried rowan berries are brewed as tea, boiled for 15 minutes, cooled to room temperature. Pour 2 tbsp into a glass of drink. l. onion juice and liquid honey. A glass is drunk per day, in equal portions, regardless of meals.
• Currant. Brew blackcurrant leaves - 3 tbsp. l. for 250 ml. When the drink has cooled, add crushed garlic cloves - 5-6 pieces, and the juice of half a lemon. Stir and let sit for 1 hour. Strain. Take similarly to rowan mixture.

Have an effective effect suppositories. Melt cocoa butter - 30 ml, add essential oil lavender - 20 drops, stir until smooth. Then they form cylinders, wrap them in foil and place them in the refrigerator. To form candles, it is better to use disposable syringes. Cut off bottom part syringe, collect a thick mass, squeeze out a column 1.5-2 cm high. Frequency of use - 2 times a day, morning and evening, duration of treatment course - 5-7 days.

Prevention of vaginal dysbiosis

Stabilization of local immunity helps prevent inflammatory diseases of the intimate area.

1. When caring for yourself, use products with lactic acid.
2. Wear underwear made from natural fabrics.
3. When having sexual contacts with unfamiliar partners, use barrier contraception (condoms).
4. Change panty liners every 3-4 hours, and sanitary pads every 1.5-2 hours.
5. You should avoid scented products when caring for your genitals.
6. Make sure your diet includes a sufficient amount of raw vegetables, fruits, dairy products and high-fiber foods.

How to restore vaginal microflora - watch the video:

At the first signs indicating a disease of the genital area, you need to choose the time to visit a gynecologist. When treating with antibiotics, introduce probiotics, prebiotics and vaginal suppositories into the therapeutic regimen to restore the vaginal microflora.