Methods for restoring vaginal microflora. To treat or not to treat vaginal microflora disorders? Who is at risk

Such an unpleasant attack as a violation of the vaginal microflora is familiar to almost every woman. And, paradoxically, in girls who have not yet begun sexual activity, it occurs almost as often as in women who live it. The insidiousness of this disease is great - in most cases it is asymptomatic. A woman lives and does not know about microflora disturbances until she encounters severe complications. So what is it, why does it happen and how to ensure the restoration of the vaginal microflora?

A disruption of the normal, healthy microflora of the vagina is called vaginal dysbiosis or vaginal dysbiosis. Most often, its signs and symptoms in women are insignificant, but if they are ignored, vaginal dysbiosis can lead to serious inflammatory infectious gynecological diseases.

What is a violation of the vaginal microflora?

When dysbiosis occurs, doctors often make a diagnosis "bacterial vaginosis". This term means gardnerellosis, simply put, this is one of the subtypes of vaginal dysbiosis, when the female reproductive microflora is dominated by gardnerella. Another type of manifestation of microflora disturbance is "candidiasis" or "thrush". In this case, the vaginal microflora is dominated by mushrooms of the genus Candida. But women often call any “inadequate” vaginal discharge “thrush” without really understanding their cause.

And recently, the asymptomatic course of gynecological diseases, including sexually transmitted diseases, is very common. Even pathological discharge in these diseases does not always occur, so without appropriate tests it is very difficult to distinguish violations from the norm. With a latent course, there is no itching in the vagina, no abdominal pain, menstrual irregularities, bleeding and other symptoms. This is why it is so important for every woman to undergo a preventive examination by a gynecologist at least twice a year.

Causes of vaginal microflora disorders

Women's health is a very delicate mechanism, and there are many causes of dysbiosis. Any stress on the female body can provoke disturbances in the vaginal microflora.

The most common causes of vaginal dysbiosis are:

• 1. Hypothermia, which leads to a decrease in local and general immunity, which also affects the vaginal microflora.
• 2. Hormonal disorders that occur during irregular sexual life, menstrual irregularities, puberty, pregnancy, after childbirth, abortion, menopause, etc.
• 3. Change of climate zone - during trips, especially to other countries, there are often exacerbations of vaginal dysbiosis.
• 4. Infections that are sexually transmitted.
• 5. Any infectious and inflammatory diseases of the pelvic organs.
• 6. Treatment with antibiotics.
• 7. Failure to comply with intimate hygiene rules.
• 8. Intestinal diseases, including intestinal dysbiosis. After all, a woman’s intestinal microflora is very closely related to the vaginal microflora.
• 9. Incorrect use of tampons during menstruation. Do not forget to change tampons strictly every 2 hours, be it day or night, otherwise excellent conditions are created in the vagina for the proliferation of opportunistic, pathogenic microflora and the development of inflammation.

But not always all these factors actually lead to disruption of the vaginal microflora. A woman’s immune system is able to maintain normal microflora, help it, and recover independently in case of minor deviations. But there are so many of these factors and they occur so often that vaginal dysbiosis in a woman in most cases develops “safely”.

The mechanism of development of vaginal dysbiosis

Normally, a woman’s vagina contains normal microflora, approximately 90% consisting of lactobacilli (the so-called Dederlein rods), only 9% bifidobacteria and less than 1% other opportunistic microorganisms that do not cause diseases. In addition, the smear reveals “key cells of the vagina” - epithelial cells of its walls, covered with a layer of those same opportunistic microorganisms. These include, in particular, fungi of the genus Candida, gardnerella, and some other bacteria.

Changes in the percentage of microorganisms that live in the vagina and the appearance of other microflora are unacceptable for normal female microflora. The woman’s immune system does not react in any way to the “normal” inhabitants of the vagina, but protects against other bacteria and infections. In addition, immunity helps restore the vaginal microflora in case of minor disturbances.

If the vaginal microflora is disturbed for one reason or another, the number of lactobacilli and bifidobacteria decreases, and the number of opportunistic microorganisms increases or pathogenic microorganisms that are not characteristic of a healthy state appear. These microorganisms can be a fungus or gardnerella (then candidiasis or gardnerellosis develop, respectively), or maybe one of the sexually transmitted infections (for example, chlamydia and trichomoniasis), or any other pathogen from the environment (for example, E. coli, streptococcus, staphylococcus, proteus).

Bacteria that cause vaginal dysbiosis are the cause of vaginal inflammation - vaginitis. The development of such inflammation depends on the pathogenicity and quantity of the pathogen and, of course, the strength of the woman’s immune system. For some time, the immune system copes with the infection, but in the absence of appropriate treatment, it is impossible to avoid the development of inflammation.

Signs and symptoms of vaginal dysbiosis

In half of the cases, vaginal dysbiosis occurs without symptoms. For quite a long time, a woman may not notice any signs of microflora disturbance. From time to time, the nature of the discharge may change slightly, but often this goes unnoticed. Normally, a woman should have no discharge at all, or it may be transparent in small quantities.

You should consider going to the doctor immediately if you experience the following symptoms:

• 1. increased amount of discharge, especially whitish-yellowish in color;
• 2. release of an unpleasant odor;
• 3. discomfort and dryness in the genital area, during sexual intercourse as well.

No further signs of vaginal dysbiosis appear; other symptoms, as a rule, indicate its complication - the development of infection and inflammation of the woman’s genital organs.

Complications of vaginal dysbiosis

With vaginal dysbiosis, the vagina is “inhabited” by a large number of pathogenic or opportunistic bacteria. These bacteria cause inflammation of the cervix ( cervicitis) and vaginal walls ( vaginitis).

Symptoms of inflammation are:

• 1. increase in the number of discharges;
• 2. unpleasant sensations appear: burning, pain, itching in the vagina and external genitalia, including after and during sexual intercourse;
• 3. vaginal dryness during sexual intercourse.

Bacteria can also infect the uterus, which can lead to the development endometritis, and can go even further to the appendages with further development adnexitis. In addition, the infection can enter the urethra, and then into the bladder, which leads to urethritis And cystitis, respectively.

Vaginal dysbiosis in girls

Unfortunately, disruption of the vaginal microflora “does not spare” even girls who have not begun to engage in sexual activity, and occurs with the same frequency as in women who are sexually active. This is due to the instability of the hormonal background of girls during their first menstruation and the structural features of the hymen. In girls, vaginal dysbiosis is rarely manifested by copious vaginal discharge, which is why it is often detected when complications have already begun.

When the onset of sexual activity begins, a large number of bacteria can be “thrown” from the vagina into the bladder, provoking the so-called "honeymoon cystitis".

Treatment and restoration of vaginal microflora in virgins can be very difficult due to the structure of the hymen, which does not allow the correct use of medications.

Vaginal dysbiosis during pregnancy

Sadly, pregnancy is one of the causes of dysbiosis. During pregnancy, its symptoms may intensify or appear, as well as inflammation of the vagina. The symptoms, as in other cases, are the same: discharge, itching in the vagina and burning in the genitals, dryness and pain during sexual intercourse.

The reason for this is hormonal changes in the body of a pregnant woman, which affects the state of her entire immune system and the vaginal microflora in particular.

Complete restoration of vaginal microflora and treatment of inflammation during pregnancy is very difficult, due to the fact that immunocorrection and antibiotic treatment are undesirable. Therefore, the main task of the gynecologist in this case is to eliminate the symptoms of the disease and prepare for childbirth.

Treatment of vaginal dysbiosis with local remedies is less effective, but harmless to both the pregnant woman and the fetus. If necessary, such local treatment can be repeated more than once.

Dysbacteriosis and sexually transmitted infections

Infections that are sexually transmitted always, without exception, lead to dysbacteriosis. If a sexually transmitted infection is detected, then the normal microflora of the vagina is impossible, it is disrupted. The causative agent of a sexually transmitted disease necessarily causes inflammation in the genital tract and contributes to the destruction of the vaginal microflora. In this case, inflammation of the genital organs is very rarely caused solely by an infectious agent. The inflammatory process caused by sexually transmitted infections always occurs together with opportunistic microflora. And this must be taken into account during treatment, that is, it is necessary to treat both the infection and restore the vaginal microflora. Otherwise, a situation arises when antibiotics completely eliminate sexual pathogens, and opportunistic microflora increases significantly.

After treatment of sexually transmitted infections in women, it is imperative to restore the vaginal microflora. In case of severe infectious diseases (chlamydia, trichomonas) or several sexually transmitted infections, specific antibacterial therapy is first carried out, and then the vaginal microflora is restored. In less complex situations, a comprehensive diagnosis of absolutely all urogenital microflora is first carried out, and then its restoration is carried out in parallel with the elimination of sexually transmitted infections.

Usually, a violation of the vaginal microflora does not provoke disease in a woman’s sexual partner, even in conditions of regular unprotected sex life. With severe vaginal dysbiosis, in rare cases, a man may develop the phenomenon nonspecific urethritis And balanoposthitis. But this only happens if a man has a predisposition to these diseases; they do not develop in a healthy male body. And diseases of the sexual partner cannot disrupt the normal microflora of a woman, except for those, of course, that are sexually transmitted. Treatment of vaginal dysbiosis does not necessarily imply treatment of the sexual partner if a sexually transmitted infection is not detected.

Vaginal dysbiosis in women with intestinal dysbiosis

Most diseases of the gastrointestinal tract (GIT) lead to disruption of the intestinal microflora. With intestinal dysbiosis, as well as with vaginal dysbiosis, the number of bifidobacteria and lactobacilli decreases, and opportunistic microorganisms increase or pathogenic ones appear.

If intestinal dysbiosis is pronounced, then the disturbance of the vaginal microflora is explained by it, then one of the intestinal bacteria - enterococci, E. coli, etc. - multiplies in the vagina.

In such a situation, treatment of vaginal dysbiosis is extremely difficult, and the possibility of relapse is very high. In this case, restoration of the vaginal microflora is possible only with parallel treatment of dysbiosis and other intestinal diseases.

Diagnosis of disturbed vaginal microflora

Diagnosis of vaginal dysbiosis consists of a gynecological examination and the following tests:

• 1. PCR diagnostics for sexually transmitted infections;
• 2. smear on flora;
• 3. culture of vaginal discharge, including determination of sensitivity to antibiotics.

A smear gives a general idea of ​​the state of the microflora and the presence of inflammation. Sowing and diagnosing sexually transmitted infections make it possible to find out which pathogens provoked the microflora disturbance and to find out what sensitivity these bacteria have to antibiotics. The cause and degree of vaginal dysbacteriosis cannot be determined solely by the result of a smear of vaginal discharge.

Treatment of vaginal dysbiosis

Restoration of microflora should include:

• 1. Elimination of opportunistic and pathogenic bacteria that cause inflammation and dysbiosis.
• 3. Restoration of local immunity of the vaginal wall, which could maintain the normal composition of female microflora in the future.

Suppression of opportunistic and pathogenic vaginal microflora

If the cause of vaginal dysbiosis is a sexually transmitted infection, then first of all, the causative agent of a sexually transmitted disease is completely eliminated from the woman’s body. In this case, treatment necessarily includes a full course of antibacterial therapy, that is, taking appropriate antibiotics.

If there are no genital infections, then taking antibiotics is not necessary to restore the vaginal microflora. In this case, they either do not treat with antibiotics at all, or use a very short course (5 days) of antibacterial treatment.
For the treatment of vaginal dysbiosis, local procedures: vaginal baths and tampons are much more effective. These procedures simultaneously combine all the necessary functions: suppression of pathogenic microflora, restoration of normal flora and local immunocorrection. For local procedures, the use of antiseptics is usually much more effective than the use of antibiotics. The fact is that their spectrum of action is much wider, and bacteria rarely develop resistance to them (immunity).

As has been said many times, the immunity of the vaginal wall controls the state of the vaginal microflora, preventing the growth of pathogenic bacteria. That is, a violation of the microflora is always associated with a decrease in the immune defense of its wall. That is why local immunocorrection must necessarily be part of the treatment of dysbiosis.

In simple, unadvanced cases, the use of local immunomodulators is sufficient for immunocorrection. And if the forms of the disease are advanced, restoration of the immune system will require more serious methods of influence; sometimes a course of immunomodulatory treatment is required before treatment with antibiotics.

Restoring the vaginal microflora usually takes 3-4 weeks. It is advisable for both sexual partners to be thoroughly examined by a specialist first. After treatment, a follow-up examination is carried out and control tests are performed. If no more symptoms of dysbacteriosis are detected, then the restoration of the vaginal microflora can be considered complete and we can continue to deal only with the prevention of the disease.

Restoring microflora after thrush: tablets and suppositories for restoring microflora

Thrush in most cases occurs after treatment with antibiotics. Therefore, the treatment process is quite complex and long: first treatment with antibiotics, then treatment after antibiotics, then restoration of the microflora.

For such restoration there are vaginal probiotics, which contain lactobacilli. But these drugs are not always equally effective. The problem is that any infection has a destructive effect on the upper layer of the epithelium. As a result of desquamation, beneficial microorganisms do not have the opportunity to gain a foothold in the vagina and lactobacilli simply die, literally 5-7 days after using the probiotic, giving candida the opportunity to multiply uncontrollably. This is precisely what explains the frequent exacerbations of thrush. Therefore, in order to avoid such developments, after a course of treatment of any infection, it is necessary to use a probiotic, which contains not only lactobacilli, but also a special component that restores the epithelium. In other words, we need a drug with a dual mechanism that can restore the normal balance of microflora and prevent exacerbation of the disease.

The most popular are vaginal tablets "Gynoflor". To restore the microflora, drugs such as "Vagilak"(“Laktogin”) and "Ecofemin". When symptoms no longer bother you for more than a week, it is advisable to take a course (weekly) of vaginal tablets "Vaginorm S", restoring the normal pH of the vagina and, accordingly, promoting the development of healthy flora.

There are also vaginal suppositories to restore microflora, for example "Bifidumbacterin". The product is used for 10 days, 1 suppository in the morning. Another suppository for restoring microflora is "Lactobacterin", the course of treatment is the same 10 days, 1 suppository, but at night.

One of the treatment options is orally “Normoflorin” B and L, twice a day, morning and evening, for a month. And in parallel suppositories for restoring microflora "Kipferon" who use 2-3 courses, 10 times with breaks per week. Undoubtedly, during the treatment process it is necessary to periodically take bacteriological cultures to observe how the microflora changes.

Prevention of vaginal microflora disorders

Prevention is a rather complex issue in this case. Often the cause of vaginal dysbiosis, be it an intestinal disease, hormonal instability, sexually transmitted infection, etc., cannot be determined. Then only general recommendations on strengthening the immune system and maintaining hygiene make sense.

It is advisable for all women who have undergone a course of microflora restoration to visit a gynecologist every 3 months for a year after treatment. This is necessary in order to detect a relapse in time and prevent the development of complications. It is much easier to restore vaginal microflora in the initial stages. If no deviations are noted during the first year, then you can visit the doctor once every six months.

More about the vaginal microflora:

Vaginal dysbiosis is expressed in disruption of the 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 that vaginal dysbiosis is meant.

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 ones:

• 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-term or frequent treatment with 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 contributes to the development of perfect conditions in the vagina for the growth of 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 rarely can it manifest itself as itching and profuse vaginal discharge with an unpleasant fishy odor.
• Any microorganisms with pathogenic activity.

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% of beneficial lactobacilli (the so-called Dederlein bacilli), about 10% - bifidobacteria, and less than 1% of the “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 slight 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. In the absence of 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 untreated treatment can contribute to the development of vaginitis or colpitis, in which the discharge becomes purulent, pain and pain occur in the genitals, and often 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. Since during this period the female body undergoes enormous hormonal changes, immunity decreases, nutrition and lifestyle changes, against this background discharge, itching or burning in the genitals, pain during sexual intercourse, etc. may appear or intensify.

Since any drug therapy is generally contraindicated during pregnancy, it is not possible to receive full treatment. Any treatment for 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 to symptomatic treatment or, in other words, elimination of 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 genital infection in the vagina shifts the pH, contributing to the occurrence of an inflammatory reaction and further 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 is cultured from the vagina - E. coli, enterococci, etc.

In this case, treatment is complex, since there is a high probability of relapse. In this case, restoration of normal vaginal microflora is carried out while simultaneously treating 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 rare cases occurs with heavy 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 relationship, a large number of bacteria are thrown from the vagina into the bladder, which can provoke 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. An absolutely healthy male body is not afraid of these inflammatory diseases. They will not develop in a completely healthy body.

It is worth noting that no diseases of the partner affect the microflora of a woman’s vagina, except for sexually transmitted 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 an 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 microflora disorder 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 of antibiotics and antiseptics is used. 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 are used. 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, douching with lemon juice diluted with water, lactic acid, as well as inserting tampons soaked in kefir into the vagina are effective for treating dysbiosis. 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. Restoring microflora at the initial stage of its disturbance 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.

Violation of the vaginal microflora occurs more than once in a woman’s life. Moreover, this trouble can affect not only women who are sexually active, but also virgins. What should be the normal vaginal microflora, what are the symptoms of its negative changes and how to treat it?

Normally, many microorganisms live in the mucous membrane of the female genital organs, but about 95% of them are lactobacilli. These microorganisms are good; they produce lactic acid, which does not allow harmful microorganisms to multiply. The remaining 5% are opportunistic microorganisms - gardnerella, fungi of the genus Candida, etc. Sometimes the number of lactobacilli begins to decrease, and they are replaced by harmful microorganisms. Then a violation of the vaginal microflora gives the following symptoms:

• copious discharge (gray, green or white), often with a pungent odor;
• redness and itching of the genitals;
• pain during sexual intercourse due to vaginal dryness.

If vaginal microflora disorders are not treated, pathogens can infect the urinary system and spread further into the fallopian tubes and ovaries. The result is kidney problems, infertility, adhesions in the tubes, and ectopic pregnancy. This pathology poses a great danger to expectant mothers. After all, their risk of premature birth and postpartum endometritis increases several times.

But before we talk about getting rid of this pathology, we will find out what are the causes of disturbances in the vaginal microflora in women, because any disease is easier to prevent than to treat.

Most often, changes in microflora occur due to hormones. More precisely, due to hormonal imbalances, which often occur in women during menopause, as well as when taking certain medications. For example, oral contraceptives.

In addition, chronic diseases, such as diabetes, can have a certain impact. You will have to think about how to restore the vaginal microflora even after long-term use of antibiotics, frequent use of vaginal contraceptives (spermicides) or douching. By the way, antibiotics are often found in store-bought meat and dairy products, so you can get dysbiosis without directly taking antibacterial agents.

If you have corresponding symptoms, you need to consult a gynecologist. But you are unlikely to be given an effective prescription after the first appointment, since you will need to examine the smear microscopy and the results of bacteriological culture. To prescribe tablets or suppositories for vaginal microflora disturbances, the doctor must know which pathogen is the culprit of dysbiosis. It would also be useful to get tested for hidden sexually transmitted infections.

If Candida fungus is detected in the smear, and symptoms typical of candidiasis, such as itching and white, cheesy discharge, bother you, the doctor will prescribe antifungal agents. Suppositories for intravaginal use or tablets for oral administration may be prescribed. In mild cases, a single dose of the drug is sufficient for the complete disappearance of unpleasant symptoms.

If gardnerella is detected in the smear, treatment will be carried out with other drugs, antibacterial and antiseptic. And this disease will be called bacterial vaginosis. After treatment, gynecologists usually recommend taking a course of 7-10 days to normalize the microflora. The choice of drugs for topical use is very wide: “Lactozhinal”, “Acipol”, “Acilact”, etc. “Vagilak” shows good results when taken orally.

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Vaginal microflora is an important component of the woman’s immune system. Normally, this is an acidic environment, which prevents the penetration of pathogenic bacteria. Disturbance of microflora is called dysbiosis.

The most common reasons are external factors:

• Hypothermia;
• Inadequate regimen for taking hormonal medications;
• Irregular sex life;
• Climate change;

• Violation of personal hygiene rules;
• Intestinal dysbiosis;
• Infections and inflammatory processes in the pelvic organs;
• Incorrect use of tampons and pads during menstruation, untimely replacement of personal hygiene products.

Normally, the immune system is able to independently regulate the ratio of bacteria, and restoration of the vaginal microflora occurs without the help of medications. If a woman constantly faces one of the risk factors, the normalization of the vaginal microflora is carried out with special preparations.

Signs

Symptoms of vaginal dysbiosis manifest themselves clearly only in cases where the flora is seriously disturbed and requires complex treatment. Often, the symptoms of the initial stages are almost invisible:

• The discharge becomes white-yellow;
• During sexual intercourse and in a calm state, discomfort and dryness are felt, which are temporarily eliminated with hygiene products;
• The discharge smells unpleasant.

Many women associate these signs with the approach of menstruation and taking medications. If additional symptoms are observed, they speak of complicated dysbiosis, which has led to infectious diseases. Additional symptoms:

• Burning and hyperemia of the vaginal walls;
• Redness of the labia;
• Dryness in the vagina;
• Delayed menstruation;
• The discharge takes on a distinct ammonia or musty odor.

Dangerous complications that dysbiosis causes in the absence of treatment for a long time:

• Infection of the cervical canal and uterus, leading to endometritis;
• Spread of infection to the appendages, adnexitis;
• Inflammation of the bladder and urethra, cystitis, urethritis.

Complicated forms of any infectious diseases are quite difficult to treat.

Treatment regimen

Since it is difficult to restore the vaginal microflora, especially with complications, without identifying the cause of dysbiosis, the treatment regimen is as follows:

1. Detection of the cause of dysbiosis;
2. Elimination of pathogenic bacteria in the vagina;
3. Restoration of natural microflora;
4. Immunostimulating therapy to consolidate the result in the future.

To detect the causes, the gynecologist will prescribe laboratory tests of urine, blood, and microflora smears. If pathogenic bacteria are suspected, both partners should take a smear.

If the cause is not a pathogenic bacterium, vaginal probiotics are immediately prescribed. Among the forms of drugs there are tablets and ointments, but suppositories are the most effective for restoring microflora in women.

If dysbiosis has caused complications, the pathogenic microflora and complications are first eliminated, and only then treatment is started in order to normalize the microflora.

Elimination of pathogenic flora

It is useless to restore the microflora as long as the pathogenic infection continues to destroy it. The most common cause of dysbiosis is thrush.

In this case, the following suppositories are prescribed to restore the vaginal microflora:

• Clotrimazole;

• Nystatin;

• Pimafucin;

Treatment with these suppositories should be prescribed by a doctor after identifying the Candida fungus in a smear for microflora. The active ingredients can cause itching and redness, and some of the drugs are prohibited during pregnancy and lactation.

If the cause is more serious pathogens: ureaplasma, trichomonas, chlamydia, a restorative course of complex therapy with antibiotics is carried out. In this case, according to doctors, the use of lactobacilli can only worsen the situation, creating a favorable environment for the proliferation of infections and viruses.

Recovery phase

After eliminating the root cause, a smear is taken again for microflora. If no pathogenic microorganisms are detected, restoration of the microflora in gynecology begins.

The following drugs are used to restore microflora:

If the problem is a decrease in acidity, treatment is carried out using suppositories with lactic acid:

The drugs are prescribed taking into account the age, weight of the patient, her sensitivity to the components of the drug, taking into account the conditions of pregnancy, puberty, menopause, and lactation.

Use of suppositories

Most often, treatment is carried out with local drugs; suppositories with lactobacilli and hormones are popular.

• Vagikal - suppositories for normalizing microflora and suppressing the proliferation of pathogenic microorganisms, have a mild anti-inflammatory effect, treatment lasts ten days.
• Gynoflor - due to the content of lactobacilli, they promote the reproduction of natural microflora with the necessary acidity, available in the form of vaginal tablets.
• Estriol - restores fungal-damaged epithelium with a mild wound-healing effect. The duration of treatment is 7 days, the suppository is inserted into the vagina once a day before bedtime.

• Kipferon - strengthens both local and systemic immunity, the course of treatment is ten days, then a break of 5 days and another course. For complete treatment, repeat two or three courses.
• Bifidumbacterin - suppositories that are used both to restore vaginal microflora and to treat intestinal dysbiosis. Suppositories are placed twice a day for ten days, the effect of the drug is quite mild, therefore it is not prohibited during pregnancy.
• Vaginorm - normalizes the acidity of the vagina and suppresses the proliferation of pathogens, the duration of treatment is no more than a week.

If dysbiosis and candidiasis have developed due to long-term use of antibiotics, it is necessary to use drugs that restore the intestinal microflora: yogurt in capsules, Linex, natural homemade yogurts with pharmaceutical starter cultures.

Treatment with folk remedies

Traditional methods of restoring microflora can be a successful addition to drug therapy, enhancing its effect. To do this, you need to contact a gynecologist and select a traditional medicine method that would be combined with the active ingredient of the drugs used.

• You can prepare medicinal tampons yourself. To do this, brew a chamomile decoction according to the prescription on the pharmacy packaging for the collection of chamomile officinalis. Then dip the tampon into the broth, wring it out lightly and insert it into the vagina.
• You can use a purchased tampon, or make your own from sterile cotton wool and gauze.
• Tampons with kefir and honey are also used. First make sure that there are no allergic reactions to honey - a drop of honey is applied to the wrist, rubbed into the skin, and the reaction is observed for six hours.

• To prepare a tampon, you need to soak it in honey and insert it into the vagina in the morning. In the evening, a tampon with kefir is inserted - it is better to purchase bio-kefir or prepare it yourself using pharmaceutical bacterial starter cultures.
• A tampon can also be moistened with sea buckthorn oil and left for several hours.
• Among douching procedures, douching with chamomile with calendula and kefir is popular. At the same time, the doctor may prescribe douching with medicinal solutions, for example, Furacilin.

Tampons should not be kept in place for longer than four hours. Before douching, consultation with a doctor is required, since the procedure is prohibited during pregnancy, endometritis, and fibroids.

Prevention

For preventive purposes, personal hygiene products should be reviewed, excluding cheap products with dyes, flavors, and allergens.

To strengthen the immune system, the doctor may prescribe vitamin and mineral complexes:

• Kvadevit.

It is necessary to visit a gynecologist once every three months in order to promptly recognize the manifestation of dysbiosis and prevent chronic disturbance of the vaginal microflora. If no relapse occurs within a year, you can visit a gynecologist every six months.

What is a violation of the vaginal microflora? Disturbance of the vaginal microflora (vaginal dysbiosis, vaginal dysbiosis) is a phenomenon associated with the functioning of the female reproductive system. Violation of vaginal microflora: symptoms, treatment depend on many factors. Such factors include the general condition of the patient, the course of concomitant diseases, diet, quality of sexual life, etc. Disturbance of the vaginal microflora is manifested by whitish discharge from the vagina. Such discharge may have different consistency, odor and abundance. Such discharge may be a normal part of the vaginal cleansing process of a healthy woman. But vaginal discharge may also indicate a pathological process, including vaginal dysbiosis.

According to statistics, a violation of the vaginal microflora occurs in every second woman. Such a disorder can occur in mature women after the onset of menopause, in middle-aged women with an established sex life, in girls before the onset of sexual activity, in girls before the onset of the menstrual cycle. Vaginal dysbiosis often goes unnoticed. A woman may not suspect a violation of the vaginal microflora for a long time. An asymptomatic course is dangerous due to its complications. It is complications in asymptomatic cases that force the patient to go to a specialized clinic.

Normally, a woman’s vagina is inhabited by normal, non-pathogenic microflora. This microflora ensures the functioning of the genital organs. The vaginal microflora consists of approximately 90% lactobacilli, 9% bifidobacteria and less than 1% other opportunistic microorganisms. Opportunistic microorganisms normally do not provoke the development of the disease, but under the influence of predisposing factors they can cause the disease. Opportunistic microorganisms cover the walls of the vagina. These include fungi of the genus Candida, Gardnerella and some other microorganisms. The body of a healthy woman controls the ratio of microorganisms in the vagina and does not allow the appearance of uncharacteristic microflora. At the same time, the immune system does not react in any way to representatives of the characteristic microflora of the vagina. If minor changes occur in the vaginal microflora, the microflora will resume on its own. This process does not affect the woman’s health in any way. Exposure to predisposing factors and disruption of the vaginal microflora reduces the number of lactobacilli and bifidobacteria. At the same time, there is an increase in the amount of opportunistic microflora, and pathogenic microorganisms also appear. Such a microorganism can be gardnerella, a fungus of the genus Candida, a sexually transmitted infection (trichomoniasis, chlamydia, gonorrhea, etc.), as well as another pathogen from the environment (staphylococcus, streptococcus, Proteus, E. coli, etc.). Such microorganisms, when multiplying and living, cause inflammation of the vagina. Inflammation depends on the woman’s level of immunity, the general condition of her body, the number of pathogenic microorganisms, etc. In the absence of treatment for inflammation and in the absence of therapy against pathogenic microorganisms, the disease will progress.

Symptoms of vaginal microflora disorders

Violation of the vaginal microflora, as mentioned above, is often asymptomatic. For a long time, a woman may not even be aware of a violation of the vaginal microflora. But still, a violation of the vaginal microflora provokes a number of symptoms. Thus, various types of vaginal discharge may be observed. Often women ignore this symptom or do not notice it at all. The discharge is not accompanied by dryness of the vagina and external tissues of the genital organs, or discomfort during sexual intercourse. Over time, the amount of discharge increases and such discharge acquires a characteristic odor. If other symptoms are observed, they refer to symptoms of concomitant diseases. After all, dysbacteriosis is often the cause and predisposing factor to the development of sexually transmitted diseases, erosion processes, inflammatory processes, tumor growth, etc.

Complications of microflora disturbances include: inflammation of the vaginal walls (vaginitis), inflammation of the cervix (cervicitis). These complications occur most often. Symptoms of inflammation include an increase in vaginal discharge, the appearance of unpleasant sensations when urinating, the appearance of unpleasant sensations in the perineal area (itching, burning, pain, stinging, etc.), pain during sexual intercourse or after sexual intercourse, and other symptoms. Pain during sexual intercourse occurs due to vaginal dryness and insufficient secretion. Long-term infection can spread to all internal genital organs. This can cause inflammation of the uterus (endometriosis), inflammation of the uterine appendages (adnexitis). Infection and pathogenic bacteria can enter the urethra. Penetration of pathogenic bacteria into the urethra provokes the development of cystitis and urethritis.

There are many reasons for the development of vaginal microflora disorders. Violation of vaginal microflora: symptoms, causes, treatment - every woman needs to avoid predisposing factors. It is better to prevent the development of a disease than to treat its consequences.

Violation of vaginal microflora - causes:

Local or general hypothermia. Hypothermia causes a decrease in immunity and is reflected in the ratio of microorganisms in the vagina.

Hormonal imbalances. Hormonal imbalances occur with irregular sexual activity, menstrual irregularities, puberty, pregnancy, after childbirth, abortion, with the onset of menopause, etc. A sharp change in hormonal levels is reflected in the condition of the genital organs.

Change of climate zone. A change in climate zone or a sharp change in climate provokes an exacerbation of dysbacteriosis.

Sexual infections. Sexual infections can be both a cause and a consequence of disturbances in the vaginal microflora.

Inflammatory process of the pelvic organs. The inflammatory process of the pelvic organs provokes the occurrence of specific symptoms, and the cause of inflammation can be an imbalance of microorganisms in the vagina.

Taking antibiotics. Long-term use of antibiotics disrupts the vaginal microflora and destroys not only harmful microorganisms, but also beneficial microorganisms. Therefore, with long-term use of antibiotics, it is necessary to colonize beneficial microorganisms in the vagina (which should be done by an experienced gynecologist).

Failure to comply with the rules of personal hygiene or sexual hygiene. Failure to maintain hygiene can cause the introduction of pathogenic microflora into the vagina.

Intestinal disease (intestinal dysbiosis). The intestinal microflora is associated with the vaginal microflora. Therefore, the presence of one of them causes a violation of the other.

Poor hygiene during menstruation. Poor menstrual hygiene involves the improper use of tampons and pads during menstruation. It is recommended to replace menstrual hygiene products every two hours. If you ignore the recommendations, then favorable conditions are created for the proliferation of opportunistic vaginal microflora, as well as for the development of inflammation.

The above factors do not always lead to disruption of the vaginal microflora. After all, a woman’s immune system is able to control and regulate the vaginal microflora if it changes. But still, it is better to avoid predisposing factors.

Violation of vaginal microflora - treatment

Treatment of vaginal microflora disorders is based on the results of preliminary diagnostics. For diagnostic purposes, the following tests are carried out: flora smear, PCR test, culture of vaginal discharge with determination of sensitivity to antibiotics. A flora smear allows you to determine the state of the vaginal microflora and identify inflammation. The PCR test allows you to determine the type of microorganism that caused the microflora disturbance. Bacterial culture also allows one to identify the pathogen and determine its sensitivity to antibiotics. In parallel with laboratory tests, an ultrasound examination of the pelvis and calposcopy are performed. Ultrasound examination of the pelvis allows you to assess the condition of the genital organs, their shape, the presence of tumors, etc. Cytoscopy allows you to assess the condition of the vaginal walls and identify uncharacteristic changes in the epithelial cover of the vagina. High-quality diagnostics are simply necessary. After all, 90% of treatment depends on the results of the diagnosis.

Treatment of vaginal microflora disorders includes:

Suppression of pathogenic and opportunistic microorganisms. If a violation of the vaginal microflora is associated with a sexually transmitted infection, then treatment is aimed at the complete destruction of such an infection. In this case, treatment includes a course of antibiotics. But if genital infections are not caused by a violation of the vaginal microflora, antibiotics are not prescribed. Sometimes a short course of antibiotics is prescribed. Local procedures are considered very effective in treating vaginal microflora disorders. This is how special tampons, suppositories, creams, ointments, special baths, etc. are prescribed. Such drugs combine all the objectives of treatment: suppression of pathogenic microflora, restoration of normal vaginal microflora, correction of immunity. It is worth noting that in the treatment of vaginal microflora, the use of antiseptics is much more effective than the use of antibiotics. The effectiveness of antiseptics is explained by the broad action and immunity of bacteria to antiseptics.

Restoration of normal microflora. In order to restore the vaginal microflora, special vaginal preparations are used. Such drugs allow you to populate the vagina with useful and necessary microorganisms, as well as restore the vaginal walls.

Restoring the immune system of the vagina. Restoring the immunity of the vaginal wall will help maintain the normal composition of the vaginal microflora. For this purpose, various systemic and local drugs are used. It is not recommended to restore immunity on your own. Drugs that correct immunity have contraindications for use and specific application. Advanced forms of the disease require a serious approach to treatment. Immunostimulants are often combined with antibiotics. This treatment takes on average several weeks (2-4 weeks). It is worth noting that when treating vaginal microflora disorders, it is recommended to conduct a study of the health status and sexual partner of the sick woman. After completion of treatment, control studies are carried out. Control studies make it possible to confirm the quality of treatment and confirm the elimination of predisposing factors to relapse of vaginal dysbiosis.

You can prevent disruption of the vaginal microflora by following the rules of prevention. For the purpose of prevention, all women are recommended to visit the office of a gynecologist-endocrinologist at least 1-2 times a year. So, when visiting a specialist, you should report changes in the body, previous diseases, bad habits, etc. This information allows you to timely assess changes in the state of the vaginal microflora. If the gynecologist detects the influence of predisposing factors, he prescribes a number of necessary studies. Also, measures to prevent violations of the vaginal microflora include: timely treatment of sexually transmitted infections; timely treatment of acute diseases; proper nutrition; rejection of bad habits; use of mechanical contraceptives; having one sexual partner, etc.

Experienced doctors, including a gynecologist-endocrinologist, practice at the Hippocrates clinic. With us you can undergo the necessary examinations, as well as undergo treatment of gynecological diseases using modern methods. Our specialists accept appointments by appointment. You can make an appointment at any time by phone. Take care of your health.