Vaginal biocenosis and antimicrobial therapy

Over the past decades obstetrician-gynecologists have noted an increase in the number of patients with infectious and inflammatory diseases of the genital organs. They are caused not only by sexually transmitted infections. Often, “female diseases” are caused by a violation of the normal ratio of microorganisms that are in the vagina of each woman. Doctors call this phenomenon a violation of the biocinosis of the vagina.

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Biocinosis of the vagina is a combination of microorganisms and fungi that inhabit the vagina. Normally, they are in proportions that provide a genital function and protection against infections.

The composition of microorganisms in each woman is individual and depends on many factors, including age and lifestyle.
The basis of the flora of the vagina is lactobacilli. In the process of their life, they form lactic acid – one of the important components that determine the acidity of the environment of the vagina (pH). Acidic medium inhibits the growth of pathogenic microbes. If for some reason there is a deficit of lactobacilli, the acidity of the vaginal environment decreases, and the number of pathogenic microorganisms grows rapidly.

In the ecosystem of the vagina there are not only useful microorganisms. The composition of normal microflora may include staphylococci, mycoplasmas, streptococci, corynebacteria, peptostreptococci, gardnerella, enterococci, bacteroides, enterobacteria, veylonelli, bifidobacteria, yeast fungi of the genus Candida. The total proportion of these microorganisms should not be above 5-8%. Under the influence of various external or internal factors, their concentration may change, and they exhibit their negative properties. Violation of the natural balance of microorganisms in the vagina often leads to inflammatory diseases of the pelvic organs, violations of sexual function, endometritis, miscarriages, complicated pregnancy, intrauterine infection of the fetus and the birth of a sick child.

The main factors leading to the disruption of biocinosis include:

  • Hormonal changes in the female body
  • Prolonged use of oral or intrauterine contraceptives
  • The use of antibiotics, affecting the vagina’s microflora
  • Frequent douching
  • Frequent change of sexual partners
  • Chronic inflammation of the genital organs

One of the most common causes of vaginal biocinosis is antimicrobial therapy, which was not properly performed. Imbalance of microflora often leads to uncontrolled use of local antibacterial or antiseptic drugs. In addition, the change in microflora can be caused by the appointment of antibacterial agents without taking into account probable or detected microbes.

The main signs of the pathological process in the vagina are abundant discharges with an unpleasant odor, which increase after menstruation or sexual intercourse; Itching in the perineum. Sometimes rapid and painful urination is possible. At the same time, in every fourth woman the change in the balance of microorganisms proceeds asymptomatically.


Since the consequences of the vaginal flora imbalance can be very serious, it is important to respond in a timely manner to the symptoms that appear and to be examined.

Therapy depends on the causes and severity of the pathological process and includes two stages. At the first stage it is necessary to suppress pathogenic pathogens after their identification by results of analyzes. The approach to the choice of therapy is individual. At the second stage it is necessary to restore the natural balance of lactobacilli in vaginal biocinosis.

Antimicrobial therapy for the normalization of vaginal biocinosis involves the use of drugs that suppress the infection. These drugs can be used both systemically in the form of tablets, and locally (gels, creams, suppositories). These drugs include flagyl, sulbactomax, metronidozole, clindamycin. More and more attention is attracted to antimicrobial agents based on extracts of medicinal plants containing essential oils.

To restore the microflora use probiotics, prebiotics and synbiotics. In addition, it is required to correct the lifestyle and nutrition: to normalize the sleep and rest regime, to include in the diet yoghurts, biochephors and sauerkraut. To increase lactobacilli in the vagina, it is necessary to normalize the stool (get rid of constipation or diarrhea). To ensure the normal processes of the vagina’s microflora, it is also important to adjust the menstrual cycle. For this, combined oral contraceptives are used.