Gynaecology

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Healthy Equilibrium – Healthy Vagina

The vagina is a sensitive area of a woman’s body and forms an “ecosystem” that is in equilibrium in a healthy state. Important elements of a healthy vaginal “ecosystem” are a well proliferated and matured mucous membrane (epithelium) and the natural vaginal flora consisting of lactic acid bacteria. Together they protect the vagina against infections.

A well proliferated, mature and intact vaginal epithelium provides the necessary moisture and elasticity. Furthermore, it is indispensible for the colonisation of protective lactic acid bacteria and thus for the establishment of a healthy vaginal flora. The proliferation and function of the  vaginal epithelium is regulated by the body’s own hormones, particularly the estrogens.

Besides an intact vaginal epithelium, lactic acid bacteria (or lactobacilli) are essential for a healthy “ecosystem”. The lactobacilli adhere to the surface of the proliferated and mature vaginal epithelium and thereby form the healthy, protective vaginal flora, which prevents vaginal infections. This protection is based on various properties of the lactobacilli. On the one hand, they produce lactic acid, which leads to a healthy, acidic vaginal milieu with a pH-value of 4.0 – 4.5. On the other hand, the growth of disease-causing germs is inhibited or they are even killed by substances produced by the lactobacilli. The adherence and the colonisation of the vaginal epithelium by the lactobacilli also prevent adherence and colonisation of the disease-causing germs.

Thus, the equilibrium and the interaction between the intact vaginal epithelium and the lactobacilli play an important role in the natural defence against disease-causing germs and the maintenance of a healthy vaginal ecosystem.

Vaginal Infections

Generally, one differentiates between two types of vaginal infections: on the one hand, the sexually transmitted infections, e.g. HIV, syphilis, etc., and, on the other hand, the infections, that can also occur without sexual contact.
The latter vaginal infections are usually due to a disturbance in the natural defence mechanisms of the vagina. The healthy, natural vaginal flora can be disturbed by various factors:

Treatment with antibiotics
High-dosed hormonal contraceptives
Various chronic diseases (e.g. diabetes)
Immunological disorders
Hormonal changes (e.g. during pregnancy or menopause)
Other internal or external influencing factors (e.g. excessive personal hygiene or sexual behaviour as well).
Infections can occur more easily as a consequence of a disturbed vaginal ecosystem.

Disturbances of the natural vaginal flora can result in the colonization of the vagina by various germs leading to an infection. Some of these pathogens, for example, the candida yeasts, are normally harmless “cohabitants” on the skin and mucous membranes. In a disturbed vaginal ecosystem they proliferate and cause unpleasant symptoms then. Besides these candida yeasts, there are also different bacteria that can lead to a vaginal infection.

Normally a well proliferated and matured epithelium and the lactic acid bacteria in the vagina provide a healthy equilibrium. A specific whitish/clear discharge is completely normal. But if the amount increases, the colour changes or an unpleasant fishy odour develops, the vaginal ecosystem is disturbed.

The following symptoms can indicate an infection and call for an examination by a gynaecologist: a copious, grey-coloured discharge, an unpleasant fishy odour, redness, itching or pain in the vaginal area or pain during intercourse or urination.

Untreated infections not only have a negative impact on well-being, they can also lead to long-term problems. For example, vaginal infections increase the risk of premature birth during pregnancy, or can lead to increased urinary tract infections.

Vaginal infections should be examined and treated by a gynaecologist. Resolving a disturbance of the vaginal ecosystem at an early stage lowers the risk of infection. There are numerous options available for treatment:

Disturbances of the vaginal ecosystem or mild infections can be treated with lactobacilli products applied vaginally. A combination of lactobacilli with a small amount of estriol (hormone) is effective since this supports the proliferation and maturation of the vaginal epithelium as well as the establishment of healthy vaginal flora.
Bacterial infections can be treated with various antibacterial substances either applied vaginally or taken orally.
Yeast infections are usually treated locally with specific anti-mycotic substances (e.g. as vaginal suppositories or cream). In recurrent cases, treatment with tablets for oral intake is an option.
Viral infections can be treated only conditionally with medications. Anti-viral agents inhibiting viral proliferation are helpful during an infection with genital herpes
On the one hand, the normal vaginal flora is damaged by the infection and, on the other hand, most therapies against infection also have a more or less negative effect on the lactobacilli. After treatment with antibacterial or anti-mycotic preparations the normal, protective vaginal flora must be restored. This usually occurs within the first two weeks after treatment. During this period, however, the chance of recurrence or a secondary infection is the greatest. Following treatment of a vaginal infection, vaginal lactobacilli therapy with the addition of a hormone is recommended to minimise this risk and support the redevelopment of the normal flora with lactobacilli.

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