What is cytolytic vaginosis?
Cytolytic vaginosis is one of the causes of vaginal discharge. Its existence as a specific diagnosis is debated.
What is the cause of cytolytic vaginosis?
The normal vagina of an adult woman is colonised by lactobacilli. These bacteria produce lactic acid, which maintains an acid pH, and hydrogen peroxide, which is an antiseptic agent. The lactobacilli protect the vagina from pathogenic infections and are considered important for vaginal health.
Cytolytic vaginosis has been diagnosed when there is an overgrowth of the lactobacilli. It has been suggested that they can irritate the cells that make up the vaginal lining, causing them to break up. The damaged or fragmented cells are then shed with the normal vaginal secretions.
What are the symptoms of cytolytic vaginosis?
Many women with cytolytic vaginosis are unaware of it. It may be reported after a vaginal swab or cervical smear. It has been associated with the following symptoms:
- Abundant whitish vaginal discharge, which may be thin and watery or thick and curd-like
- Vaginal and/or vulval itching (pruritus vulvae)
- Burning (vulvodynia), especially on passing urine (dysuria)
- Discomfort during sexual intercourse (dyspareunia)
- Acidic vaginal pH (3.3 to 5.5).
Symptoms are similar to those of vaginal thrush. Like thrush, they have been reported to get worse in the second half of the menstrual cycle. However, in cytolytic vaginosis, high vaginal swabs do not culture the yeast that causes thrush, Candida albicans, and topical antifungal and oral antifungal agents are not effective.
How is the diagnosis of cytolytic vaginosis made?
Cytolytic vaginosis is diagnosed in women with vaginal symptoms that have not settled down or have recurred after treatment for thrush.
The laboratory reports numerous lactobacilli and epithelial cells on vaginal wet mount. There are few inflammatory cells, no yeasts and no other infective organisms.
What is the treatment for cytolytic vaginosis?
If cytolytic vaginosis is diagnosed, no specific treatment is required if there are no symptoms. Antifungal medications should be discontinued.
Some women find it helpful to use pads instead of tampons for menstruation.
Symptoms can be reduced by using baking soda (sodium bicarbonate) to increase vaginal pH. This discourages the growth of lactobacilli. Options for treatment include:
- 30–40 g of baking soda in 1 litre of water as a douche daily for 2 weeks then as required.
- 2–4 tablespoons of baking soda in 5 cm depth of water in a warm bath, several times in the first week, then once or twice per week.