Age-related changes, influencing factors and crosstalk between vaginal and gut microbiota: a cross-sectional comparative study of pre- and postmenopausal women

Objective: The ideal vaginal environment is maintained by Lactobacillus species, which keep the vagina clean and free of infections, including sexually transmitted diseases and human papilloma virus infection. Other reported health benefits of Lactobacillus include a favorable impact on fertility and immunity, leading to a reduced risk of gynecological malignancies. Age-related decline in estrogen affects the population of Lactobacillus, leading to dominance of pathogenic flora and increased diversity in vaginal microbiota. In this study, we compared the differences between the vaginal microbiota of premenopausal and postmenopausal women. In addition, we examined the relationships between vaginal and gut microbiota, as well as their relationships to sex hormones and equol producing ability. Methods: This was a cross-sectional study of 35 premenopausal and 35 postmenopausal women, ranging from 27 to 76 years of age. We compared parameters such as the composition of the gut and vaginal microbiota, vaginal pH, sex hormones in the blood (estradiol and follicular stimulating hormone), and urinary equol concentration. Results: In the vaginal microbiota of premenopausal women, Lactobacillus species constituted approximately 71.98%, and pathogenic flora constituted approximately 16.87%. They were 10.08% and 26.78%, respectively, in the vaginal microbiota of postmenopausal women. Therefore, the proportion of Lactobacillus was significantly low, whereas microbial diversity and vaginal pH were significantly high (p<0.0001) in postmenopausal women. The compositions of the vaginal microbiota were significantly different in pre- and postmenopausal women. However, such differences were not noticeable in the gut microbiota. Urinary equol production had no significant correlation with vaginal microbiota, although it had significant relationships with gut microbiota in postmenopausal women. There were significant correlations among bacterial species in the gut and vaginal microbiota, especially in postmenopausal women. In both groups, the proportions of vaginal Lactobacillus were inversely correlated with vaginal microbial diversity and vaginal pH. Conclusion: Postmenopausal women had significantly low lactobacillus and high pathogenic flora in their vaginal flora, whereas such age-related differences were not identified in gut microbiota. There were significant correlations among the bacterial species inhabiting the gut and vaginal microbiota, especially in postmenopausal women, indicating potential crosstalk between each other.

Comparing the Effects of Two Cream Formulations, Henna (Lawsonia inermis) and Clotrimazole, on Vaginal Candidiasis: A Randomized Controlled Trial

Background: Vaginal candidiasis is the most prevalent infection among reproductive-aged women. The current treatment for this disorder includes azole compounds. Objectives: The aim of this study was to compare the effects of two creams, henna (Lawsonia inermis) and clotrimazole, on vaginal candidiasis. Methods: In this trial, 80 women with vaginal candidiasis were recruited and randomly assigned into two groups to receive either henna (n = 40) or clotrimazole (n = 40) for one week. The ethanol extract of henna was prepared. Vaginal discharge was cultured, and vaginal pH, colony formation, lactobacillus formation, and vaginitis subjective symptoms were evaluated before and one, two, and four weeks after the intervention. The chi-square test, independent t-test, and Generalized Estimating Equations were were used for analyzing the data using SPSS version 22. Results: After four weeks of the intervention, almost 90% of the women in the henna group declared no burning sensation, itching, discharge, irritation, or dyspareunia, while only 45%, 5%, 37.5%, 52.5%, and 27.5% of the participants in the clotrimazole group did not have these symptoms, respectively (P < 0.001). The means (SD) of colony formation were 290.85 (47.35) and 265.12 (37.46) in the henna and clotrimazole groups, respectively, at the baseline, which reduced to zero and 25.45 (25.09) in the 4th week of the intervention (P = 0.001). Compared with the clotrimazole group, there was a significant increase in the mean of lactobacillus formation and a significant decrease in vaginal pH in the henna group (P < 0.001). Conclusions: Henna vaginal cream could significantly reduce the symptoms of vaginal candidiasis, such as burning sensation, itching, discharge, irritation, and dyspareunia. Also, it could decrease colony formation and vaginal pH and increase lactobacillus formation.

Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis

In modern society, 75% of all women worldwide have had vaginitis at least once in their lives. The vagina has a dynamic microbial ecosystem with varying vaginal pH levels. An imbalance in that ecosystem can alter the vaginal pH and tip the scale to the point of causing issues, such as vaginitis, that require medical attention. Although vaginitis is not an incurable disease, it causes discomfort and pain that disrupt women’s daily lives. The most common causes of vaginitis include bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. In this review, we discuss the causes, diagnostic methods, and symptoms of different types of vaginitis, the relationship of vaginitis to the prevalence of other diseases, issues associated with recurrent vaginitis and the immune system, and a variety of effective available treatments. In our article, we summarize the relationship of pH with the vaginal ecosystem, discuss the associated factors of vaginal pH, and finally introduce the different available vaginal pH self-test products.

24 The Effects of Vaginal pH on Fertility of Beef Cows and Heifers Enrolled in the 7-d Co-synch + Controlled Internal Drug Release (CIDR) Protocol

The objective of this study was to evaluate the effect of vaginal pH on fertility of beef cows and heifers enrolled in a fixed-time artificial insemination (TAI) protocol. Year 1, 40 multiparous cows; and year 2, 48 multiparous cows and 41 heifers with no signs of vaginitis were enrolled. Vaginal flushes were collected for all females on D0, D7 and D10 and immediately analyzed for pH with a pH meter. As evidence of vaginitis, CIDR score was determined at CIDR removal (D7) following a 1 to 4 scoring system: 1=no secretion; 2=clear secretion; 3=purulent secretion; 4=purulent secretion and blood. Pregnancy status was determined by transrectal ultrasonography approximately 40 days after TAI. No animals had CIDR scores 1, whereas 23.7% of animals had a score 2, 69.6% a score 3, and 6.6% a score of 4. There was no effect of CIDR score on pregnancy outcome (P = 0.697). However, vaginal pH on D7, differed according to CIDR score (P = 0.045), where score 2 had greater pH (7.32±0.04) than score 4 (7.09±0.08), and score 3 were intermediate (7.25±0.02). No effect (P = 0.307) of CIDR score on vaginal pH on D10 was observed. There were no differences (P &gt; 0.01) between vaginal pH of pregnant and open animals on D0 (7.06±0.05); D7 (7.26±0.03); and D10 (7.21±0.04). Nonetheless, on D10 females with vaginal pH 7.1 &lt; pH ≤ 7.34 had greater (P = 0.005) PR (n=56; 66.1%) than cows with pH &gt; 7.35 (n=33; 45.5%), and pH &lt; 7.09 (n = 39; 33.3%). We conclude that vaginitis caused by the CIDR changes vaginal pH on D7, which is not carried on to D10. In addition, there is indication of an optimal vaginal pH range at the day of TAI for maximum PR to the protocol.

PSVIII-28 Dietary impacts on rumen, vaginal, and uterine environments in beef heifers

This experiment examined the effects of diet composition on rumen, vaginal, and uterine environments in beef heifers. Fifteen rumen-cannulated, pubertal Angus-influenced heifers were used in a replicated 3 x 3 Latin square design (28-d periods and 21-d washout intervals). Dietary treatments included (as-fed) diets based on 100% grass hay (HF), 61% grass hay + 39% corn-based concentrate (INT), or 25% grass hay + 75% corn-based concentrate (HG). Treatments were offered individually to heifers once daily at 2% of their body weight. Heifers also received 280 g/d of a mineral mix containing melengestrol acetate. Rumen, vaginal, and uterine fluid samples were collected on d 0 and 28 of each period for pH measurement. Data were analyzed using the MIXED procedure of SAS (SAS Inst. Inc., Cary, NC) using results from d 0 as independent covariates, and heifer as the experimental unit. Rumen pH on d 0 did not differ (P = 0.97) among treatments (7.197, 7.194, and 7.188 for HF, INT, and HG, respectively; SEM = 0.038). Ruminal pH on d 28 was greater (P ≤ 0.01) in HF compared with INT and HG (6.805, 6.628, and 6.380, respectively; SEM = 0.049), and greater (P &lt; 0.01) in INT compared with HG. Vaginal and uterine pH on d 0 did not differ (P ≥ 0.24) among HF, INT, and HG (6.914, 6.965, 6.780 of vaginal pH, respectively, SEM = 0.082; 6.644, 6.760, 6,592 of uterine pH, respectively, SEM = 0.079). Uterine and vaginal pH on d 28 also did not differ (P ≥ 0.64) among HF, INT, and HG heifers (6.926, 6.937, 6.918 of vaginal pH, respectively, SEM = 0.051; 6.567, 6.507, and 6.457 of uterine pH, respectively, SEM = 0.084). Therefore, dietary composition impacted rumen pH of beef heifers as expected, but without consequences to their vaginal and uterine pH.

Vaginal pH Measurement as a Strategy for the Early Diagnosis of Vulvovaginal Atrophy in the Development of Menopause

Objective: Most studies use clinical examination and evaluation of symptoms as subjective forms for the diagnosis of vaginal atrophy. Vaginal hormonal cytology and vaginal pH are objective forms commonly used, however, mainly for treatment control purposes. Despite the relevance of the early diagnosis of vaginal atrophy, we are not aware of studies that objectively or subjectively evaluate the evolution of the parameters with this intention. The aim of the study was to assess if the instruments most used in scientific studies for indication and follow-up of AVV therapy could be used for the early diagnosis of AVV. Methods: The sample consisted of 40 women, 21 in the menopausal/ premenopausal transition (Group 1) and 19 in the postmenopausal (Group 2), between 40 and 65 years old. Results: It was observed that the set of parameters evaluated, such as: symptoms, clinical examination, vaginal pH, cell maturation value and questionnaire, mainly when used in an associated way, suggest being efficient for the diagnosis of AVV. In general, the observed changes in pH measurement show a good association with cell cytology, which was very characteristic in the two experimental groups (pre and postmenopausal). In addition, pH also showed good association with clinical examination parameters and the main symptoms and signs of menopause. Conclusion: Finally, the results herein shown seems to be promising in relation to the use of vaginal pH measurement as a “tool” for the early diagnosis of AVV.