Let’s begin with what a healthy vagina looks like. It is warm, pink and moist. The environment is slightly acidic due to the lactic acid produced by the many healthy bacteria residing there.
The medical term for the diverse mix of bacteria populating the vagina and regulating its acidity is called: “vaginal flora.”
The level of acidity or lack of can actually be measured by checking the pH level. A pH of 3.5 to 4.5 means there is a perfect amount of good bacteria and no over growth of bad bacteria that can cause vaginal odor, irritation or sometimes an infection. The pH balance fluctuates during the menstrual cycle and is least acidic on days just prior and during menstruation.
A healthy vagina produces secretions to cleanse and regulate itself. These secretions are normal vaginal discharge. All women have some vaginal discharge but the amount and appearance can change throughout the menstrual cycle. Normal discharge may appear clear, cloudy white and/or yellowish when dry on clothing. At times it may be thin and stringy. Many women state there is a noticeable “scent” or odor to their discharge particularly when sexually aroused. There are many things that can affect the amount and consistency of normal vaginal discharge with no need to be alarmed. They are: menstrual cycles, emotional stress, nutritional status, pregnancy, medications (including birth control pills) and sexual arousal.

There are many factors that can cause the pH to rise higher than 4.5 and temporarily throw off the delicate balance of the normal flora inside the vagina.
They are:

  • Menstruation
  • Tampons
  • Intercourse
  • Douching and cleansing agents
  • Menopause or pregnancy
  • Hormone fluctuations

Usually the vagina recovers very quickly after the above situations, but there are clues to alert you if the delicate balance has been disturbed and there may be an infection brewing.

Any normal discharge will not cause: • vaginal irritation • burning during urination • itching or • a foul odor.
In addition, it is not normal if the color of the discharge is: • gray • green or • dark brown
Two most common vaginal infections are yeast and BV (bacterial vaginosis).
The reason for these infections is microorganisms’ imbalances in the vaginal flora.
Yeast infection: the yeast grows quickly out of control, the amount of “unhealthy”/ “bad” bacteria increases until there are more “bad” bacteria than “good.”
* Common Misperceptions about Vaginal Health – What’s Normal, What’s Not and What to Do About It By Rebecca Hulem, Gyn Nurse Practitioner, Certified Menopause Clinician

Symptoms:

  • a white cottage cheese like discharge, vaginal itching, burning and sometimes swelling of the vaginal tissues.

BV imbalance can cause:

  • a grayish discharge, a foul “fishy” odor and occasionally burning in the vagina.

Nearly half of the BV doesn’t have any symptoms.
It is best to see your Gynecologist for an evaluation and/or treatment.

Vagina is an internal organ, but it is not sterile as it is connected with the exterior.
One of the way of protection is the presence of a large number of “good” bacteria, i.e. non-pathogenic saprophytic bacteria in the vagina, which avoid the presence of unwanted microorganisms.
Another common term to refer to these bacteria, is acidophilus bacilli, because they operate and proliferate better and develop more intensely in acid medium. These bacilli generate an acid medium of 3.5 to 4.5, which creates a virtuous circle that facilitates only their growth and hampers the growth of other germs.
The second most bacteria-populated place in the human being is “lactic acid bacteria” or “Lactobacillus acidophilus”, often abbreviated as L. acidophilus – generally been considered as guardians of the vaginal ecosystem.
All the microorganisms living in the vagina are known with the generic name of “vaginal microbiota” or simply “microbiota”.
**Importance of Lactic Acid in Maintaining Vaginal Health: A Review of Vaginitis and Vaginosis Etiopathogenic Bases and a Proposal for a New Treatment

There are more than 20 vaginal lactobacillus species been identified, out of which only 6 are really important to the vaginal ecosystem:

  • L. crispatus,
  • L. gasseri,
  • L. iners,
  • L. jensenii,
  • L. vaginalis,
  • L. buchneri

In order to maintain a healthy vagina what is really important is not the presence of acidophilus bacilli, but rather the existence of lactic acid and an acidic pH.

  • A low and acidic pH is generally considered as the primary mechanism for maintaining the composition of a healthy vaginal microflora.
  • Indeed, most lactobacilli thrive best at a pH < 4.5, which clearly justifies its designations as “acidophilus” or lovers of acidity.
  • The characteristic pH of women of reproductive age, i.e. between 3.5 and 4.5, is achieved thanks to the presence of a sufficient amount of lactic acid in the vagina.
  • Therefore Lactic Acid molecule is the key to maintaining a medium which favors the growth of lactobacilli in a vaginal environment.
  • Lactic acid is synthesized in the vagina by Lactobacillus acidophilus, obtained from pyruvic acid, through a glucose fermentation mechanism.

Lactic acid maintains an acidic pH around 3.5 – 4.5 and it is not favorable for the growth of fungi, protozoa, Haemophilus and other unwanted bacteria, which generally need a pH greater than 6.0. Whereas, lactobacilli are acidophilic feel comfortable in an acidic environment, which enables their maximal proliferation.
Lactic acid is produced and the acidity is reached thanks to the following:

  • Ovaries produce estradiol.
  • The multilayered epithelium of the vaginal mucosa proliferates thanks to estradiol, which also induces the glycogen loading of these cells.
  • Vaginal epithelial cells gradually flake out in the vaginal lumen.
  • Desquamated cells undergo a lytic process which allows the release of the glycogen contained in them.
  • Glycogen is metabolized through acidophilus bacilli via anaerobic fermentation, i.e., without oxygen. The main “waste” product resulting from glucose anaerobic fermentation is lactic acid, which is, as mentioned, the cornerstone to acidify the vaginal environment

Achieving an acidic pH during a vaginal infection like vaginitis or vaginosis would enable women’s own bacteria and more specifically those still present in the vagina to proliferate, though in smaller amounts.
The ideal treatment of vaginitis or vaginosis consists of the administration of an antifungal or an antibiotic, as appropriate, to significantly reduce the amount of pathogens, and then quickly acidify the vagina with lactic acid.
Thanks to acidity, the growth of germs causing the symptoms will decrease, and the quick growth of Lactobacillus acidophilus specific to each woman will be possible. As already mentioned, more lactic acid will be produced and any symptomatic recurrence will be prevented.
It would be safer and more advisable to acidify the vagina as soon as possible after one or several menstrual periods through the administration of lactic acid at the end of the period.

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