Influence of the Normal Menstrual Cycle on Vaginal Tissue, Discharge, and Microflora

Eschenbach, David A.; Thwin, Soe Soe; Patton, Dorothy L.; Hooton, Thomas M.; Stapleton, Ann E.; Agnew, Kathy; Winter, Carol; Meier, Amalia; Stamm, Walter E.

doi:10.1086/313818

Cited by 240 publications

(201 citation statements)

References 24 publications

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“…Menstrual flow makes women wear more sanitary pads, which may favor the onset of infections. Nevertheless, many other factors change in this situation (hygiene frequency, hormones, less sexual relations) and can also cause changes in the vaginal flora reported in literature (4,17,18) . Sanitary pads are used during period, panty liners are used between them, and these are products widely available and accessible nowadays, including to the poorest sectors of society (3) .…”

Section: Discussionmentioning

confidence: 99%

“…However excessive occlusion and humidity in the area of vulva caused by synthetic underwear, tight pants, menstruation and the use of sanitary pads may have a negative influence on the skin barrier and cause changes in temperature and pH of the region, making the vulva susceptible to vulvovaginal diseases (2)(3)(4) . The most common types of vulvovaginitis in the reproductive age of women are bacterial vaginitis (BV) and vulvovaginal candidiasis (VC), and they usually manifest as vaginal discharge accompanied by bad odour and itching, respectively (5) .…”

Section: Introductionmentioning

confidence: 99%

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Association of sanitary pads and clothing with vulvovaginitis

Bardin¹,

Giraldo²,

Benetti‐Pinto³

et al. 2013

J Bras Doenças Sex Transm

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Introduction: Vulvar occlusion and moisture buildup resulting from the use of sanitary pads, synthetic underwear and/or tight pants are considered risk factors for the development of vulvovaginitis (VV). However, this association is still poorly elucidated. Objective: To associate the use of sanitary pads and clothing with the presence of bacterial vaginitis (BV) and vaginal candidiasis (VC). Methods: Cross-sectional study aimed at analyzing the use of sanitary pads and clothing in 307 volunteers from 18 to 45 years old, with and without BV and/or VC. A questionnaire comprehending six domains was applied individually to the volunteers, in an outpatient gynecology clinic at a university hospital (University of Campinas, Brazil). This study analyzed three of six domains. Vaginal material was collected for microbiologic diagnosis of BV (Nugent criteria) and VC (Gram stain and culture of the fungus in Saboureaud). Exclusion criteria were: use of antibiotics within 15 days, history of cancer, positive HIV and/or syphilis and immunosuppressive disease. Statistical analysis were made with Fischer and chi-square tests, using the software EPI INFO 0.5. Significance level was set at p<0.05. Results: In total, 141 (46%) women were diagnosed with VV. The mean age was 32 (±6.8) years and most women were Caucasian (52%), had a steady partner (83%) and were using hormonal contraceptives (64.5%). Women with presence of VV used more panties made of synthetic fabric (10.6% x zero), had more menstrual cycles (72.3 x 55.4%) than those without VV (p<0.005 and p<0.0001) and showed patterns of sanitary pads similar to those without VV. Conclusion: Habits of usage of sanitary pads is not associated with the presence of VV. Presence of menstrual cycle and use of synthetic underwear have been related with greater frequency of VV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of sanitary pads and clothing with vulvovaginitis

Bardin¹,

Giraldo²,

Benetti‐Pinto³

et al. 2013

J Bras Doenças Sex Transm

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“…Yet the levels of Lactobacillus remain constant throughout the cycle, the non-Lactobacillus bacteria increase during the proliferative phase and the concentrations of Candida albicans become higher in the pre-menstrual period. 13 Antibiotics may alter the vaginal ecology, therefore the treatment of asymptomatic women, although with a fresh examination showing the absence of Lactobacillus, is very questionable. To induce a perturbation in the endogenous microflora based solely on the microscopic findings may trigger the selective proliferation of microorganisms that were being inhibited and may be damaging to the vagina's health.…”

Section: Fluctuations In Vaginal Floramentioning

confidence: 99%

Novos conhecimentos sobre a flora bacteriana vaginal

Linhares

Giraldo²,

Baracat³

2010

Rev. Assoc. Med. Bras.

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The aim of this review is to update knowledge about the vaginal ecosystem, emphasizing non-cultivation methods for bacterial identification (gene amplification), the several Lactobacillus species that comprise normal vaginal flora and influence of host genetics on bacterial interactions with local innate and acquired immune defenses. A Medline (Pubmed) search from 1997-2009 for relevant articles was performed and the most informative articles were selected. The use of non-cultivable techniques (genes amplification techniques) have enabled a better knowledge about the composition of the vaginal ecosystem. In most women in the reproductive age there is a predominance of one or more species of Lactobacillus: L. crispatus, L. inners and L gasseri. However, in other apparently healthy women there is a deficiency or complete absence of Lactobacilli, which are substituted by other lactic acid-producing bacteria: Atobium, Megasphaera and/or Leptotrichia species. The infectivity and/or proliferation of pathogenic bacteria in the vagina is suppressed by lactic acid production, by products of endogenous bacteria and by activation of local innate and acquired immunity. Vaginal epithelial cells produce several compounds with antimicrobial activity. These cells have Toll-like receptors on their membrane that recognize molecular patterns associated with pathogens. Recognition leads to production of pro-inflammatory cytokines and stimulation of antigen-specific immunity. The production of IgG and IgA antibodies is also triggered in the endocervix and vagina in response to infection. Vaginal flora composition and the immune mechanisms constitute important defense mechanisms. Criteria of normal and abnormal flora have to be reviewed and genetic polymorphism can explain variations in flora composition. This new knowledge should be included in the clinical practice of gynecologists and obstetricians to improve patients care.

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“…Some studies suggest that colonization rises in the luteal phase of the menstrual cycle (Engberts et al, 2007;Eschenbach et al, 2000;Odds et al, 1988); consequently, it is often thought to be associated with hormonal changes in the menstrual cycle. Several studies have documented point prevalence of vaginal colonization of Candida spp.…”

Section: Introductionmentioning

confidence: 99%

Premenstrual vaginal colonization of Candida and symptoms of vaginitis

Watson

Grando

Garland

et al. 2012

Journal of Medical Microbiology

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Although premenstrual exacerbation of vulvovaginal symptoms attributed to Candida spp. is well documented, the causation of these symptoms is not well understood. This study describes the daily vaginal colonization of Candida in three women. A single pilot study was designed to test the methodology of the proposed randomized controlled trial, Garlic and Candida. This study reports the colonization of Candida spp. in three women. Ten women aged 18-50 who reported at least one episode of vulvovaginal candidiasis were recruited by the University of Melbourne. Each participant took daily vaginal swabs for 2 weeks during the luteal phase of their menstrual cycle, which were analysed for quantitative colony counts of Candida spp. Of these, three women were colonized with Candida spp. For the first time, to our knowledge, daily colonization of Candida during the luteal phase of the menstrual cycle is described in three women, demonstrating an increase in the colony count preceding symptom development. This small study demonstrated the colonization of Candida spp. during the luteal phase of the menstrual cycle in three women. Candida colonization is poorly understood, yet investigating the relevance of the link between symptom exacerbation and the menstrual cycle in those women who experience recurrent episodes of vulvovaginal candidiasis may influence the management of this condition.

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Influence of the Normal Menstrual Cycle on Vaginal Tissue, Discharge, and Microflora

Cited by 240 publications

References 24 publications

Association of sanitary pads and clothing with vulvovaginitis

Association of sanitary pads and clothing with vulvovaginitis

Novos conhecimentos sobre a flora bacteriana vaginal

Premenstrual vaginal colonization of Candida and symptoms of vaginitis

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