The human body is made up of numerous microorganisms that make up the whole ecosystem. Bacteria inhabit not only the surface of the skin, but also the mucous membrane of the internal organs. Their number is several times greater than the number of cells of the human body itself. Normal microflora implies numerous microbiocenosis, it is like a kind of community. What is its role in the functioning of the female body? About this in the article below.
History reference
Back in the 19th century, medical scientists wondered what microbiocenosis is. This was interesting not only to Soviet, but also to foreign scientists who, using a microscope, were able to do the first research and analysis of the condition of the vaginal mucosa. This question was raised against the background of the study of deviations from the normal functions of the female body in the postpartum period, in particular against the background of frequently occurring endometritis.
At that time (1892) Albert Doderlein first published in his dissertation drawings of bacteria, which today many know as Lactobacillus. This allowed us to conclude that in the body of a healthy woman, these sticks have a numerical advantage over the rest.
A few years later (in 1910), the Finnish scientist in his work published the results of his work, where he described for the first time four degrees of purity of the vaginal mucosa. In his opinion, microbiocenosis is not only morphological signs, but also a leukocyte reaction, the numerical value of epithelial cells. Therefore, so much attention was paid to the extent to which it relates:
- The prevalence of lactobacilli, single epithelial cells, the complete absence of leukocytes.
- The presence of single white blood cells, a decrease in the number of Lactobacillus rods.
- Lactobacilli in a single amount, the presence of another flora, the presence of trichomonads, gram-negative diplococci, epithelial cells in a single amount is possible.
- The complete absence of lactobacilli, the presence of trichomonads, the presence of other microorganisms, an increased number of epithelial cells, pronounced leukocytosis.
Later, this classification was supplemented and slightly modified by other scientists, but all of them were united by the fact that they paid attention to the presence of lactobacilli and the pH level. To date, all research and the latest findings of scientists are enshrined in the recommendations of the World Health Organization, which dictates the rules for the study and analysis of vaginal microbiocenosis.
What it is?
Depending on the living conditions, microbiocenosis is a “family” of microorganisms that is associated with microecology and the food chain. If a microflora malfunctions in the female body, for example, an increase in the number of pathogenic bacteria, a decrease in oxygen-producing lactoflora, then bacterial vaginosis occurs. The highest content in the microbiocenosis of the vagina is reached by microaerophilic bacilli of Lactobacillus spp. These are microorganisms that produce hydrogen peroxide. Much less often it is produced by anaerobic gram-positive sticks.
In addition to lactobacilli, Gardnerella vaginalis, anaerobes Peptostreptococcus spp, and gram-positive bacilli - Bifidobacterium spp., Propionibacterium spp. Live in the vaginal microflora. - P. acnes, Clostridium spp. It is also worth noting that normally gram-negative bacilli strictly anaerobic Bacteroides spp may be present. bacteroids: B. vulgatus, B. urealyticum, B. fragilis, B. ovatus, B. uniformis, B. distasonis, B. multiacidus Porphyromonas spp., Fusobacterium spp. The presence of genital mycoplasmas in the microflora is considered a normal component of the vaginal microbiocenosis: U. urealyticum, M. hominis are present in about 15% of women who have an active sex life. And this is not the whole list of what is a normal component of the genital tract of most women.
Based on this, it can be concluded that the microflora of the female body is populated by a large number of different microorganisms, which are in a healthy state in equilibrium with respect to each other, do not lead to pathological changes in the vagina and membranes of the vulva.
Types of microbiocenosis
In order to determine where the norm, and where the deviation, it is necessary to know about the division into types of normal microflora:
- Transient. It is unusual for this environment, temporarily formed in it. It is not numerous, it multiplies slowly. As a rule, in contact with the mucous membrane or surface of the skin does not lead to the development of diseases. These can be saprophytic opportunistic microorganisms that exist for several hours, days, or even weeks. The composition and transient microflora is affected by the level and rhythm of a woman’s life, working and resting conditions, nutrition, environment, stressful situations and injuries.
- Resident. It is considered constant and therefore unstable in terms of the number of its characteristic species. Their number in contrast to the transient is large and plentiful. Depending on the age of a person, it can be detected in different parts of the body.
In any organism, the beginning of the formation of microflora occurs at the moment of birth and continues in the process of life. However, there are areas of the body that remain sterile from the presence of extraneous microorganisms: cerebrospinal fluid, blood, pleural and articular fluid. Protect them and internal organs, and immune cells.
Bacteria in the vagina
Along with normal microflora, bacteria can also inhabit the vaginal mucosa, which, interacting with the epithelium, perform important functions for the body: immunomodulating, vitamin-forming, enzymatic and others. But in some cases, they become the reason for the development of the urogenital inflammatory process. Thanks to modern technologies, during the analysis of the vaginal microbiocenosis, it is possible to determine the species composition of microflora. Almost 90% of women are carriers of epidermal staphylococcus. He is actively involved in colonial resistance.
Even if there is no infection, this does not mean that there is no pathogen for the development of infection. This is what usually happens when a hemolytic staphylococcus is detected in a smear test for microbiocenosis.
If a woman consulted a doctor, then not always in the usual smear result she can get information about the presence or absence of viruses. This is due to the fact that many of them are in the "sleep" stage and do not manifest themselves in any way. This is called an “intermediate state,” in which one should be wary. This is not about pathology, therefore, most likely, many patients will completely abandon the proposed preventive treatment. And this will turn out to be a mistake, which can develop into a real inflammatory process.
If there are complaints, we can talk about the development of dysbiosis, which is manifested by the absence or insignificant amount of microorganisms useful for the reproductive system. At the same time, there is an increased amount of conditionally pathogenic microflora, a large number of leukocytes.
Vaginitis is accompanied by a clear development of the inflammatory process. If its pathogen is sexually transmitted, then inflammation is considered specific. In the presence of opportunistic flora, the disease is a non-specific inflammation. To get an accurate idea and give a correct assessment, an analysis of the smear is taken, followed by sowing the bacteria in a nutrient medium. The effectiveness of treatment is enhanced by subsequent analysis to determine sensitivity to antibiotics. This will allow you to prescribe an adequate treatment and not spend a lot of money and time on finding the right one.
The nature of external changes
In violation of microbiocenosis, bacterial vaginosis occurs, which is characterized by the appearance of foamy, possibly viscous secretions of gray, whitish color. The disease can also be identified by a characteristic unpleasant odor that resembles rotten fish. This is because anaerobes, being in high concentration inside the vagina, emit volatile amines. They lead to an unpleasant odor. If a woman has it after intercourse, it is explained by the fact that the seminal fluid has an alkaline environment and, getting on the vaginal mucosa, leads to a specific aroma.
It is possible that at the same time a woman is tormented by itching and burning in the genital area. However, almost fifty percent of the girls who encountered this type of illness reported no unpleasant symptoms. If the disease is of a prolonged nature, then the discharge can change the color to greenish, and the character is replaced by curd. During a gynecological examination, the doctor can diagnose a uniform distribution of secretions along the entire length of the walls of the vagina.
Especially dangerous may be the course of bacterial vaginosis during a woman's pregnancy, in the period before and after childbirth. If surgery was performed, then the development of endometritis is likely. If we are talking about a pregnant patient, then the presence of pathogenic microorganisms in the microflora of her vagina can lead to fetal malnutrition, after birth - to pneumonia.
Age effect
Doctors and scientists consider it necessary to distinguish the results of the analysis of microbiocenosis in women depending on their age. So, in childhood and adolescence in a girl, he is relatively unstable, the hymen performs a barrier (protective) function. With the transition to the adolescent stage, an increase in the production of sex hormones responsible for the production of lactic acid bacteria is noted. They somewhat stabilize the microflora in the vagina. Abundant discharge of the mucous membrane leads to a decrease in opportunistic flora. In general, after sixteen years, the girl has a stable microbiocenosis, which will remain so throughout the reproductive age.
In adulthood, a woman can have about 40 different types of different bacteria. Almost 95% of their total number are lactic acid, and the remaining 5% are opportunistic. A decrease in hormonal levels during menopause has a significant effect on the state of microflora. The number of lactobacilli becomes significantly lower. This leads to increased growth and provokes the multiplication of bacteria such as E. coli, candida, staphylococcus and others. Therefore, most women note the occurrence of unpleasant symptoms, such as dysbiosis in the vagina, inflammatory processes, and thrush.
During pregnancy, the female body becomes a favorable environment for the development of lactobacilli. This is due to an increase in the amount of glycogen produced. By the third trimester, the quantitative value of yeast microorganisms increases and aerobic gram-positive cocci and gram-negative bacilli, bacteroids, non-spore-forming strict anaerobes decrease. The microflora of a pregnant woman becomes more uniform. The reason for this is physiological, biochemical and morphological changes in the genital tract.
If during pregnancy a woman is diagnosed with bacterial vaginosis, it is extremely important to apply adequate treatment methods in a timely manner. As a rule, it is aimed at restoring and normalizing the vaginal microflora, maintaining the level of lactobacilli. Normally, vaginal discharge does not exceed 1-2 ml / day, they should have a transparent shade, pH in the range of 4-4.5. A viscous cervical plug serves as a mechanical barrier to viruses and bacteria. For a healthy body, this means that it can independently cope with the infection that gets inside, confronting it. The normal functioning of the reproductive system and the entire female body during pregnancy is the key to successful delivery on time.
Negative factors
What affects the deterioration of microflora? After the results of microbiocenosis are obtained, the doctor decides. He can establish the cause of a non-specific inflammatory process. It can be:
- Violation of the rules of intimate hygiene, frequent douching.
- Regular use of local methods to prevent unwanted pregnancy.
- Hormonal failure, prolonged use of oral hormonal contraceptives.
- Immunodeficiency (primary or secondary).
- Chronic diseases of the intestines or genitourinary system.
It is not necessary to exclude cases when therapy based on the use of antibiotics was incorrectly conducted. In particular, the lack of an integrated approach, which includes the need to take medications that restore microflora.
Diagnostic Methods
Back in the last century, scientists managed to bring the methods of diagnosing the state of microflora in the vagina to a new level. For the diagnosis, it is enough to determine 3 of 4 indicators, which include the detection of acidity of the medium (pH), the presence of key cells that undergo special staining using the Gram method, the presence of rotten fish odor, copious discharge. Today, the determination of microbiocenosis is possible even at home with the help of special test strips that show the state of pH.
In terms of medical research, the most informative is a smear on a Gram-stained microbiocenosis. The data obtained may indicate a leukocyte reaction, morphological features of microflora, the ratio of its individual components. Quantitative typing and determination of microorganisms can be detected using polymerase chain reaction (PCR).
In deciphering the microbiocenosis analysis in women, it is necessary to pay attention to the excess of indicators over 10 to the 5th degree of lactobacilli. This indicates the development of the inflammatory process characteristic of vaginosis.
Thanks to the determination of microbiocenosis by chromatography-mass spectrometry, which was made possible as a result of numerous studies by George Osipov (professor), information on the quantitative and species analysis of microbes can be obtained. According to the scientist’s conclusion, each microorganism has its own marker, the presence of which indicates the presence or absence of microbes, as well as their number. The advantage of using the method of chromatography-mass spectrometry of microbiocenosis is as follows:
- During one study, it is possible to obtain information on the presence of about 58 types of microorganisms, which can lead to the development of the inflammatory process.
- This is a highly sensitive and reliable way to obtain information regarding the state of microflora.
- The technique can be used to assess the condition of any organ.
- It is possible to identify an infection that is in a so-called “sleeping” state. This is due to the formation of a film of polysaccharide, which envelops the colonies, clogging them in a kind of capsule.
Treatment methods
The correct decoding of microbiocenosis (analysis) in women allows you to choose a treatment regimen that will quickly bring his condition back to normal. The main goal is to restore normal microflora in the vagina, as well as inhibiting the growth of pathogenic microorganisms that are not characteristic of this biotope. To quickly stop the symptoms of the disease, it is necessary to choose a treatment regimen that allows you to ensure a high content of the drug in the vagina. At the second stage, it will be necessary to restore the level of normal lactoflora. It is possible to normalize microbiocenosis with the help of probiotics and eubiotics.
For most patients, treatment consists of taking Metronidazole, Tinidazole, Clindamycin. The forms of application are different, but oral (tablet) is most popular and affordable in terms of price. The duration and frequency of admission is determined by the attending physician. It is extremely important to adhere to the treatment regimen in order to exclude relapse of the disease.
Intestinal microflora
Too many doctors note an inextricable link between the state of the intestinal microflora and the work of the pelvic organs. It plays an important role in the functioning of the immune system, affects metabolic processes. Therefore, one should not lose sight of those factors that can adversely affect the intestinal microbiocenosis. It is known that this organ is inhabited by a huge number of bacteria and microorganisms. The most active of these are bacteroids and bifidobacteria.
Violation of the digestive processes leads to damage to the walls of the intestine, a change in the internal environment of the intestine and, as a result, dysbiosis. To diagnose this deviation, various methods are used:
- Biochemical express methods.
- Bacteriological analysis.
- Endoscopic examination, which consists in the study of microflora of the small intestine.
- Gas-liquid chromatography.
In order to restore disrupted microflora, it is recommended to use probiotics as a treatment. These are living microorganisms that, when ingested, have a beneficial effect on the environment, improve metabolic functions, immune and biochemical reactions.