July 23, 2020

Cytolytic Vaginosis (CV): Lactobacillus Bacteria Overgrowth

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Summary

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We talk a lot about the power of good bacteria in the gut and vaginal microbiome. But is there such a thing as too much good bacteria? 

Turns out the answer is yes. Too much Lactobacillus in the vaginal microbiome can be problematic. Even though this microorganism is considered the most beneficial when it comes to vaginal health, too much can cause a condition known as Cytolytic Vaginosis aka CV [1].

We’ll give you the 411 on this pesky condition and clear advice on avoiding it if you’re currently struggling with Cytolytic Vaginosis symptoms.

Why is CV often misdiagnosed?

Chances are you have never heard of CV before. A study reported that it affects only about 1.7% of women. However, we believe this percentage might be higher, as CV is often misdiagnosed as a yeast infection. Not surprising, because the symptoms can be similar, and may include:

  • White or yellowish vaginal discharge
  • Red and inflamed vulvar skin
  • Itchiness
  • A burning sensation
  • Pain during sex and while peeing [1]

Strikingly, 85% of women with CV treated with antifungals do not see their symptoms improve. This reflects how frequently CV can be mistakenly diagnosed as a yeast infection.

How to distinguish CV from other vaginal infections

A unique feature of CV is its cyclical nature. Symptoms tend to be worse during ovulation and in the days before your period [1].

During these days, your estrogen production increases, which promotes the accumulation of a molecule called glycogen in your vagina. Glycogen is eaten by Lactobacillus bacteria which then produce lactic acid. A lot of lactic acid will irritate and damage your vaginal cells [2].

CV can be easily mistaken for a yeast infection when only symptoms are considered, that’s why a correct diagnosis should be based on more than just symptoms. 

A history of antifungal treatments that did not work suggests the condition could be CV. When in doubt, ask your provider for additional tests, as these will help establish a correct diagnosis, including:

  • Tests that check for yeast, trichomoniasis, chlamydia, and bacterial vaginosis (BV)-associated bacteria to help rule out other infections.
  • A pH measurement–Vaginal pH tends to be lower in women with CV (from 3.5 to 4.4) [3, 4].
  • Looking at your vaginal sample under a microscope–to confirm CV and rule out other infections [1, 4].

In CV, the vaginal microbiome looks “normal”

When it comes to the vaginal microbiome, all we know is that in CV, Lactobacillus are highly abundant. But this is also true for healthy women. A small study found an association between high levels of Lactobacillus crispatus with CV. The same association was not found for a different Lactobacillus species [5].

There are no known complications from CV

Unfortunately, there are no quality studies that address CV complications in women. We hope this will change in the future as more women are correctly diagnosed and research moves forward.

Things you can do to avoid CV

There are some general rules that will help you maintain a healthy vaginal microbiome. You can check our guide on vaginal health tips

Stay alert on any changes in the color, smell, and quantity of your vaginal discharge. It is normal for it to vary during the menstrual cycle (if you are not pregnant) but any major change or unpleasant smell should be investigated.

Vaginal probiotics containing Lactobacillus species are sometimes recommended to promote a healthy vaginal community.

A few things to consider:

  • If your vaginal community is already dominated by Lactobacillus, there is no need to take any extra vaginal probiotics. If you are taking a gut probiotic with Lactobacillus in it, follow the recommended dosage. It’s super unlikely to overdose on probiotics, but it’s best to avoid any unwanted effects.

If your vaginal community is not dominated by Lactobacillus, you could benefit from vaginal probiotics. Depending on your particular case, the recommendation might be to take more than the recommended dosage, and that’s fine.

Cytolytic Vaginosis can be treated

The sooner you take action, the better.

Cytolytic Vaginosis treatment involves raising the vaginal pH for a short period of time to clear the excess of Lactobacillus. This can be done using a Sitz bath.

A Sitz bath is made by mixing one tablespoon of baking soda with 4 liters of lukewarm tap water [1]. Then all you have to do is sit in there and wait for Lactobacillus to stop partying. Ask your provider for detailed instructions on how to do this and for how long, especially if you are pregnant as it might not be recommended for you.

A study reported that doing Sitz baths every two days for ten days was enough to see an improvement in symptoms [1].

Cytolytic Vaginosis may be frustrating and uncomfortable. Fortunately, today doctors are better able to diagnose it. Hopefully, with this information, you can arm yourself with information to support your healing. 

Want to better understand your vaginal health and get to the root cause of symptoms? Check out our Tiny Health Vaginal Health Test and receive a detailed report and personalized tips to bring your vaginal flora back to balance naturally.

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References

[1] Hacısalihoğlu, U. P., & Acet, F. (2021). A Clinicopathological Diagnostic and Therapeutic Approach to Cytolytic Vaginosis: An Extremely Rare Entity that may Mimic Vulvovaginal Candidiasis. Journal of cytology, 38(2), 88–93.

[2] Amabebe, E., & Anumba, D. (2018). The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Frontiers in medicine, 5, 181.

[3] Yang, S., Zhang, Y., Liu, Y., Wang, J., Chen, S., & Li, S. (2017). Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis. Gynecologic and obstetric investigation, 82(2), 137–143.

[4] Sanches, J. M., Giraldo, P. C., Bardin, M. G., Amaral, R., Discacciati, M. G., & Rossato, L. (2020). Laboratorial Aspects of Cytolytic Vaginosis and Vulvovaginal Candidiasis as a Key for Accurate Diagnosis: A Pilot Study. Aspectos laboratoriais da vaginose citolítica e candidíase vulvovaginal como uma chave para o diagnóstico preciso: Um estudo piloto. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 42(10), 634–641.

[5] Xu, H., Zhang, X., Yao, W., Sun, Y., & Zhang, Y. (2019). Characterization of the vaginal microbiome during cytolytic vaginosis using high-throughput sequencing. Journal of clinical laboratory analysis, 33(1), e22653.