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Some cases of cytolytic vaginosis (CV) are proving tricky to treat with baking soda and ‘leaving it alone’. CV is not the new kid on the block any longer, but is still not widely understood, being an unexpected situation that has thrown everyone off a little.
Lactobacilli are supposed to be ‘good’, but it seems reasonable that any bacteria can become a problem if the circumstances are right. Additionally, lactobacilli produce lactic acid, which has a very low pH (acidic) and will irritate, burn and sting an inflamed cell.
To be diagnosed, a doctor can examine vaginal fluids under a microscope and find an abundance of lactobacilli compared to a normal sample. This observation, with symptoms, can help diagnose CV.
Please do not self-diagnose CV! It could be so many other issues.
New treatment ideas for CV
There are some strategies to treat CV that can be employed.
- Pomegranate as an oral herbal extract as directed by a herbalist and in a pessary to modulate bacterial populations
- Bloodroot orally as a herbal extract as directed by a herbalist and in a pessary to modulate bacterial populations
- Borax in the bath, with a very gentle vaginal wash or pessary (borax is very high pH, working in the same sort of way as baking soda)
- Using non-crispatus strains of probiotics vaginally
- Microbial antagonism and reduced free oestrogen with Bifido species
- Using intravaginal prebiotics that L. crispatus can’t break down, such as glucomannan. L. crispatus lives mainly on α-glucans like glycogen and maltose (using its amylopullulanase enzyme) and doesn’t carry the endo-β-mannanase machinery needed to cut the mannose backbone of glucomannan, so the fibre feeds mannan-degrading species rather than the overgrown L. crispatus itself1,2,3
- Vaginal goldenseal
- Vaginal ozonated sunflower oil
It’s important to remember that everyone is different. If you’re struggling with CV and finding no relief, we recommend booking with a My Vagina clinical naturopath. Usually, it’s not just a vagina problem; it’s a body problem. We know what to do and can help.
CV and AV switching
CV can often appear with aerobic vaginitis (AV) (but not typically with bacterial vaginosis). We think that is because AV causes inflammation, thus any lactic acid from lactobacilli will cause stinging and burning, much like lemon juice in a cut.
It is our experience that CV that doesn’t resolve by itself is usually not CV at all, or is CV being driven by another underlying condition. That means when trying to treat suspected chronic CV, you need to be looking at drivers of CV and consider alternatives – maybe treatment isn’t working because lactobacilli overgrowth is not the problem.
If you’re unsure and have ongoing issues with suspected CV, make an appointment with one of our vulvovaginal specialist naturopaths who can help you get to the bottom of your symptoms and do the right testing.
Treating CV
The treatment provided so far has been antibiotics that lactobacilli are not resistant to, or baking soda vaginally.
Why baking soda?
The baking soda is designed to increase the pH and thus diminish lactobacilli populations by creating an unfriendly high-pH environment temporarily. These two treatments, however, are not working for some people.
What lactobacilli cause CV?
The main culprit of CV seems to be Lactobacillus crispatus, present in some vaginal probiotics, but may be L. gasseri. Some people get CV after one treatment with lactulose or vaginal probiotics, while others have been using the treatment for weeks and weeks.
It’s impossible to know who will suffer and who will not, or who can leave it be/using baking soda and recover quickly.
Why doesn’t CV resolve on its own?
Other factors that are involved in CV can be hormonal factors (relative oestrogen excess) and blood sugar dysregulation. Underlying factors can keep CV sticking around because they increase accessible vaginal sugars.
Vaginal sugars feed bacteria, though some species thrive on specific sugars. For example, lactobacilli thrive on glycogen, which is produced by vaginal cells under the influence of oestrogen. More oestrogen results in more glycogen, resulting in more lactobacilli.
This article is general information and not a substitute for personalised medical advice. If you suspect you have cytolytic vaginosis, please see an experienced vulvovaginal practitioner.
- Hertzberger R, May A, Kramer G, van Vondelen I, Molenaar D, Kort R. Genetic Elements Orchestrating Lactobacillus crispatus Glycogen Metabolism in the Vagina. International Journal of Molecular Sciences. 2022;23(10):5590.
- van der Veer C, Hertzberger RY, Bruisten SM, et al. Comparative genomics of human Lactobacillus crispatus isolates reveals genes for glycosylation and glycogen degradation: implications for in vivo dominance of the vaginal microbiota. Microbiome. 2019;7(1):49.
- La Rosa SL, Leth ML, Michalak L, et al. The human gut Firmicute Roseburia intestinalis is a primary degrader of dietary β-mannans. Nature Communications. 2019;10(1):905.
