Vaginitis, Colpitis: Anatomy-Physiology

Since the basics of colpitis/vaginitis are partly very complex, some basics will be presented:

Anatomy and function of the vagina

The vagina (vaginal) as a connecting organ between the vulva (the external genitals) and the portio (cervix) represents not only functionally, but also anatomically, a special feature in the genital area. As a protective organ between the outside world and the abdomen, the vagina consists of a multilayered, non-keratinizing squamous epithelium, the so-called mucosa (no mucous membrane!). This is surrounded on the inside by smooth, latticed and longitudinal (good extensibility), and on the outside by transversely striated, actively mobile musculature. The anterior and posterior walls lie against each other in an unstretched state, forming transverse folds (stretch reserve for intercourse, birth) and an H-shaped gap. The mucosa is hormone-dependent and contains no glands. Glycogen is deposited in the mucosa by estrogens. Glycogen depletion due to cytolysis (“dissolution” of a cell by abolishing its membrane integrity) of gestagen-induced exfoliated cells produces lactic acid. This leads to an acidic pH value and is thus an important protection against infection. In accordance with the requirements in the course of life, the vaginal epithelium is very thin in childhood and in the senium (old age), thus easily vulnerable and at risk of infection. In sexual maturity, it is highly built up, thick and resistant.

Physiology of the vagina

Fluor

A fluor vaginalis (vaginal discharge) is physiological, can vary greatly from individual to individual, and is also hormone-dependent. During the menstrual cycle, it is most pronounced just before ovulation. Vaginal secretion (vaginal discharge) consists of vaginal transudate (non-inflammatory body fluid), exfoliated epithelial cells and cervical mucus. Notice. The hormone-dependent, very strong liquefaction of the cervical mucus (secretion secreted by the glands in the cervix) shortly before ovulation can be used to determine ovulation (Billings method). It can be very difficult to distinguish between physiological and pathological (pathological; inflammation). Physiological secretion is odorless or smells slightly acidic. It has a whitish color and a creamy consistency. The pH is between 3.8 and 4.5. Under the microscope, there are masses of epithelia and lactobacilli, but hardly any bacteria. Normal flora (microbiota) of the vagina.

Lactobacteria in high bacterial counts 105 to 108/ ml (of > 50 different types, 5 – 7 types occur in humans). Important are strains that can form hydrogen peroxide. They have a bactericidal (“bacteria-killing”) effect against anaerobes. Since colonization and growth are estrogen-dependent, lactobacteria are found in the first weeks after birth, later not, and again from menarche (occurrence of the first menstrual period) to menopause (time of the last spontaneous menstruation). Reduced physiologically during menstruation and during the postpartum period. Due to the location and function of the vagina, various germs of the skin and perianal area (“around the anus“, as well as those of the partner, always settle. Therefore, various germs in low germ count (up to 104 – 105/ml) are physiological. In a healthy woman usually 3 – 8 germs can be grown e.g. group B streptococci, enterococci, Gardnerella vaginalis, Ureaplasma urealyticum, Clostridium perfringens and Mycoplasma. In other words, colpitis is characterized less by the spectrum of bacteria than by the bacterial count. Always pathological are bacteria of group A streptococci and Staphylococcus aureus, as well as the protozoan Trichomonas vaginalis. Eubiosis – Dysbiosis

The environment of the vagina and the vaginal flora represent a biological equilibrium that can vary greatly, so that the transition from still physiological (healthy) to pathological (sick) is fluid. There are considerable interindividual differences. The assessment also depends on the symptoms, which are perceived very differently.

  • Eubiosis: Eubiosis is the healthy vaginal flora of an asymptomatic, microbiologically inconspicuous woman.
  • Dysbiosis: Dysbiosis refers to an imbalance of the vaginal flora with reduction of lactobacteria, an increase in leukocytes (white blood cells) and possibly an increase in various bacteria present.Bacterial dysbiosis cannot be attributed to normal vaginal flora or to a specific vaginal infection. Some patients suffer from increased fluorine (discharge) and the signs of vulvitis (burning, pruritus (itching), redness, pain).

Protection against infection

The vagina has two mechanisms against bacterial and viral infections: H2 O2 (oxygen superoxide) and NO (nitric oxide):

  • H2 O2 is produced in various species of lactobacteria and has a bactericidal (“bacteria-killing”) effect.
  • NO: The acidic environment in the vagina allows the formation of NO. It acts bactericidal and virucidal (“virus-killing”). A dual, NO-releasing system, ensures this. NO is either released directly from the epithelial cells (at a lactobacillus-induced acidic pH below 4.5, nitrite is formed from nitrate), or it is secreted by macrophages (“scavenger cells”).