Vaginal dysbiosis – a “red flag” of pelvic floor dysfunction
AbstractBackground. Pelvic organ prolapse is a serious medical and social problem that inevitably leads to a decrease in the quality of life of women. All cases of genital prolapse are based on the pelvic floor dysfunction (PFD), which may exist for a long time before the manifestation of the organs’ descent. The prevalence of PFD varies widely due to the lack of standard diagnostic methods and criteria for diagnosis. While a gynecological examination reveals PFD in 50% of women, PFD can be suspected in only 5% of patients based on complaints alone or specialized questionnaires. The first symptoms of an anatomical defect in the closure of the introiutus vaginae in PFD may be associated with recurrent vaginal dysbiosis (due to dysfunction of the main factor of the vaginal biotope protection).
The aim of the study was to investigate the state of vaginal biocenosis in women with pelvic floor dysfunction.
Material and methods. A cohort prospective randomized comparative study involved 141 women aged 18–45 years who applied to one of the clinical bases of the Department of Obstetrics and Gynecology with a Course of Perinatology, Moscow State Medical Institution, Department of Gynecology, City Clinical Hospital # 29 named after N.E. Bauman, for planned surgical treatment. The patients were divided into the main group (with PFD, n=112) and the control group (without PFD, n=29). A standard clinical and instrumental examination of gynecological patients was performed. To verify PFD, a comprehensive perineological examination of the pelvic floor was performed. In addition, a comprehensive assessment of the vaginal biotope was performed. Statistical analysis was carried out using the StatTech v.3.1.6 program (developer – Stattech LLC, Russia). The results of the study are presented as absolute (abs) and percentage values (%), mean values and standard deviations (M±SD), median (Me), and lower and upper quartiles (Q1–Q2).
Results. The patients were comparable in age, BMI, main anamnestic parameters. On the basis of comprehensive perineological examination the women were evidently divided into groups: physical, manometric, sonographic findings were statistically significantly worse in the main group and became the criteria for N 81.8 pelvic floor dysfunction. Patients with pelvic organ prolapse more than grade II according to POP-Q were not included in the study. The complaints of abnormal genital discharge, itching and burning sensation in the vulva region should be referred to the common primary manifestations of PFD in the examined women. Focused questioning revealed that 35.7% (n=40) of the women with PFD had a history of recurrent vulvovaginal infections. Microscopic, cultural and molecular genetic studies of the vaginal biocenosis revealed statistically significant differences between the patients with PFD and the control group (p<0.05). The number of leukocytes in the vagina ≥10 per field of view was found in 60.7% (n=68) of patients with PFD and in 13.8% (n=4) of women in the control group. 27.7% (n=31) of patients with PFD had ≥25 leukocytes in the visual field in the cervical canal (and none of the patients in the control group).
According to the cultural study, the growth of a wide range of opportunistic microorganisms in women with PFD was noted. When evaluating the molecular genetic study of vaginal discharge, it was found that the lowest titer of lactobacilli and the predominant amount of obligate anaerobic flora were statistically significant in women with PFD (p<0.05).
Conclusion. Recurrent disorders of the vaginal biotope are one of the major early symptoms of PFD. The role of dysbiotic disorders in the PFD manifestation is obviously poorly studied. A comprehensive study of the vaginal biotope is required to detect disorders.
Keywords:pelvic floor dysfunction; genital prolapse; pelvic floor; vaginal biocenosis
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Toktar L.R., Orazov M.R., Pak V.E., Aryutin D.G., Li K.I., Samsonova I.A., Gaifulin R.F., Yeseneeva F.M. Vaginal dysbiosis – a “red flag” of pelvic floor dysfunction. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11 (3): 52–62. DOI: https://doi.org/10.33029/2303-9698-2023-11-3-52-62 (in Russian)
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