The clinical presentation is strikingly similar to candidal vaginosis, characterized by dyspareunia, dysuria, abundant whitish discharge and pruritus [1] [2]. A cyclical appearance of symptoms, most likely during the luteal phase of the menstrual cycle is observed [1].

• Rhinorrhea

  【鼻口蓋管嚢胞】*nasopalatine duct cyst 【鼻糸状菌症】*rhinomycosis 【鼻歯槽嚢胞】*nasoalveolar cyst 【鼻出血】【鼻血】*rhinorrhagia 【鼻障害】【鼻症】*rhinopathy 【鼻石】*rhinolith 【鼻痛】*rhinalgia 【鼻洞炎】*rhinoantritis 【鼻副鼻腔炎】*rhinosinusitis 【鼻閉塞】*nasal obstruction 【鼻ポリープ】【鼻茸】*nasal polyp 【鼻漏】*rhinorrhea [medo.jp]

• Polydipsia

  苔癬様皮膚症】【苔癬様皮膚病】*lichenoid dermatosis (退)* 【退行形成】【退形成】*retroplasia *anaplasia 【退縮眼振】*retractory nystagmus *nystagmus of retraction (太) 【太鼓バチ状指】【太鼓バチ指】*clubbed finger ＝バチ状指、バチ指 (代) 【代謝疾患】*metabolic disease (体) 【体静脈狭窄】*systemic vein stenosis (多) 【多飲多食症】*polydipsia [medo.jp]

• Halitosis

  口蓋垂炎】*uvulitis *staphylitis 【口蓋垂裂】*cleft uvula *uvula bifida[L] 【口蓋乳頭嚢胞】*cyst of papilla palatina 【口蓋裂】*cleft palate *palatoschisis 【口腔乾燥症】*xerostomia 【口腔真菌症】*oral mycosis *stomatomycosis 【口腔病巣性粘液沈着症】*oral focal mucinosis 【口臭】*bad breath *foul breath *halitosis [medo.jp]

• Excoriation

  Vulva appears normal, i.e. no erythema, swelling edema,, or excoriations 2. Vaginal discharge is white and tends to be thick or pasty 3. Thew it no odd associated with (he discharge. If a whiff test is performed it is negative 4. [sexualhealthmedicine.com]

  Baking soda sitz baths offer relief by removing irritating acid secretions from contact with the vulvar tissues and also just a local soothing effect to excoriated tissue from itching. [encognitive.com]

• Formication

  Several species of lactobacilli ferment both glycogen and glucose to lactic acid, carbon dioxide, alcohol, formic acid, acetic acid, and hydrogen peroxide. It is these acids that cause the problem. [encognitive.com]

• Vaginal Discharge

  METHODS: Fungal cultures, 10% potassium hydroxide (KOH) and Gram stained preparations and pH measurements were performed on the vaginal discharge material of each patient. [ncbi.nlm.nih.gov]

  The pH was 3.5 to 5.5 and the clinical symptoms were profuse vaginal discharge (VD) especially whitish-cheesy vaginal discharge and other symptoms of vaginal candidiasis. [unboundmedicine.com]

  Vaginal discharge is white and tends to be thick or pasty 3. Thew it no odd associated with (he discharge. If a whiff test is performed it is negative 4. The vaginal epithelium can appear slightly erythematous 5. pH 4.5 6. [sexualhealthmedicine.com]

• Vulvar Burning

  However, the patient with cytolytic vaginosis can complain of vaginal pruritis and burning, dyspareunia, and vulvar burning when micturating (vulvar dysuria). The patient’s symptoms intensify during the luteal phase of the menstrual cycle. [sexualhealthmedicine.com]

  I purchased a PH balanced lubricant and have been taking baking soda baths, which seem to help the vulvar burning from time to time. [vulvodyniasirenblog.wordpress.com]

  They typically complain of a thick, odorless, white vaginal discharge and intense pruritus; dysuria and dyspareunia along with a sensation of vulvar burning or discomfort may also be present. [prognosisapp.com]

  The most common symptom is itching, but vulvar burning, dysuria, and entry dyspareunia are often present as well. [encognitive.com]

• Tampon Use

  In many women using tampons, the vaginal pH can be sufficiently raised merely by discontinuing tampon use and thus restoring menstrual flow. [prognosisapp.com]

  Paavonen recommended women discontinue tampon use until they are symptom-free for at least 6 months ( 52 ). [answers.google.com]

  Instead of tampons, she should use nondeodorant sanitary pads. [nursing.advanceweb.com]

• Cheesy Vaginal Discharge

  The pH was 3.5 to 5.5 and the clinical symptoms were profuse vaginal discharge (VD) especially whitish-cheesy vaginal discharge and other symptoms of vaginal candidiasis. [unboundmedicine.com]

  The women presenting with cytolytic vaginosis complain of a thick or thin white cheesy vaginal discharge, pruritus, dyspareunia, vulvar dysuria, and a cyclic increase in symptoms that are more pronounced in the luteal phase ( 11, 37, 49 ). [ispub.com]

• Profuse Vaginal Discharge

  The pH was 3.5 to 5.5 and the clinical symptoms were profuse vaginal discharge (VD) especially whitish-cheesy vaginal discharge and other symptoms of vaginal candidiasis. [unboundmedicine.com]

A presumptive diagnosis can be made based on clinical findings and reported complaints, but because numerous pathogens may cause a similar presentation, it is necessary to perform a vaginal smear and subsequent microscopic examination [1]. The proposed criteria for cytolytic vaginosis are evidence of cytolysis, abundance of lactobacilli, absence of Trichomonas vaginalis, Gardnerella vaginalis or Candida sp. on wet smear and pH of the smear between 3.5-4.5 [4].

• Cytolytic Vaginosis

  Cytolytic vaginosis occurs due to overgrowth of Lactobacillus species and subsequent lysis of epithelial cells in a highly acidic environment. [symptoma.com]

  The good news is that once the disease is recognized the simple natural remedy for cytolytic vaginosis is baking soda. What is Cytolytic Vaginosis? Cytolytic vaginosis is an overgrowth of the bacteria lactobacilli. [earthclinic.com]

  What is cytolytic vaginosis? Cytolytic vaginosis is one of the causes of vaginal discharge. Its existence as a specific diagnosis is debated. What is the cause of cytolytic vaginosis? The normal vagina of an adult woman is colonised by lactobacilli. [dermnetnz.org]

  Cytolytic Vaginosis also know as, cytolytic vaginitis, cytolysis vaginosis, cytolysis vaginitis, Doderlein’s cytolysis is not an infection. [vaginosisinfo.com]

• Gram-Positive Rods

  Definition / general Presence of gram positive rods (lactobacilli) with cytolysis of intermediate cells Terminology Also known as bacillus vaginalis, bacillus Doderlein Epidemiology Lactobacilli are the most abundant bacteria found in normal vaginal flora [pathologyoutlines.com]

  rods, now referred as lactobacillus species. [ncbi.nlm.nih.gov]

  Historical Perspectives In 1892, Doderlein first identified the presence or absence of gram-positive rods in normal vaginal flora ( 16 ). He named these organisms Doderlein's bacilli. [ispub.com]

• Gram-Positive Bacteria

  Clindamycin will also have an inhibitory effect on Gram-positive bacteria, except the enterococci. Additionally, clindamycin would not have a suppressive effect on the Gram-negative facultative bacteria. [sexualhealthmedicine.com]

Once the diagnosis is confirmed, the main goal of therapy is elevation of vaginal pH through douching with sodium bicarbonate solution or through the use of a vaginal sodium bicarbonate suppository [1] [4]. In most cases, intravaginal douching is performed for twice weekly for 2-3 weeks, while antibiotic therapy is not necessary [1].

The condition is self-limiting and easy to treat, but the diagnosis is often made erroneously as chronic candidal vulvovaginitis that does not respond to therapy [3], which is why the diagnostic workup should be properly conducted [2] [6].

Lysis of vaginal epithelial cells is caused by overgrowth of lactobacilli, but the exact cause remains unclear [2].

The exact rates of this condition in women is unknown, but cytolytic vaginosis is almost exclusively encountered in women during childbearing age [2]. Because lactobacilli convert glucose to lactic acid, it is hypothesized that women suffering from diabetes mellitus are more prone to this condition due to a higher circulating level of glucose [1].

Under physiological conditions, Lactobacilllus species provide numerous beneficial effects as normal vaginal flora, predominantly by acidification of the local environment through production of lactic acid from glucose and the influence of estrogen [1]. An additional function is the production of hydrogen peroxide (H2O2), a potent free radical that prevents the ability of pathogenic microogranisms, such as Escherichia coli, Gardnerella vaginalis, but also Candida sp., to grow and cause an infection [2] [5]. Competition for nutrients and secretion of acidolin, which also inhibits growth of other organisms, are additional mechanism of protection [2]. In some women during reproductive age, however, a phenomenon of Lactobacillus overgrowth in this environment can occur and cause lysis of vaginal epithelial cells due to excessive acidification [1].

Apart from adequate hygiene, no other preventive measures are currently known regarding prevention of vaginal infections.

Cytolytic vaginosis is a term that describes lysis of vaginal epithelial cells as a result of abundant growth of Lactobacillus sp., which normally reside in the vagina as normal flora [1]. As a protective mechanism against harmful pathogens, lactobacilli produce hydrogen peroxide (H2O2) and preserve the vaginal microenvironment, but for still undisclosed reasons, abundant growth of this bacterial organism can occur in women during childbearing age and cause marked lysis of epithelial cells, primarily due to profound acidification during the process of glucose conversion to lactic acid [1]. The clinical presentation includes dysuria, whitish discharge, dyspareunia and pruritus, with symptoms most commonly appearing in cyclic fashion [1] [2]. To make the diagnosis, it is necessary to obtain a vaginal smear and perform a microscopic examination that will exclude other pathogens that present with similar complaints, most notable being Trichomonas vaginalis, Gardnerella vaginalis and Candida species [3] [4]. Cytolytic vaginosis is treated by increasing pH, most commonly through the use of sodium bicarbonate, either in the form of vaginal suppositories or douching [1].

Cytolytic vaginosis is a condition characterized by overgrowth of Lactobacillus species, which normally comprise normal vaginal flora and protect from various harmful microorganisms via several mechanisms. For some reason, abundant growth of this bacteria reduces normal pH of the vagina, causing a profoundly acidic environment in which destruction of epithelial cells (cytolysis) occurs. Symptoms such as painful urination, itching, whitish discharge and pain during intercourse are most frequently reported. This condition is almost exclusively seen in women during childbearing age and symptom often appear in cyclical fashion. The diagnosis can be made by obtaining a vaginal swab for microscopic examination. Increasing vaginal pH is the main principle of therapy, which is achieved by douching with sodium bicarbonate or use of vaginal suppositories containing sodium bicarbonate for 2-3 weeks. Cytolytic vaginosis is self-limiting and does not pose a risk for women, but it is often not recognized due to striking similarities of more common conditions such as vulvovaginitis caused by Candida, which is why careful examination is necessary to make the right diagnosis.

1. Suresh A, Rajesh A, Bhat RM, Rai Y. Cytolytic vaginosis: A review. Indian J Sex Transm Dis. 2009;30(1):48-50.
2. Cerikcioglu N, Beksac MS. Cytolytic vaginosis: misdiagnosed as candidal vaginitis. Infect Dis Obstet Gynecol. 2004;12(1):13-16.
3. Hu Z, Zhou W, Mu L, Kuang L, Su M, Jiang Y. Identification of cytolytic vaginosis versus vulvovaginal candidiasis. J Low Genit Tract Dis. 2015;19(2):152-155.
4. Cibley LJ, Cibley LJ. Cytolytic vaginosis. Am J Obstet Gynecol. 1991;165(4 Pt 2):1245-1249.
5. Hillier SL, Krohn MA, Klebanoff SJ, Eschenbach DA. The relationship of hydrogen peroxide-producing lactobacilli to bacterial vaginosis and genital microflora in pregnant women. Obstet Gynecol. 1992;79(3):369-373.
6. Demirezen S. Cytolytic vaginosis: examination of 2947 vaginal smears. Cent Eur J Public Health. 2003;11(1):23-24.