Factors influencing vaginal cytology, pH and bacterial flora in elderly women

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Abstract
Objective. To evaluate factors influencing the vaginal micro‐environment in elderly women. Study design. Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 ± 1.4 years, range 65–84 years) who were not taking estrogens. Results. Vaginal pH was 6.5 ± 0.1, KPI was 3.0 ± 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro‐environment resembled that of fertile women, with a predominance of laclobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p > 0.001) in women weighing ≥ 85 kg, or with a body mass ≥ 9th decentile or with a diastolic blood pressure ≥ 100 mmHg and in women (p > 0.05) with a high menopausal age (≥ 53 years). Vaginal pH was lower (p > 0.001), KPI was higher (p > 0.01) and there was an increased (p >0.05) presence of lactobacilli in smokers compared to non‐smokers.Conclusions. The latter finding is somewhat paradoxical as cigarette smoking has previously been shown to negatively influence estrogen metabolism. The influence of cigarette smoking on the vaginal micro‐environment may be a direct local effect of nicotine.

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