INTRODUCTION

To understand vaginitis and cervicitis one must understand what has been defined as a healthy vaginal microflora. The assumption is that Lactobacillus is a key factor in maintaining a healthy vaginal ecosystem; however, there are likely other important factors that are at play that maintain the vaginal ecosystem in a healthy state. Although there is still a significant void in our knowledge of all components of the vaginal ecosystem needed to maintain it in a healthy state, we do know that Lactobacillus does apparently have a significant role in maintaining dominance and suppresses the pathogenic bacteria. A healthy vaginal ecosystem is defined as an ecosystem that exhibits no symptoms (odorless; no itching, burning, or discomfort), discharge is white to slate gray, and microscopically the squamous epithelial cells are well estrogenized and there are ≤5 white blood cells seen microscopically at 40× magnification per field. The bacteria observed at 40× magnification are mostly large bacilli, and other bacterial morphotypes are rarely observed.

An understanding of the dynamics of endogenous vaginal microflora and its interaction with the vaginal ecosystem is emerging. The available data enable us to begin to understand the role of Lactobacillus in maintaining a healthy vaginal flora and possibly preventing infection of the lower as well as the upper genital tract. Lower genital infection or alterations of the endogenous vaginal microflora result in vaginitis.