Department of Obstetrics and Gynaecology, Université de Sherbrooke, Sherbrooke, QC.
Department of Obstetrics and Gynaecology, Université de Sherbrooke, Sherbrooke, QC.
J Obstet Gynaecol Can. 2021 Aug;43(8):943-948. doi: 10.1016/j.jogc.2021.04.008. Epub 2021 Apr 29.
Many women with pelvic organ prolapse opt for a pessary, and some of these women develop erosions of the vaginal mucosa. Ongoing erosions might lead to the discontinuation of this otherwise effective, non-invasive, and inexpensive treatment. The objectives of this study were to investigate the differences in vaginal pH and variations of the vaginal microbiota among pessary and non-pessary users.
For this descriptive observational study, 30 women, followed in our urogynecology clinic, were recruited to form 3 equal groups: 2 groups of women using a pessary (with and without erosions) and 1 control group of women not using a pessary. Vaginal pH was measured distally and next to the erosion. Vaginal swabs were used to investigate the vaginal microbiota by sequencing the V4 region of the 16S ribosomal RNA gene and analyzing the data with Qiime2. Descriptive statistics were reported using the median values. Vaginal pH comparisons between groups were made using a Kruskal-Wallis test with Dunn's correction for multiple comparisons.
The pH of the vagina was more alkaline in women with erosions compared with women in the other 2 groups (P < 0.01). Also, the pH of the distal vagina was not different from the pH next to the erosion (P = 0.25). Patients with erosions displayed significant differences in their vaginal microbiota, which contained a much greater bacterial diversity with an increase in gram-negative bacteria (e.g., Bacteroidetes, Actinobacteria) and a decrease in lactobacilli.
In our study, women with vaginal erosions had significantly higher vaginal pH and more complex vaginal microbiota than women in the control groups. Treatments focusing on lowering the vaginal pH and/or re-establishing the vaginal microbiota should be considered.
许多患有盆腔器官脱垂的女性选择使用子宫托，其中一些女性会出现阴道黏膜糜烂。持续性的糜烂可能会导致这种原本有效、非侵入性且价格低廉的治疗方法被迫中断。本研究的目的是调查子宫托使用者和非使用者之间阴道 pH 值和阴道微生物群的差异。
在这项描述性观察研究中，招募了 30 名在我们泌尿科妇科诊所就诊的女性，将她们分为 3 组，每组 10 人：使用子宫托（有糜烂和无糜烂）的 2 组女性和未使用子宫托的 1 组对照组女性。在阴道远端和糜烂部位测量阴道 pH 值。使用阴道拭子通过测序 16S 核糖体 RNA 基因的 V4 区并使用 Qiime2 分析数据来研究阴道微生物群。使用中位数报告描述性统计数据。使用 Kruskal-Wallis 检验和 Dunn 校正的多重比较检验来比较组间的阴道 pH 值。
与其他两组女性相比，有糜烂的女性阴道 pH 值更高（P<0.01）。此外，阴道远端的 pH 值与糜烂部位的 pH 值没有差异（P=0.25）。有糜烂的患者阴道微生物群存在显著差异，其细菌多样性显著增加，革兰氏阴性菌（如拟杆菌门、放线菌门）增多，而乳杆菌减少。
在我们的研究中，有阴道糜烂的女性阴道 pH 值明显更高，阴道微生物群更复杂。应考虑采用降低阴道 pH 值和/或重建阴道微生物群的治疗方法。
