Cytolytic Vaginosis (CV): what is it?

Too much of a good thing? How the overgrowth of Lactobacilli can produce symptoms similar to other vaginal infections.

What is cytolytic vaginosis (CV)?

Cytolytic vaginosis—  also known as Lactobacillus overgrowth syndrome (or Doderlein’s cytolysis) —  is a condition  that arises when typically protective bacteria (Lactobacilli) over-multiply and cause vaginal discomfort. 

CV is often confused with other vaginal conditions given its similarity in symptoms and the lack of specific diagnostics for the condition. It is often brought up as a potential cause of symptoms that don't respond to treatments designed for yeast infections or  bacterial vaginosis (BV).

Although less common than yeast infections or bacterial vaginosis, cytolytic vaginosis can lead to a range of equally disruptive symptoms, including abnormal vaginal discharge, itchiness and pain during sex.

You may want to talk to your doctor about CV if:

  • You experience symptoms similar to yeast infections
  • Tests for candida (yeast) come back negative
  • Your symptoms don't respond to anti-fungals

Based on the existing (and limited) research to date, CV isn’t officially classified as an infection or STI. 

How common is it and what are the risk factors?

While there isn't enough research to assess the exact prevalence of cytolytic vaginosis, there are a few risk factors researchers have highlighted for CV. It primarily affects women of reproductive age, and is thought to occur most frequently when estrogen levels are high--specifically during pregnancy or the luteal phase of the menstrual cycle (the days after ovulation but before your period.)

In addition, individuals with diabetes (both Type 1 and Type 2) are thought to be at slightly greater risk of developing cytolytic vaginosis, as studies have shown certain bacteria responsible for the condition are potentially more abundant in women with raised serum glucose levels. 

What causes cytolytic vaginosis?

Typically, the vagina is an acidic environment (with a pH between 3.8 and 4.5) mostly consisting of a lactic-acid producing bacteria known as Lactobacilli. The high concentration of this bacteria helps to keep unwanted infections and pathogens at bay by keeping the pH low . 

However, in some cases, these Lactobacilli can overgrow and cause a process referred to as lysis, aka the breaking down of the vaginal epithelial cells (that’s where the name “cytolytic vaginosis” comes from!).

Cytolytic vaginosis doesn’t have any one specific cause or trigger — your vaginal ecosystem is a highly sensitive microcosm of bacteria, after all — but certain factors such as the recent use of antibiotics, high-strength probiotics, or antifungal medications may contribute to CV.

What are the symptoms of cytolytic vaginosis?

Irritation to the vaginal walls caused by the dissolution of the cell membrane can cause a range of symptoms. These include:

  • Excessive or increased vaginal discharge, most often white and watery or cottage-cheese-like in consistency and appearance (similar to a yeast infection)
  • Discomfort during penetrative sex
  • Itching of the vagina and/or vulva
  • Bladder pain/burning while peeing
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How is cytolytic vaginosis diagnosed?

Unfortunately, there is no accepted diagnostic or agreed upon diagnostic criteria for cytolytic vaginosis. Instead, it is often a process of elimination of other conditions that may be causing symptoms. (We know this is frustrating — it is something we hope to change with our research!).

The symptoms of cytolytic vaginosis often resemble that of yeast infections and other vaginal health conditions, which can sometimes lead to repeat misdiagnoses and failed treatments. More specifically, the symptoms are often similar to yeast infections, but unlike yeast infections, symptoms of CV won’t respond to anti-fungal medications — so this can be a key indicator that there’s something else going on.

One benefit of the metagenomics used in an Evvy test is that it can tell you what proportion of your vaginal microbiome is Lactobacilli so you and your doctor can deduce if that’s contributing to your symptoms while determining the prevalence of BV associated bacteria.  

How is cytolytic vaginosis treated?

Like many vaginal health conditions, there is still so much that we don’t know about cytolytic vaginosis. There is no standard treatment for cytolytic vaginosis since it is yet to be officially recognized as an infection and there is no definitive diagnostic test for it.

That said, given the known causes, increasing vaginal pH may help reduce Lactobacilli levels. Below are a couple examples of alternative treatments: 

It's extremely important to note that these treatments can negatively impact the vaginal microbiome (since they are designed to reduce Lactobacilli levels), and we would not recommend them unless you have been diagnosed with CV, since they may cause bacterial vaginosis.

  • Avoid probiotics or any products containing Lactobacilli.
  • Douching: Douche daily for 2 weeks with a mixture of 30 to 40g of baking soda in 1 liter of water
  • Vaginal suppository: Fill empty gelatin capsule with baking soda. Insert capsule into the vagina twice a week for two weeks.

Make sure to consult with your doctor before attempting any of the above treatments. Given the lack of research, knowledge, and training on CV in the medical community, we suggest you specifically seek a provider who is familiar with CV and can help guide you on the best way to diagnose and treat it.

Can I prevent it?

Although there are no proven ways to prevent CV, some general good practices for the maintenance of vaginal health include: 

  • Monitor changes in vaginal discharge
  • If you need soap, use a pH balancing unscented bar soap. Avoid liquid soaps as they are more concentrated.
  • Avoid scented hygiene products, like vaginal sprays, powders, toilet paper, detergent, pads, etc
  • Avoid high consumption of sugar and alcohol
  • Wear breathable cotton underwear

We know the lack of concrete answers here can be frustrating, and we hope Evvy's research continues to shed light on this important but overlooked topic!

Referenced in this article:

  1. Puri S. Cytolytic vaginosis: A common yet underdiagnosed entity. Ann Trop Pathol 2020;11:29–32 https://www.atpjournal.org/article.asp?issn=2251-0060;year=2020;volume=11;issue=1;spage=29;epage=32;aulast=Puri
  2. Suresh, A., Rajesh, A., Bhat, R. M., & Rai, Y. (2009). Cytolytic vaginosis: A review. Indian journal of sexually transmitted diseases and AIDS, 30(1), 48–50. https://doi.org/10.4103/0253-7184.55490
  3. Yang S, Zhang Y, Liu Y, Wang J, Chen S, Li S. Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis. Gynecol Obstet Invest. 2017;82(2):137–143. doi: https://pubmed.ncbi.nlm.nih.gov/27300413/

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