Cytolytic Vaginosis: What Discharge Looks Like and How to Treat It

Cytolytic vaginosis (CV) —  aka Lactobacillus overgrowth syndrome or Doderlein’s cytolysis — is a condition that occurs when typically protective bacteria (called Lactobacilli) over-multiply in your vaginal microbiome and cause vaginal discomfort.  

Cytolytic vaginosis was only discovered fairly recently (we’re talking 1991). Frustratingly, it’s often confused with other vaginal conditions, such as bacterial vaginosis (BV) or yeast infections, because it can cause similar symptoms — including abnormal vaginal discharge, itchiness, and vaginal pain. This means it’s also often misdiagnosed (particularly when people self-diagnose). 

That’s why we’ve compiled everything you should know about cytolytic vaginosis, from causes to testing to treatment. Read on to learn more. 

Key takeaways

• Cytolytic vaginosis is caused by an overgrowth of Lactobacillus bacteria in the vaginal microbiome, not a pathogen or infection in the traditional sense.
• CV discharge is typically white and watery or cottage-cheese-like, making it easy to mistake for a yeast infection.
• Risk factors include high estrogen levels, pregnancy, diabetes, and the use of Lactobacillus-containing probiotics.
• If antifungal treatments aren't working and symptoms keep coming back, CV could be why.
• The Evvy Vaginal Microbiome Test can show whether Lactobacilli are dominant in your microbiome and help rule out other causes of your symptoms.

What causes cytolytic vaginosis?

Typically, an optimal vaginal environment is dominated by protective bacteria such as Lactobacilli. The lactic acid produced by these bacteria helps maintain a low vaginal pH (between 3.8 and 4.5), which keeps pathogens (such as Gardnerella and E. coli) at bay and can help prevent vaginal infections.

However, in some cases, these Lactobacilli can overgrow. This triggers a process known as lysis, which simply means the breakdown of the vaginal epithelial cells lining the vaginal wall. This irritation can cause a host of symptoms like itching and abnormal discharge. If you’re into etymology, ‘lysis’ is where the name “cytolytic vaginosis” comes from. 

In short, cytolytic vaginosis occurs when typically protective Lactobacilli overgrow and irritate the vaginal epithelium. 

What are the risk factors for cytolytic vaginosis?

There are a few risk factors that can increase your likelihood of developing cytolytic vaginosis.

Hormonal changes

Cytolytic vaginosis mainly affects women of reproductive age and is thought to occur most frequently when estrogen levels are high, such as when taking hormone replacement therapy (HRT), experiencing a hormonal imbalance, or during pregnancy. 

Additionally, some research suggests it may be more common during the luteal phase of the menstrual cycle, aka the days after ovulation but before your period.

Diabetes

People with diabetes (both Type 1 and Type 2) are also thought to be at slightly greater risk of developing cytolytic vaginosis, as studies have shown the bacteria responsible for the condition are potentially more abundant in women with high blood sugar levels. 

Taking probiotics

The risk of cytolytic vaginosis can also increase with behaviors that replenish Lactobacilli, such as taking probiotics containing these bacteria or overdoing other vaginal health regimens meant to support their growth. 

That’s why it’s so important to test your vaginal microbiome before taking any supplements, even something as simple as a probiotic or prebiotic. There can be too much of a good thing!

What are the symptoms of cytolytic vaginosis?

Cytolytic vaginosis irritates the vaginal walls, which can lead to uncomfortable and unpleasant symptoms. Symptoms of cytolytic vaginosis 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 or pain during sexual intercourse
• Itching or burning of the vagina and/or vulva
• Pain or discomfort when peeing. 

Cytolytic vaginosis symptoms often resemble those of other vaginal infections, which can sometimes lead to repeated misdiagnoses and failed treatments.  

You may want to talk to your doctor about cytolytic vaginosis if you experience any of these symptoms but haven’t been diagnosed with a yeast infection, or your symptoms aren’t going away after using an antifungal treatment — this can be a key indicator that there’s something else going on.

What does cytolytic vaginosis discharge look like?

CV discharge is typically white and either watery or thick, sometimes resembling the cottage-cheese-like texture associated with a yeast infection. It's usually odorless or has a mild scent, which is one of the few clues that it might not be BV. The volume of discharge can increase noticeably, particularly in the second half of the menstrual cycle when estrogen levels are higher, and Lactobacilli are more active.

Because the discharge doesn't have a distinctive color or smell, it's one of the hardest symptoms to use as a diagnostic clue on its own. Many women with CV report cycling through antifungal treatments without relief, which is often the first real sign that something other than a yeast infection is at play.

How is CV discharge different from a yeast infection or bacterial vaginosis?

The discharge in CV, BV, and yeast infections can look similar, but there are some subtle differences worth knowing.

• A yeast infection produces thick, white, cottage-cheese-like discharge with no strong odor, usually alongside intense itching. 
• BV discharge tends to be thin, gray, or off-white, with a distinctive fishy odor, and it's associated with a raised vaginal pH (above 4.5). 
• CV, by contrast, produces white, watery, or chunky discharge that's usually odorless, and the vaginal pH is actually lower than normal (typically below 3.8), because the Lactobacilli overgrowth produces excess lactic acid.

That lower-than-normal pH is one of the most useful distinguishing features. If a provider checks your pH and it's unusually acidic alongside yeast-infection-like symptoms that haven't responded to antifungals, CV is worth investigating.

How to test for cytolytic vaginosis 

Unfortunately, cytolytic vaginosis is often a diagnosis of exclusion, meaning it requires eliminating other conditions that can cause similar symptoms, such as a yeast infection. We know this is frustrating — it is something we hope to change with our research!

The good news is that diagnosis can be confirmed by looking at a vaginal smear under a microscope (using a method called microscopy) in the doctor's office. 

Additionally, while cytolytic vaginosis isn't well studied, it is thought to be uncommon. While it might be comforting to have a potential diagnosis to point to for your symptoms, make sure not to self-diagnose and talk to your doctor before using any treatments designed for cytolytic vaginosis.

One benefit of the Evvy Vaginal Microbiome Test is that it can tell you what proportion of your vaginal microbiome is Lactobacilli, so you and your doctor can figure out if cytolytic vaginosis may be contributing to your symptoms.

While the Evvy test cannot confirm a cytolytic vaginosis diagnosis (you need a microscope to do that), it can help to determine the abundance of Lactobacilli compared to other bacteria, as well as eliminate other potential causes of your symptoms.

Cytolytic vaginosis treatment options 

Like many vaginal health conditions, there is still so much that we don’t know about cytolytic vaginosis — another motivator for closing the gender health gap! 

Baking soda baths

While cytolytic vaginosis isn’t a commonly diagnosed infection, there is one standard treatment for it: a sodium bicarbonate (baking soda) bath. The baking soda helps by reducing Lactobacilli levels, and research demonstrates it is effective at reducing symptoms in individuals with cytolytic vaginosis. 

But before you start running the water and lighting candles, it’s extremely important to note that this treatment can negatively impact the vaginal microbiome (since it is designed to reduce Lactobacilli levels) and isn’t recommended unless you have been diagnosed with cytolytic vaginosis because it may increase your risk for bacterial vaginosis or aerobic vaginitis (AV).

Avoiding probiotics 

If you think you have cytolytic vaginosis, you may want to stop taking any Lactobacillus-containing probiotics, since the point of probiotics is to increase Lactobacilli and the solution for cytolytic vaginosis is to reduce Lactobacilli. 

Regular probiotic usage can often make symptoms of cytolytic vaginosis worse. If you’re diagnosed with cytolytic vaginosis and are using probiotics (either for your vaginal or gut health), you may want to take a hiatus and see if your symptoms lessen.

Reconsider treatments

Finally, you may also want to avoid products that lower vaginal pH or support Lactobacillus species in the vaginal microbiome — such as boric acid, vitamin C, or "pH balancing" products. These may exacerbate symptoms of cytolytic vaginosis. 

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

Can I prevent cytolytic vaginosis?

Although there are no proven ways to prevent cytolytic vaginosis, there are a few behaviors you may want to consider if you’ve been diagnosed with it: 

• Consider avoiding probiotics, products with Lactobacillus bacteria, and treatments that lower your vaginal pH unless you know you have low Lactobacilli levels 
• Maintain balanced estrogen levels
• Keep blood sugar under control.

As mentioned, a few of the recommended treatments and behaviors for cytolytic vaginosis are the exact opposite of what to do to keep your vaginal microbiome in good shape. That’s why it’s so important to have a solid understanding of your own microbial composition before jumping to action — otherwise, you risk using the wrong treatment for your needs. To learn more about exactly what’s up down there, try the Evvy Vaginal Microbiome Test for yourself.

FAQs about cytolytic vaginosis 

How common is cytolytic vaginosis?

Cytolytic vaginosis is pretty uncommon, but it’s something to be aware of, especially since its symptoms (like itching, abnormal vaginal discharge, and irritation) can easily be confused with a yeast infection or bacterial vaginosis. While estimates on how many women it affects vary, some doctors suggest it could impact a small percentage of women of reproductive age, particularly those with higher levels of Lactobacilli. This condition happens when these normally helpful bacteria grow a bit too much. Since cytolytic vaginosis isn't as widely recognized and is often mistaken for other infections, it’s hard to know exactly how prevalent it is. 

How is cytolytic vaginosis diagnosed?

Women dealing with cytolytic vaginosis often find themselves misdiagnosed with recurring yeast infections or bacterial vaginosis because the symptoms can be similar. Traditional tests for infections might not pick up the overgrowth of Lactobacilli that causes cytolytic vaginosis. Unfortunately, diagnosing cytolytic vaginosis can sometimes be tricky — it often involves ruling out other possible conditions, like yeast infections, which can be a bit of a process. Typically, a healthcare provider will need to take a closer look at vaginal secretions under a microscope for an accurate diagnosis. 

What is the best treatment for CV?

When it comes to treating cytolytic vaginosis, the goal is to balance out the acidity in the vaginal environment (make the vaginal pH less acidic), which can help manage the overgrowth of Lactobacilli. One popular home remedy is taking a baking soda bath. Some people also find relief using baking soda-filled gelatin capsules as vaginal suppositories for a more targeted approach. Make sure to speak to your healthcare provider before trying any treatments for cytolytic vaginosis.

What color is cytolytic vaginosis discharge?

CV discharge is typically white or off-white. Unlike BV, it doesn't tend to have a grey or yellow tint, and it's usually odorless or only very mildly scented. The texture may be watery and thin or thicker and clumpy, but the color remains consistently white, which is part of why it's so easily mistaken for a yeast infection. If your discharge has a strong odor or an unusual color, like green or grey, it's more likely to indicate a different condition, and it's worth getting tested to find out what's actually going on.

Can cytolytic vaginosis cause thick white discharge?

Yes, thick white discharge is a hallmark symptom of CV, and it's one of the main reasons it's mistaken for a yeast infection. The discharge can range from watery to cottage-cheese-like in consistency, depending on the individual and the stage of your menstrual cycle. If you're seeing thick white discharge alongside itching or vaginal discomfort but antifungal treatments haven't helped, CV could be worth discussing with your provider.