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

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.