Treating Imbalance in Vaginal Microbiota Following Destruction of Cervix
Study Objective: To improve the outcome of surgical destruction of the cervix in women with benign cervical conditions (BCC). Study Design: This was a cohort, observational, prospective study. Materials and Methods: In a group of 411 patients of child-bearing age who had BCC that required a destructive treatment, a blind randomization was used to select 168 women. Depending on the technique used to destroy the cervical tissue, these subjects were further stratified into the following three groups: radio-wave surgery (n = 63), cryodestruction (n = 57), and diathermocoagulation or diathermoconization of the cervix (n = 48). Study examination included medical history; basic clinical examinations; a gynecological examination; an assessment of vaginal microbiota, the perineal area and bowel functioning; colposcopy with acetic acid or Lugol''s solution; cytology; and morphology. The state of vaginal microbiota was assessed based on the changes that occurred in the preoperative period and at months 1 and 3 after the destructive procedure. Study Results: This study showed that patients with BCC initially had high rates of concomitant imbalance in vaginal microbiota, including bacterial vaginosis (44.6%) and vaginitis (26.8%). In women with BCC that require a destructive treatment, the following factors were considered to be predictors of imbalance in vaginal microbiota in the postoperative period: a destruction technique (χ <sup>2</sup> = 6.64), dysfunction of the perineal and pelvic-floor muscles (χ <sup>2</sup> = 3.86), smoking (χ <sup>2</sup> = 8.15), HPV infection (χ <sup>2</sup> = 8.51), imbalances in vaginal microbiota before destructive treatment (χ <sup>2</sup> = 3.81), a history of abortion (χ <sup>2</sup> = 6.04), and chronic constipation associated with intestinal bacterial overgrowth (χ <sup>2</sup> = 16.35). The study treatment included chlorhexidine followed by ascorbic acid administered intravaginally (Vaginorm-C). As part of preoperative preparation, this treatment helped restore normal vaginal microbiota in 85.4% of women. Chlorhexidine in combination with Dexpanthenol, given from day 15 post-surgery, followed by ascorbic acid administered intravaginally (Vaginorm-C), helped restore normal vaginal flora in 77.4% (in one month) and in 90.6% (in three months) of women. In the group of subjects who had a radio-wave procedure, the efficacy of this treatment was 1.2-fold higher (p < 0.05). Conclusion: The key pathway underlying an imbalance in vaginal microbiota that develops after a destructive treatment for BCC is vaginal contamination with intestinal flora associated with an increase in vaginal pH. The severity of this contamination correlates with the risk of inflammatory complications in the postoperative period (r = 0.68). The changes in vaginal microbiota depend on the destructive technique (r = 0.81) - the most positive changes are seen when a radio-wave technique is used. Apart from using antimicrobial agents, restoration of vaginal microbiota before and after destructive treatment for BCC requires normalization of vaginal pH.