Chijioke Iremeka
Maternal health experts have warned that constant washing of the vagina with soap or other detergents raises the risk of preterm births and miscarriages.
The gynaecologists say it causes an imbalance of lactobacillus – a type of good bacteria responsible for the maintenance of vaginal acidity.
According to them, though Lactobacillus is a good vaginal bacteria, the physicians warned that lower amounts of it reduce vaginal acidity, which encourages infection-causing bacteria that thrive in lower acidic environments, adversely affecting pregnancy.
According to an online medical portal, Mayo Clinic, lactobacillus acidophilus is a probiotic that helps to maintain the number of healthy bacteria in the stomach, intestines and vagina.
Lactobacillus bulgaricus bacteria.
Speaking exclusively with PUNCH Healthwise in different interviews, the experts stressed that a shortage of lactobacillus in the vagina could lead to ascending infections, miscarriages and preterm births.
Shedding light on this, a Professor of Obstetrics and Gynaecology at the Department of Obstetrics and Gynaecology, Faculty of Medicine, Nnamdi Azikiwe University, Anambra State, George Eleje, said aside lactobacillus, which is a good vagina flora, there are other organisms that could be harmful during pregnancy, including anaerobe bacteria.
According to him, anaerobic bacteria constitute a substantial component of the normal vaginal flora and of the outer cervical canal, saying that it is expected that substantial vaginal infections will be caused by it.
Prof George Eleje
He said, “Normal vaginal microbiome comprises both aerobic and anaerobic bacteria, with lactobacillus being among the predominant microbiota.
“Lactobacilli provide defence against infections by the maintenance of vaginal Potential Hydrogen.
“However, if there is anything that alters the acidity of the vagina, like washing of vagina with soap, it reduces the level of lactobacilli in the vagina and this opens the door to those organisms that can thrive in lower acidic levels, especially candida albicans.
“Also, diseases like diabetes, HIV and any immune suppressant will reduce the ability of the lactobacilli to regulate vagina pH, thereby, leading to the presence of other organisms that ordinarily can’t survive in the acidic environment of the vagina.”
Eleje, who is also a Consultant Obstetrician and Gynaecologist at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, described candida albicans as a fungus that is typically found in small amounts in the intestines and vagina.
He noted that healthy bacteria in the body control the balance of candida to ensure that it doesn’t get out of hand but that a lower amount of lactobacilli causes candida to overgrow, causing candidiasis.
Eleje added, “There is something called ascending infections, which occur when infectious pathogens residing in the external genitalia of the mother access the amniotic sac, weakening the taffeta membrane and leading to preterm labour and premature rupture of the membrane.
“In pregnant women, the infection can reach the placenta either by ascending infection from the vagina or by infected seminal fluid, which may then get to the baby.”
Speaking on the solution, he said pregnant women should maintain good vagina health by not washing with soap or any detergents, saying that ordinary water is enough.
While noting that some detergents may be detrimental to the lactobacilli, he urged pregnant women with diabetes to have it under control otherwise, it could cause immunosuppression, which will encourage the growth of harmful organisms.
He advised those with Human Immunodeficiency Virus, to stick to their medications to maintain good immunity during pregnancy.
On her part, a Consultant Gynaecologist and Obstetrician at the Epe General Hospital, Epe Lagos State, Dr Cynthia Okafor, said a number of infections have been linked to miscarriage and other adverse pregnancy outcomes, such as stillbirth and preterm delivery.
She noted that about 15 per cent of early miscarriages and 66 per cent of late miscarriages have been attributed to infections, hence the need for pregnant women to ensure that they do not compromise their vaginal health.
“In a recent study, 78 per cent of 101 tissue samples from miscarriage were infected with bacteria, whereas all the control samples from medically induced abortions were uninfected,” Okafor added.
Published in the National Library of Medicine, a study by Sevi Giakumelou et al, titled, ‘The role of infection in miscarriage,’ affirmed that in healthy women, the normal genital tract flora consists mostly of lactobacillus species bacteria.
The study stated that other potentially virulent organisms, such as Gardnerella vaginalis, group B streptococci, Staphylococcus aureus, Ureaplasma urealyticum or Mycoplasma hominis occasionally displace lactobacilli as the predominant organism in the vagina, leading to a condition known as bacterial vaginosis.
“BV is present in 24 to 25 per cent of women of reproductive age and causes a rise in the vaginal pH from the normal value of 3.8 to 4.2 up to 7.0.
“It is usually asymptomatic but may result in a vaginal discharge, which can be grey in colour with a characteristic ‘fishy’ odour. BV has been associated with premature delivery and with miscarriage,” the study stated.
The authors, however, concluded that further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.
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