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Cytolytic Vaginosis (Döderlein's cytolysis or Lactobacillus overgrowth syndrome)

 

Cytolytic vaginosis is a controversial condition as there isn't enough evidence to confirm it exists (Kraut 2023).

 

In theory, it describes the overgrowth of 'good bacteria' called lactobacilli that live in the vagina and release acid needed to keep your vaginal ph between 3.8 and 4.5. This prevents the growth of harmful bacteria whilst keeping thrush at bay. 

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However, with too many lactobacilli, the acid may begin irritating the vaginal walls and vulva. Thus treatment is targeted to lowering the pH via baking soda baths or, more controversially, douches. 

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Once again, we emphasise this is an extremely controversial condition due to the lack of research.

 

Different ethnicities of women have different vagina microbiomes (Condori-Catachura 2025). For example, white women of Northern European descent often exhibit CST I (L. crispatus dominant) microbiomes, while Hispanic women are more frequently found in CST IV (non-Lactobacillus dominant) or CST III (L. iners dominant). The latter might then be diagnosed with our Western view of medicine as pathological, even though for that population, it is perfectly healthy. 

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Ms Dhairyawan (2024) HIV and sexual medicine consultant, highlights there is a bias currently in medicine that all pathologies are attributed to a foreign microbe or disease. This means autoimmune conditions and nerve problems that cannot be picked up under the microscope are under-reported. If you have been diagnosed with cytolytic vaginosis, you should immediately seek a second opinion from a vulva clinic and rule out vulva pain syndromes. 

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Again, systemic medical inequality and the lack of research in women's health has frustratingly left us with more questions than answers.