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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. 

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"After a severe thrush infection left a residual burning at the opening of the vagina, I went to a gynaecologist as no GUM clinician nor GP knew what was - I tested negative for everything. I said I didn't have pain in my vagina, but the consultant said, "Well, I think you do have pain in your vagina." They instructed me to douche bicarbonate of soda up the vagina after a diganosis of CV. They said to douche however many times a day for symptom relief. As I had no symptom relief I douched 15 times a day - often some of the water would go up into my uterus and fall down 2 hours later, so it'd look like I'd wet myself sometimes at work.

 

I reported to the consultant's secretary that the treatment wasn't working and their response was "The only patients the Doctor can't help are those who think they know more than him." I continued trying to be a 'good patient' and was given Augmentin when the pain didn't go. This triggered more drug-resistant thrush and moved my pain up from 2/10 to 5/10. I then went to a vulval clinic for a second opinion. They said cytolytic vaginosis was highly controversial and, in fact, I had vestibulodynia - nerve damage of the vulval vestibule. Within a year of the Augmentin, I was unable to work due to pain." – Philly, Founder of Thrush Support

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