Cytolytic Vaginosis: Diagnostic Challenges and Therapeutic Approaches

Objective: This study aims to provide a comprehensive review of cytolytic vaginosis (CV), a condition often overlooked in clinical practice, to improve understanding of its pathophysiology, diagnostic challenges, and effective management strategies.Methods: An integrative literature review was conducted using publications from the last 34 years. Searches were performed in the Google Scholar, Scopus, and Web of Science databases, focusing on articles in English and Portuguese that addressed cytolytic vaginosis, the vaginal microbiome, Lactobacillus species, and therapeutic approaches.Results: Cytolytic vaginosis is a form of vaginal dysbiosis characterized by an overgrowth of Lactobacillus species, leading to an abnormally low vaginal pH. This hyper-acidity causes the lysis of vaginal epithelial cells, resulting in symptoms such as itching, burning, and a thick, white, clumpy discharge. CV symptoms are cyclical, often worsening in the premenstrual phase, which helps differentiate it from vulvovaginal candidiasis (VVC). Diagnosis is primarily based on microscopic examination of vaginal fluid, revealing an abundance of pleomorphic lactobacilli, epithelial cell fragments, and a low pH (<4.5), while excluding common pathogens like Candida and Gardnerella. The main treatment involves alkalizing the vaginal environment with sodium bicarbonate to reduce the Lactobacillus population and restore microbial balance.Conclusion: Cytolytic vaginosis is a significant, yet frequently misdiagnosed, cause of vulvovaginitis in reproductive-aged women. Increased clinical awareness and proper use of microscopic diagnostic tools are essential for accurate identification. Effective management with simple alkalizing agents offers symptomatic relief and prevents the inappropriate use of antibiotics and antifungals. This review highlights the need for continued education and research to improve diagnostic protocols and develop more targeted treatments for this condition.