Factors influencing vaginal cytology, pH and bacterial flora in elderly women

OBJECTIVE: To evaluate factors influencing the vaginal micro-environment in elderly women. STUDY DESIGN: Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 +/- 1.4 years, range 65-84 years) who were not taking estrogens. RESULTS: Vaginal pH was 6.5 +/- 0.1, KPI was 3.0 +/- 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro-environment resembled that of fertile women, with a predominance of lactobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p < 0.001) in women weighing > or = 85 kg, or with a body mass > or = 9th decentile or with a diastolic blood pressure > or = 100 mmHg and in women (p < 0.05) with a high menopausal age (> or = 53 years). Vaginal pH was lower (p < 0.001), KPI was higher (p < 0.01) and there was an increased (p < 0.05) presence of lactobacilli in smokers compared to non-smokers. CONCLUSIONS: The latter finding is somewhat paradoxical as cigarette smoking has previously been shown to negatively influence estrogen metabolism. The influence of cigarette smoking on the vaginal micro-environment may be a direct local effect of nicotine.