Reproductive and Sexual Health Handbook

The vagina is a muscular canal between the uterus and the vulva. The vaginal mucosa is similar to that in the mouth, and similar diseases can infect the vagina as in the oral cavity. The anatomical relationships of the vagina are shown in Figure 4.1:

bladder and urethra cervix rectum and anus uterovesical and rectovaginal peritoneal pouches scarum and coccyx

Figure 4.1 The Vagina

The normal vagina is colonised by lactobacilli and other aerobic and anaerobic bacteria from puberty onwards. Commensal lactobacilli metabolise glycogen in the vaginal epithelium to produce lactic acid which results in the maintenance of an acidic vaginal environment (pH<4.5). Other commensal bacteria include anaerobic streptococci, diphtheroids, coagulase-negative staphylococci and beta-haemolytic streptococci. In the normal vaginal ecosystem the ratio of anaerobic to aerobic bacteria is 2-5:1. Some commensal organisms can constitute infection if they ‘overgrow’ including candida albicans, staphylococcus aureus and beta-haemolytic streptococci and the organisms associated with bacterial vaginosis.

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