Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora

The vaginal microflora of healthy asymptomatic women consists of a wide variety (two to five isolates at any one time) of anaerobic and aerobic bacterial genera and species dominated by the facultative, microaerophilic, anaerobic genus Lactobacillus. That the vaginal flora forms part of a dynamically changing ecosystem is evident from the variable prevalence and population levels of each bacterial species detected with repetitive longitudinal sampling, with pregnancy, and with stage in the menstrual cycle. This review emphasizes the role that vaginal lactobacilli may play in control of the vaginal microflora and maintenance of the normal state. Lactobacilli possess many antagonistic properties and produce many metabolites that may be important in maintaining dominance in the vagina. Contradictory data from previous studies regarding the impact of factors such as contraception, catamenial products, and physiologic elements on the vaginal microflora are due in part to poor study design and differences in methodology. Well-designed and controlled investigations with large numbers of individuals in each group are needed, and the limitations of the methodology for such investigations must be considered. Studies of the normal flora, exploring the interaction of lactobacilli and other bacterial species, must be performed before the pathologic processes resulting in vaginitis or systemic sequelae are investigated.