The vagina is an organ that protects itself and the genitalia situated above it, so, to understand better its infection process, we have to analyze its factors of protection.



What are the protection factors of the vagina?

	The normal hormonal production rate of the ovary. The estrogens (follicular hormone) are of decisive importance. If the vagina isn’t receiving enough estrogens, the vaginal epithelium will not reach the sufficient thickness and the cells will not contain enough glycogen.
	The glycogen. This substance of the vaginal epithelium is made up from the fermentative sugar (maltose and dextrose). From the superficial layers of the vaginal epithelium, rich in glycogen, various cells are released, in different quantities, that fall to the light of the vagina. In the luteal phase (the effect from the progesterone) there is a massive cellular wear out. The epithelial cells decompose into various fragments that slowly dissolve (cytolysis). In the cytolysis it is possible that various ferments from the cells are freed and these transform into sugar the glycogen contained in the cells.
	The bacillus Döderlein lactic acid, normally exist in the vagina. They live off this sugar and ferment it, turning it into lactic acid. The destruction of the vaginal epithelium in the adult woman is produced only by the bacillus Döderlein, meaning that the cytolysis is a genuine bacterial process during the time of sexual maturation.
	The lactic acid with a pH of about 4. The bacillus Döderlein can only exist in an environment of approximately ph=4.

These four factors make the vagina a body guard organ. If one of them fails then the pH is modified to the alkaline side, causing an emigration and the unlimited growth of germs. In this case not only colpitis and flow are originated, but also an ascending infection.

While the lactic acid with a pH=4 is retained in the vagina, the pathogens mentioned are not dangerous for it, even when they endure in the vagina, because they need a little acid or alkaline environment for reproduction. Therefore, we can conclude by saying that the lactic acid (pH=4) is a disinfectant produced by the vagina.

What alters or interrupts the protective action of the vagina (ph=4)?

Physiologically, in each menstruation. The secretory flow from the uterus is alkaline and it neutralizes the lactic acid protector. This decreases for a few days the defensive capabilities against the germs. Therefore, we can say that during the menstruation, the defensive capability of the woman is reduced.

Pathologically:

	In case of massive penetration of external germs either trough the vulva or intestines, or insufficient closure of the vagina (eg. Prolapse, the decline, perineal tear poorly cured), opens the door for a massive germ penetration of the vulva.
	In case of massive penetration from the germs on top, that is purulent inflammation of the lining of the cervix, destructive cancer of the neck or of the uterus, endometritis, and so on.
	Hypersecretion of the cervix (alkaline secretion always).
	In vaginal washings, especially those use for cleaning the vagina, where they are used soapy solutions. Also foreign bodies alter the pH of the vagina, such as pessaries and panties too tight.
	If grueling diseases such as diabetes mellitus. Also in pregnancy.
	In hormonal disorders. The classic example of the colitis senile, due to the lack of estrogens.
	In the treatment with antibiotics, steroids and oral contraceptives with a high content of estrogen, use of antihistamines. Deficiency of iron, folic acid, Vit B12 and zinc. A diet too rich in carboyhydrates.
	Stress and depression that significantly weaken the immune system.

Symptoms

The vaginal candidiasis is caused by a fungus or yeast that is found in the vagina and/or vulva called Candida Albicans. The pathogen Candida Albicans is a facultative pathogen (friend): the presence of fungi aftosos in the vagina does not mean any disease, they are present in small amounts in the mouth, gastrointestinal tract, skin and vagina.

Only by improving the living conditions for Candida Albicans in the vagina, ie, when the normal pH is altered, when the grade of acidity has been diverted towards the alkaline side, becomes the germ pathogen, and leads to a colpitis, the thick flow, yellowish white that usually accompanies a strong pruritus (itching), burning and inflammation.

The flow may be weak or on the contrary very abundant, It also makes the urinating or having sexual relations very painful. In the acute menstruation the vagina is red and swollen.

Other symptoms that often accompany a candidiasis are: tiredness, fatigue, migraine headaches, constipation and/or diarrhea, abdominal distension, desire to eat carbohydrates (sweets), depression, dizziness, sore joints and muscles, insomnia, irritability, chronic infections, allergies, ear and eye discomfort, nail problems, choking, aphonia and anal itching.

Diagnosis

The candidiasis is note easy to diagnose. It is important to conduct a thorough and detailed study of the patient (evaluation of symptoms, medical history, analysis of their diet and lifestyle, etc.). In order to diagnose and establish a treatment that is successful. Each patient presents special connotations that should be considered at the moment of the treatment.

Generally candidiasis is diagnosed by its symptoms, appearances, and study of the vaginal samples.

Most of the candids adhere to the wall of the intestinal mucosa (small intestine), so it is difficult to appear in the stool cultures, although it is common to find high levels of arabinose in the presence of candidiasis bowel and vulvovaginal in urine.

The arabinose is a five-carbon sugar to the role of aldehyde called aldosa.

It is suspected that the arabinol produced by the yeast in the gastrointestinal tract is absorbed into the portal circulation, and then becomes arabinose through the liver.

The arabinol not metabolizad endógenamente and is excreted in the urine. Thus high levels of arabinose in urine can be a good indicator of candide infections.

The candida increases the intestinal permeability, producing arabitol and arabinose. Any other substance that uses the system Phenol-sulfur-Transferase- such as acetaminophen, citrus fruits, choocalte, apples – also increases the permeability of the intestinal wall. Hence the convenience to do a study of the intestinal permeability to determine what is affecting it.



Intestinal Permeability

The increased intestinal permeability or syndrome of the “pierced” bowel is a condition which interest is increasing, and correlates among others, food intolerances, celíaco syndrome, irritable bowel, Chron’s disease, a-topic eczema, chronic giardiasis, candidiasis intestinal, autoimmune diseases.

The intestinal permeability is an important factor to be taken into account in the pathogenesis of ankylosing spondylitis and rheumatoid arthritis.

On the other hand, a diminished intestinal permeability, can cause poor absorption and cause malnutrition, even with a normal dietary intake amount.

The intestinal permeability can be affected by several factors such as: intestinal infections, secretory IgA deficiency, food allergens, toxins, alcohol and drugs principally anti-inflammatory not eseroideos (NSAIDs).

It is advisable to emphasize that in patients with arthritis, whose pathogenesis may be caused by an alteration of the intestinal permeability, it is further accentuated by the action of the NSAIDs that often appear in this disease.

Effects of Accentuated Intestinal Permeability

	Entry of poorly digested food (peptides, proteins, disaccharides, polysaccharides, lipids)
	Mass influx of antigens: alergic food (IgE), food intolerance (IgG), inflammatory and autoimmune diseases.
	Mass inflow of toxins: overload liver function and fatigue due to the high consumption of ATP.
	Massive entry of pathogens.

To assess the intestinal permeability a test of a oral overload with mannitol and lactulose in a collection of urine of six hours is used.

Treatment

If it is an acute vaginal candidiasis, treatment with any fungicide will vanish quickly but if it´s a chronic vaginal fungal infection the treatment with known fungicides, is difficult to eradicate once it is installed.

We won’t stop in the conventional fungicide treatment. Our attention is directed to the treatment of the mycosis which includes their elimination and prevention.

The oxygen-ozone therapy has a high power fungicide, bactericide and germicide, given its high potential for oxidation (EO = 2.07 V). Therefore, their use in this disease is very valuable.

The therapy is directed initially to eliminate the fungus, then to restore the pH and eventually repopulate the intestinal and vaginal flora.

Prevention

	Avoid vaginal douching. This alters the normal vaginal acid producing inflammation in the long run.
	It is advisable not to use scented detergent, bleach or fabric softener.
	Avoid clothes too tight because they restrict air circulation.
	It is convenient to use cotton underwear.
	The use of deodorants, aromatic soaps or vaginal bubble baths.
	Avoid the consumption of sugars, yeast, wheat and dairy.
	Avoid alcohol, caffeine and nicotine.
	Consume considerable quantities of garlic.
	Consume the Acidophillus Lactobacillus and Bifidobacterium Bifidum