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Vaginitis: Not an Infection, But an Imbalance?

When it comes to vaginitis, most people immediately think of 'infection'.

Bacterial vaginitis, candidal vaginitis, Trichomonas vaginitis...

It's easy to assume that symptoms arise when bacteria enter the body.

However, in reality, there are cases where no pathogens are detected even after examination, and the same symptoms often recur despite treatment.

Why on earth does this happen?

Today, we'll begin with this question and delve deeper into a new perspective: 'Vaginitis is not an infection, but an imbalance.'

The Birth and Limitations of the Infection-Centric Paradigm

In 1955, Gardner and Dukes first formalized the diagnosis of bacterial vaginitis.

They defined that when anaerobic bacteria in the vagina replace normal lactobacilli, symptoms such as a fishy odor and grayish-white discharge occur.

For decades thereafter, vaginitis was consistently regarded as a 'bacterial invasion'.

But then, something strange began to happen.

People with clear symptoms but no detectable bacteria, or those who simply didn't improve despite repeated antibiotic use.

Phenomena that could no longer be explained by the infection model increasingly began to emerge.

The Perspective: Not Bacteria, But a Collapsed 'Environment'

Recent research began to approach this puzzle from an entirely different angle.

It suggests that rather than bacteria being the problem, the vaginal environment has collapsed.

A normal vaginal ecosystem is predominantly characterized by lactobacilli (lactic acid bacteria), which produce a low pH (acidic environment), lactic acid, and hydrogen peroxide, thereby preventing pathogen invasion and maintaining self-purification.

But what happens if lactobacilli decrease due to factors such as stress, menstrual cycle, antibiotic use, sexual intercourse, or changes in the body's immunity?

Anaerobic bacteria then fill that void, leading to inflammation and symptoms. This scenario is less of an infection and more akin to the collapse of an ecosystem.

Modern Treatment: From 'Eliminating Bacteria' to 'Restoring Balance'

Thus, the discourse suggests that treatment strategies must also evolve.

Instead of antibiotics or antifungals that indiscriminately eliminate pathogens, strategies focusing on Lactobacillus supplementation, vaginal pH regulation, and ecosystem restoration are emerging.

Indeed, clinical results from Europe have shown that Lactobacillus vaccines not only reduce the recurrence of vaginitis but also lower the risk of low birth weight deliveries.

Thus, the paradigm is shifting from 'eradication' to 'restoration'.

How Korean Medicine Interprets This Paradigm Shift

In Korean medicine, vaginitis has traditionally been interpreted not as the invasion of a single pathogen, but as a complex pathological state involving Qi stagnation (氣滯), damp-heat (濕熱), Yin deficiency (陰虛), among other factors.

濕熱下注 (Damp-Heat Descending): Dampness and heat accumulate in the body's lower regions, leading to inflammation.

陰虛內熱 (Internal Heat due to Yin Deficiency): Depletion of body fluids causes deficient heat to rise, resulting in itching and a burning sensation.

氣虛濕困 (Qi Deficiency with Dampness Confinement): Weakened vital energy allows dampness to linger, leading to excessive discharge.

In other words, the core concept is that an imbalance in the internal environment, rather than an external pathogen, is the primary cause.

In that respect, it remarkably aligns with recent theories of microbial ecosystems.

Rethinking Vaginitis

We must ask ourselves:

Are these symptoms merely due to the 'presence of bacteria'?

Or, should we first consider 'why bacteria established themselves there'?

The condition of vaginitis is now shifting from how to eliminate an infection to how the body's environment has broken down and how to restore it.

And on the cusp of this change, the ancient concept of 'balance' in Korean medicine is gaining new meaning.

Vaginitis: Not an Infection, But an Imbalance? | Incheon Chronic Vaginitis

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