Aust N Z J Obstet Gynaecol. 1984 Aug;24(3):217-8
Relationship between contraceptive method and vaginal flora.
This study was undertaken to assess whether the vaginal flora was affected by the method of contraception, and in particular as to whether the incidence of vaginal candidiasis increased when oral contraceptives were used. One thousand and two consecutive vaginal or cervical swabs from women attending a family planning centre were cultured. Candida albicans was isolated from 13% of women using no contraception, 16% using oral contraceptives, and from 9%, 19% and 18% of those using diaphragms, intrauterine contraceptive devices (IUCD) and condoms respectively. These differences were not statistically significant. Women using an IUCD had significantly more Gram-positive cocci cultured than women in any other group, while those using diaphragms had significantly more Gram-negative bacilli. Our clinical impression that the use of oral contraceptives led to an increase in vaginal candidiasis, was not confirmed by this study. PIP: Increase in the number of positive cultures for fungi of bacteria taken from vaginal or cervical swabs, in oral contraceptive (OC) users was assessed. Women attending a family planning center in Christchurch, New Zealand, had a vaginal or cervical swab taken prior to a cervical smear. The swabs were placed in transport media and then cultured on brain-heart infusion agar with added chloramphenicol for Candida albicans isolation and modified Thayer-Martin agar and blood agar for Neisseria gonorrhoea. The presence of Trichomonas vaginalis was ascertained by examining a wet preparation and by culture onto Trichomonas medium. Other aerobic bacteria were isolated from the blood agar plates and identified using standard techniques. The culture results from 1002 consecutive swabs were assessed. There was no difference in the rates of infection with C. albicans between the different contraceptive groups. Similarly, there were no differences when the OC group was subdivided into those with either standard dose, low dose, or no estrogen content. When a similar analysis was carried out for the isolation of Gram positive cocci, the groups differed significantly due largely to the high rate of isolation of Gram positive cocci from women using IUDs. The patients also differed signifficantly in the rate of infection with Gram negative bacilli. To limit the number of multiple comparisons, the diaphragm and IUD groups were compared; the isolation rate of Gram negative bacilli was significantly higher in the diaphragm group. The isolation rate of Gram negative bacilli from women using IUDs or condoms was significantly higher than in those women using OCs. T. vaginalis was isolated from 1 woman who had never used contraceptives, 2 who were not using them at the time the swabs were taken, 7 taking OCs, and 1 using condoms. N. gonorrhoea was isolated from 3 women using 3Cs and 1 using an IUD. OC use was not associated with an increased incidence of cervical or vaginal infection by C. albicans, T. Vaginalis, N. gonorrhoea, or by any bacterial species. The highest rate of isolation of Gram-positive cocci was seen in women using IUDs.
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