Your vaginal microbiome is home to a complex ecosystem of millions of different bacteria and fungi. These tiny organisms live (for the most part) in harmony, chiefly thanks to the presence of lactobacilli, the protective bacteria that keep your vaginal pH low and infections at bay. 

So what happens when lactobacilli go rogue and become the cause of an infection? Yes, you can have too much of a good thing, and it’s called vaginal lactobacillosis (VL). 

Although yeast infections and bacterial vaginosis (BV) are the two most common vaginal conditions (and causes of abnormal discharge), they’re by no means the only ones. There are a lot of different bacteria living in your vaginal microbiome, and any shift can throw it off balance, causing an unwanted overgrowth. 

Vaginal lactobacillosis vs. cytolytic vaginosis  

Much like cytolytic vaginosis (CV), lactobacillosis is a vaginal disorder caused by an overgrowth of Lactobacillus. Neither of these disorders is very well studied, but they seem to share a lot of symptoms — to the point where even healthcare professionals confuse the two. 

Both VL and CV have cyclical symptoms. Researchers aren’t exactly sure why, but they believe it might be due to the fluctuations in estrogen levels throughout the menstrual cycle. When estrogen levels are high, so are Lactobacillus, which can result in worse symptoms. The main difference in symptoms between VL and CV is that women with vaginal lactobacillosis often complain of constantly having wet underwear. 

The most common symptoms of vaginal lactobacillosis are excessive, white, thick vaginal discharge and vaginal itching, two symptoms that can be easily confused for a yeast infection. Some research suggests that as many as 15% of women who complain about excessive vaginal discharge have lactobacillosis. 

The exact cause of lactobacillosis is unknown, but it’s been linked to several other conditions, including, diabetes, vulvodynia, and misuse of topical anti-fungal medications. Treatment for VL involves antibiotics ​like oral amoxicillin-clavulanate (Augmentin) or doxycycline. 

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What does lactobacillosis look like?

The other distinction between CV and VL is what they look like under the microscope. CV is thought to be caused by an overgrowth of Lactobacillus that decreases the pH to a point where it starts harming the inner lining of the vagina (vaginal epithelium). In VL, there is an overgrowth of lactobacilli, but when you look under the microscope you see that the lactobacilli are abnormally long — about 5-10 times as long as a regular Lactobacillus. 

Lactobacilli are normally rod-shaped bacteria. Below is a picture of the most frequently found vaginal lactobacilli, L. crispatus, L. iners, L. gasseri and L. jensenii. The big squished-jellyfish-looking thing at the bottom of the picture is a vaginal epithelial cell. The tiny little dots are lactobacilli, they are so small that you can barely even tell they are rod-shaped at all. 

Lactobacilli are normally rod-shaped bacteria. Above is a picture of the most frequently found vaginal lactobacilli, L. crispatus, L. iners, L. gasseri and L. jensenii. The big squished-jellyfish-looking thing at the bottom of the picture is a vaginal epithelial cell. The tiny little dots are lactobacilli, they are so small that you can barely even tell they are rod-shaped at all.

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Next let’s look at a microscope picture from a VL sample. Again we can see the large jellyfish-like epithelial cells. And you can also see a lot of little rods that look like tiny hairs or small twigs. Those are the abnormally long lactobacilli, at least five times longer than normal lactobacilli. These were first discovered in 1954 and named leptothirx for its unique shape. Later they were identified as lactobacilli.

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Yes, you read that right, this was first discovered in 1954, yet hardly any research has been done on this disorder since then. To this day, vaginal lactobacillosis is incredibly under-researched, and it’s even more rarely diagnosed. We don’t even know for sure which Lactobacillus species causes VL, or if it’s the normal species that are growing in odd ways.

Because it’s a little-known condition, many women tend to misdiagnose themselves (or get misdiagnosed by a doctor) with a yeast infection and self-medicate with over-the-counter topical antifungal medications or prescribed oral antifungals, which often provide little to no relief. To avoid this, it's important to test your vaginal microbiome and understand your microbial composition before taking any action. This way, you can ensure that you're using the right treatment for your needs. If you're curious to learn more about what's going on down there, try the Evvy vaginal microbiome test for yourself!