Vaginal flora – friend or foe? Spoiler: it can be both.

The overwhelming majority of women experience vaginal complaints at least once in their lives – burning sensations, itching, unusual discharge, and, of course, the eternal question: "Shouldn't I get a culture done?" Vaginal discharge culture is often the first diagnostic step, but unfortunately, it does not always lead to a definitive answer.

The female vagina is a complex, living ecosystem. Lactobacilli – such as L. crispatus, L. iners, or L. gasseri – form the backbone of a healthy flora. These microscopic guardians create an acidic environment that prevents the proliferation of pathogens and also regulates the local immune response. Yet, the vaginal flora of women is diverse: not everyone lives with a "classic" Lactobacillus dominance, and this does not necessarily mean there is a problem.

In fact, Candida fungus, for instance, can be detected in 60% of women – without it causing any complaints. Gardnerella, a well-known player in bacterial vaginosis, is also a frequent guest. Their presence, therefore, does not necessarily mean trouble. If we culture vaginal discharge, a microorganism can easily "grow out" that is indeed present but is not actually responsible for the symptoms. This is like a security camera recording someone at a scene – it doesn't mean they committed the offense.

Vaginal discharge culture is therefore a delicate genre: it can be misleading and lead to unnecessary treatments. At the same time, there are pathogens – such as Chlamydia – that are never part of a healthy vaginal flora, so if they appear, they indicate a real problem.

The bottom line? The vaginal flora is not black and white. Diagnosis always requires a combined interpretation of symptoms, age, cycle phase, and test results – not just a "positive culture." Let us trust in our bodies, and even more so: in professionals who see not just the bacteria, but us as a complex whole.