Lactobacilli are the most abundant bacteria in the normal vaginal flora. Vaginal lactobacillosis manifests itself as a very annoying, copious, white vaginal discharge, with a feeling of continuous wetting of the underwear. The etiology is unknown. It occurs in about 15% of patients complaining of profuse vaginal discharge. Lactobacillosis must be distinguished from candidiasis, bacterial vaginosis, and cytolytic vaginosis. Lactobacilli are the most abundant bacteria in the normal vaginal flora. The lactobacilli most commonly found in women are Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. These bacteria are responsible for maintaining a healthy balanced vaginal environment and inhibiting pathogenic bacterial growth. They exert their inhibition through several mechanisms, including competing for receptor binding on vaginal epithelial cells, thereby preventing adherence of pathogenic microorganisms. Lactobacilli also exert their inhibition by producing bacteriocins, hydrogen peroxide and lactic acid, which act antibacterially. Lactic acid inhibits the growth of bacterial vaginosis and Neisseria gonorrhea species. Hydrogen peroxide inhibits the growth of Gram-negative and Gram-positive facultative and obligate anaerobes, including such organisms as Escherichia coli, Gardnerella vaginalis, and Mobilincus. Vaginal lactobacillus is a condition in which a certain type of lactobacilli increase in number and change their morphology by becoming much longer, forming characteristic filaments called leptothrix. In asymptomatic women, vaginal lactobacilli are usually between 5 and 15 micrometers in length. Lactobacillosis causes increased production of lactic acid and hydrogen peroxide. This can contribute to the damage of epithelial cells, nerve endings and receptors, which therefore serves as a risk factor for the development of vulvodynia. Many authors describe a relationship between diabetes mellitus and lactobacillosis. They suggest that female patients with diabetes mellitus may be more susceptible to developing lactobacilli because lactobacilli are more abundant in women with high serum glucose levels. Clinically, vaginal lactobacillosis is manifested by abundant but variable white vaginal discharge, sometimes itching of the vulva, a burning sensation in the vagina after urination, and a feeling of continuous wetting of the underwear. There is usually no vaginal odor. Symptoms occur regularly, are most obvious in the progestin phase of the menstrual cycle, and are more pronounced before the onset of menstruation. There are usually no other clinically relevant findings in the vulva, vagina, or cervix of symptomatic patients with vaginal lactobacilli. Also, their vaginal acidity is within normal limits. References: 1. Fettweis JM, Serrano MG, Girerd PH, Jefferson KK, Buck GA. A new era of the vaginal microbiome:advances using next-generation sequencing. Chem Biodivers. 2012;9(5):965-976. doi pubmed 2. Korenek P, Britt R, Hawkins C. Differentiation of the vaginoses—bacterial vaginosis, lactobacillosis, and cytolytic vaginosis. Internet J Advanc Nurs Pract. 2003;6(1). 3. Suresh A, Rajesh A, Bhat RM, Rai Y. Cytolytic vaginosis: A review. Indian J Sex Transm Dis. 2009;30(1):48-50. doi pubmed