Correlation of behaviors with microbiological changes in vaginal flora

Bacterial vaginosis (BV) is characterized by dramatic changes in the vagina l ecosystem. Women without evidence of vaginal infection may exhibit transi ent changes in their flora. We prospectively followed up women by using dia ries and self-obtained vaginal smears to correlate behaviors with changes i n flora. The majority of women (38/51, 78%) had significant, although trans ient, changes. Behaviors associated with unstable flora were a history of B V, a greater number of partners, and more frequent episodes of receptive or al sex. Only the latter remained significantly associated in the multivaria te analysis. Variables that were associated with day-to-day variability in the flora included use of vaginal medication, menses, greater number of par tners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Only a minority of women (11/51, 22%) maintained a "normal " lactobacillus-predominant flora. Factors associated with instability of t he flora are similar to those epidemiologically associated with B.V.