VAGINAL PH AS A MARKER FOR BACTERIAL PATHOGENS AND MENOPAUSAL STATUS

OBJECTIVES: Our purpose was to confirm the elevation of vaginal pH exp ected in patients with bacterial pathogens in premenopausal women and to examine the relationship of serum follicle-stimulating hormone and estradiol levels to vaginal pH in menopausal patients without and with hormone replacement therapy. STUDY DESIGN: Vaginal pH was determined by phenaphthazine (Nitrazine) pH paper in 253 patients seen in a solo private practice for routine speculum examination. None of the patient s were pregnant. Measurements were made of serum levels of follicle-st imulating hormone and estradiol for 172 patients and vaginal cultures were taken from 82 patients. Vaginal pH was correlated with vaginal cu ltures and serum follicle-stimulating hormone and estradiol levels by use of statistical analysis. RESULTS: Vaginal pH was elevated in all p remenopausal patients with documented bacterial pathogens. Serum estra diol levels showed an inverse and serum follicle-stimulating hormone l evels a direct statistical correlation with vaginal pH in menopausal p atients. CONCLUSIONS: Measurement of vaginal pH is useful, effective, and inexpensive for screening purposes. A vaginal pH of 4.5 is consist ent with a premenopausal serum estradiol level and the absence of bact erial pathogens. An elevated vaginal pH in the 5.0 to 6.5 range sugges ts a diagnosis of either bacterial pathogens or decreased serum estrad iol. In patients with an elevated pH, vaginal culture should establish the diagnosis. In the absence of bacterial pathogens, a vaginal pH of 6.0 to 7.5 is strongly suggestive of menopause. Titration of estradio l level by vaginal pH during estrogen replacement therapy may help men opausal women avoid side effects or cessation of therapy.