The purpose of this study was to determine the impact of contraception, menopause and vaginal flora on the physical and biochemical properties of cervicovaginal fluid.
Vaginal swabs, cervicovaginal fluid (CVF) and cervicovaginal lavage (CVL) were collected from a total of 165 healthy asymptomatic women including: post-menopausal women (n=29), women in the proliferative (n=26) or follicular (n=27) phase, and women using the levonogestrel intrauterine device (LNG-IUD) (n=28), depomedroxyprogesterone acetate (DMPA) (n=28) or combined oral contraceptives (OCPs) (n=27). Vaginal smears were evaluated using the Nugent score. The osmolality, viscosity, density and pH of CVL samples were measured.
CVL from postmenopausal women and women with abnormal vaginal flora was less viscous and had higher pH than premenopausal women and women with normal flora, respectively. Women using hormonal contraceptives had more viscous CVL as compared to premenopausal women not using hormonal contraceptives, but this increase in viscosity was mitigated in the presence of bacterial vaginosis. Women using DMPA had less total protein in the CVL as compared to women using the LNG-IUD, and had similar protein content when compared to postmenopausal women.
The differences in CVL protein content between DMPA and LNG-IUD suggest that type of progesterone and route of delivery impact the vaginal environment. Contraceptive hormone users had more viscous CVL than women not using contraceptives. However, the presence of bacterial vaginosis impacted both the pH and viscosity (regardless of hormonal contraceptive use), demonstrating that vaginal flora has a greater impact on the physical properties of cervicovaginal fluid than reproductive hormones.