Today, I saw a woman in her 60s who had been suffering from recurrent cystitis, experiencing episodes more than once a month until a year ago.

She had been treated at various hospitals, but eventually, she was told that there were no more effective antibiotics available for her, which led her to seek consultation at our clinic.

Upon examination, her vaginal age was equivalent to that of an 80-year-old, with a vaginal pH of 8—a clear indication that her vaginal environment had become a reservoir for bacteria.

The Role of the Vaginal Microbiome in Preventing Cystitis

Under normal conditions, the vulva and vaginal canal maintain a healthy bacterial flora, dominated by lactobacilli. These beneficial bacteria produce lactic acid, creating a strongly acidic environment.

This acidic state prevents uropathogens, such as Escherichia coli (E. coli), from thriving. In other words, when the vaginal and periurethral areas are healthy, pathogenic bacteria cannot colonize the urethral entrance, reducing the risk of urinary tract infections.

The Impact of Hormonal Decline and Stress on Recurrent Cystitis

However, with the decline in estrogen levels, the urethral and vaginal mucosa undergo atrophic changes, leading to increased dryness. Since lactobacilli are sensitive to dehydration, they enter a dormant state, causing the vaginal pH to rise and creating a favorable environment for pathogenic bacteria.

Additionally, stress can further weaken the immune defense of the mucosa, making it easier for bacteria to invade and cause cystitis.

Many people have probably experienced the effects of stress on their mucous membranes—such as dry eyes, dry mouth, or chapped lips. Just as these symptoms indicate mucosal dehydration, the same mechanism affects the vaginal and urethral mucosa, increasing susceptibility to infection.

Successful Treatment: Hormone Therapy and Laser Therapy

After undergoing local estrogen therapy combined with laser treatment, this patient remained free of cystitis for an entire year.

She expressed her relief, saying:

• “I had given up on the idea of living without cystitis.”

• “The stress of constantly dealing with cystitis was truly unbearable.”

This case highlights the profound impact that vaginal atrophy and hormonal decline can have on recurrent urinary tract infections and how restoring the vaginal environment can provide long-term relief.

This experience will be shared on my blog to help raise awareness among those struggling with similar issues.