•The human vagina has several effective mechanisms of defense against exogenous microbes. Among these mechanisms, the presence of nonpathogenic commensal microorganisms, mainly Lactobacillus acidophilus, which produces antimicrobial bacteriocins, peroxides, and lactic acid from glycogen, is of primary importance.
•Thanks to the presence of lactobacilli, the pH of the vaginal fluid in healthy women is maintained between 4 and 5. The natural resistance to the colonization of pyogenic organisms is therefore mediated by lactic acid, low pH, and antimicrobial polypeptides.1,2
•A strict coincidence has been observed between an increase in vaginal pH and a higher incidence of bacterial vaginosis and of trichomoniasis also resulting in the destruction of the natural flora of lactobacilli.3
•The increase of the vaginal pH (to as much as pH 7) may also occur in postmenopausal women with consequent possible colonization of the vaginal mucosa by pathogenic microorganisms and, therefore, increased risk of local infections. Irritation of the mucosa, with consequent itching, tenderness, and unpleasant smell are the main consequences of these pathological situations
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