Effect of various hormonal and non-hormonal contraceptive methods on the vaginalmilieu -A narrative review

Globally the use of modern contraceptive methods has risen to 851 million. Use of these contraceptive methods does influence the vaginal health, which in turn affects the susceptibility towards acquiring RTI/STI. Methods to assess the vaginal health have also evolved over decades. The objective of this narrative review is to assess the influence of contraceptive methods on the vaginal health and also evaluate the methods used to assess the vaginal milieu. Suitable articles published in literature from 2007-2020 were identified from PubMed, Google Scholar using relevant keywords. Hormonal contraceptives included were combined oral contraceptive pills (COCP), Depot medroxyprogesterone acetate (DMPA)and Levonorgestrel IUCD(LNG-IUS). Non hormonal methods included were barrier methods, copper IUCD, diaphragm and vaginal sponge. Outcome parameter recorded were Nugent score, vaginal pH, bacterial vaginosis or defined microbiome profile. COCP have been shown to protect the vaginal ecosystem primarily due to their oestrogen component. The use of IUCD causes initial dysbiosis chiefly due to associated irregular bleeding but long term use of LNG IUS stabilizes the microbiome. Use of injectable DMPA though does not increase the susceptibility to HIV but can promote growth of anaerobic organisms. Literature regarding condom, diaphragm and sponge is very scanty to draw a meaningful conclusion. Hence contraceptive methods can affect the vaginal health. There is need to periodically assess the vaginal milieu using test which is appropriate as per available expertise, infrastructure and cost and treat vaginal dysbiosis in respective cohorts to prevent reproductive morbidity.