Bacterial FloraoftheSigmoid Neovagina

A healthy humanadult coloncontains amicrobial flora, of whichmostofthespecies are strict anaerobes (2). The averagepH isalkaline. Themicrobial flora ofthevagina consists mainly oflactobacilli, whichareresponsible forthe acidity ofvaginal secretions. Inpatients witha sigmoid neovagina, an isolated segmentofthecolorectum isusedas a neovagina. Onlyscarceinformation exists aboutthebacterial flora oftheexcluded colon, andtoour knowledge, none isknownabouttheflora ofthesigmoid colonusedasa vagina. Theaimofthepresent studyistodetermine the microflora ofthesigmoid neovagina. Theoperative procedure tocreate a sigmoid neovagina hasbeendescribed earlier (3). Briefly, preoperative mechanical boweldecontamination was performed. Atthebeginning oftheoperation a single-dose prophylactic antibiotic was given. Afterdissecting a planebetweenthebladderand rectumandisolating a sigmoid segment, theoralsideofthe sigmoid loopisconnected withtheperineum or thevulva; theaboral sideisclosed. Fifteen patients were studied. Ten were male-to-female transsexuals, andfivepatients had aplasia vaginae as a partoftheMayer-Rokitansky-Kuster syndrome. Noneofthepatients hadanypreexisting bowel disease. Thetimebetweensurgeryandthebacteriological study ranged from23to87months(mean, 52months). After thepatients provided informed consent, theyfilled outa questionnaire concerning theoperation, complaints, and sexualhabits. Elevenpatients complained ofsticky discharge. Thirteen patients experienced slight bloodloss, eight ofthemspontaneously andfive onlyafter sexual intercourse. Twelvepatients hadregular sexual intercourse; allofthem usedmethylcellulose as a lubricant. Condomuse was not reported. Nopatient was using antibiotics atthetimeofthe study. Speculum examination was done,andinmostpatients, thetopoftheneovagina contained some cellular debris withmucous strands. Tomeasure thepH,aNeutralit pH 5 to10paper (E.Merck,Darmstadt, Germany) was inserted intheneovagina. A direct smear was takenfromthe discharge, andthesmear was examined microscopically to detect thepresenceofTrichomonas species andcluecells. Also, an aminetestwas doneforthedetection ofbacterial vaginosis. A sterile loop was usedtocollect discharge from theneovagina forquantitative bacterial analysis. Thissamplewas placed in2mlofprereduced peptoneyeastmedium