Association between vaginal microecological dysfunction and cervical lesion severity in postmenopausal women: a retrospective study.

OBJECTIVE: To investigate the associations between vaginal microecological alterations and varying grades of cervical lesions in postmenopausal women, aiming to provide clinical evidence for the prevention and treatment of cervical lesions in this population. METHODS: A total of 441 postmenopausal women who attended Qinghai Red Cross Hospital from January 2022 to January 2025 were enrolled. According to cervical histopathology, subjects were divided into a control group (n = 147, without cervical lesions) and a study group (n = 294). The study group was further categorized into low-grade squamous intraepithelial lesion (LSIL, n = 187), high-grade squamous intraepithelial lesion (HSIL, n = 72), and cervical cancer (CC, n = 35) subgroups. General demographic data were collected and analyzed. All participants underwent high-risk human papillomavirus (HR-HPV) testing, vaginal microecological functional assays-including pH, cleanliness, hydrogen peroxide (H2O2), leukocyte esterase (LE), sialidase (SNA), prolyl aminopeptidase (PIP), coagulase (GADP), β-glucuronidase (GUS), and N-acetyl-β-D-glucosaminidase (NAG)-and screening for common pathogens such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and Trichomonas vaginalis (TV). Intergroup differences were analyzed, and multivariate logistic regression was employed to identify independent independently associated with cervical lesions in postmenopausal women. RESULTS: Baseline characteristics were comparable between groups (P > 0.05). The HR-HPV positive rate in the study group was significantly higher than in controls, increasing with lesion severity (P < 0.001). Among HR-HPV positive subjects, BV positivity was significantly higher than in HR-HPV negative subjects (P < 0.001), whereas VVC positivity was significantly lower than in HR-HPV negative counterparts (P = 0.002). HR-HPV positive women exhibited higher rates of abnormal vaginal pH ( > 4.5), decreased cleanliness (grades III-IV), and positivity for LE, GUS, and NAG compared to HR-HPV negative individuals (P < 0.001). Within the study groups, abnormal pH, decreased cleanliness, H2O2 positivity, LE, SNA, PIP, and BV detection rates were significantly elevated relative to controls, correlating positively with lesion severity (P < 0.001). Multivariate analysis identified HR-HPV infection (OR = 8.58), H2O2 positive (OR = 12.40), SNA (OR = 5.06), PIP (OR = 3.07), and BV infection (OR = 10.80) as independent independently associated with cervical lesions (P < 0.05). CONCLUSION: Cervical lesion development and progression in postmenopausal women are closely associated with persistent HR-HPV infection, vaginal microecological dysbiosis, and BV. H2O2 deficiency, BV infection, and HR-HPV positivity constitute the strongest risk factors. Monitoring and modulation of vaginal microecology may offer novel preventive and therapeutic strategies against cervical disease in this population.