This study aimed to evaluate the vaginal microecology in patients with severe vulvovaginal candidiasis (SVVC). Vaginal microecology was evaluated using vaginal secretions that were collected from 452 patients with SVVC, who were treated between September 2013 and April 2014. The predominant bacteria were lactobacilli (69.91% of the cases). The vaginal flora intensity was level II-III in 81.42% of the cases, and the vaginal flora diversity was level II-III in 77.65% of the cases. Level I cleanliness was exhibited by 276 patients (61.06%), compared to level II cleanliness in 75 patients (16.59%) and level III cleanliness in 101 patients (22.35%). Approximately 67% of the patients had a vaginal pH of <4.5. The patients with SVVC exhibited varying degrees of vaginal microecological disorders, although the predominant bacteria were still lactobacilli. Most cases exhibited vaginal intensity and diversity that were within the normal ranges.