In relation to western research; our body’s microbiota and supplemental probiotics are basically the new kids on the block. You’ve probably heard about the microbiome in your gut. It’s the collection of tiny microorganisms such as bacteria, yeasts and fungi that have a powerful effect on your health and wellness. But, most don’t know that a similar ecosystem lives in the female vagina. It is known as the vaginal microbiome, and it plays a significant role in keeping women healthy.

Yes it’s true, you have ‘bugs’ in your ‘bits’ too, and they are very important in maintaining the health of our reproductive health. The vagina is a complex balance of hormones, acidity levels and bacteria; and here’s the basics on what we can do to help maintain this balance.

A healthy vaginal ecosystem:

A healthy vaginal ecosystem is dominated by hydrogen-peroxide producing lactobacilli. Many strains of bacteria come under this umbrella of species, and protect the vagina in two main ways: (1) stick and form a barrier on the vaginal mucus to protect it against invading pathogens; and (2) produce antimicrobial substances (i.e. hydrogen peroxide & lactic acid) that fight pathogens which allows ‘good’ bacteria to grow. Optimal pH in the vagina is between 4.0-4.5 (acidic) which supports the growth of beneficial bacteria whilst deterring yeast and harmful bacteria from proliferating. It’s important to note a small presence of potential pathogens is still considered normal and healthy (e.g. Candida spp. & E. coli).

Causes of an unhealthy vaginal ecosystem:

Antibiotic use: kills off the ‘good’ and the ‘bad’ bacteria.

Increased frequency of intercourse: semen is very alkalising and can change the pH in the vagina thus reducing its anti-microbial effectiveness against the growth of pathogens due to a less hostile environment.
Spermicides: used as a form of contraception; has shown to reduce numbers of hydrogen-peroxide producing lactobacilli.
Vaginal washing: douching, soaps and chemical feminine hygiene products can change the acidity of the pH and can also kill or dislodge beneficial bacteria therefore reducing defensive barriers against potential infections. Rule: water alone is perfectly fine!
Smoking: can alter oestrogen and pH levels in the vagina; whilst studies have found traces of nicotine in cervical/vaginal discharge which may promote inflammation.
Dramatic hormonal changes: drastic oestrogen alterations (e.g. post menopause) can alter pH and reduce levels of hydrogen-peroxide producing bacteria.

Consequences of microbial imbalance can result in increased risk of candida infections, bacterial vaginosis, recurrent UTIs and STI’s e.g. gonorrhoea and chlamydia.

Probiotics & vaginal microbiota:

‘Probiotics’ are living organisms which are beneficial to the body when consumed or applied. They can be found naturally in food; however are often used therapeutically via oral capsules. In terms of treatment for reproductive health, probiotics can also be applied intra-vaginally (deposited inside the vagina) in the form of creams/ointments, pessaries or even placed on top of a tampon dipped in pre-biotic solution or natural greek yogurt and then inserted into the vagina.

‘Prebiotics’ are ‘food’ for the probiotics which allows them (and other beneficial bacteria) to grow and thrive. The product ‘Lactulose’ is considered the vaginal probiotic as it cannot be used by pathogens and is utilised as a food source by lactobacilli.

Specific conditions and key indicated probiotics may include:

Vaginal candidiasis (thrush):

Common infection caused by the overgrowth of yeast (Candida albicans)

Oral probiotics: Lactobacillis (L.) acidophilus La5; L. rhamnosus GR-1; L. Reuteri RC-14
Intra-vaginal probiotics: L. rhamnosus GG; L. acidophilus NAS
Lactulose: oral use and intra-vaginal application
Other herbs: Green tea, oregano, pomegranate husk

Recurrent UTIs:

UTI (Urinary tract infection). Almost half of women experience recurrences after initial infection. Common risk factors include: reduced levels of lactobacilli bacteria, increased number of sexual partners, increased intercourse frequency, and failure to urinate soon after intercourse.

Oral probiotics: L. rhamnosus GR-1; L. fermentum RC-14
Intra-vaginal probiotics: L. rhamnosus GR-1; L. fermentum B-54
Lactulose: oral use and intra-vaginal application
Other herbs: Bear berry (Arctostaphylos uva-ursi), cranberry (reduces adhesion properties to harmful bacteria), couch grass, juniper berries

Bacterial vaginosis:

Microbial syndrome where naturally occurring bacteria is out of balance. i.e. vaginal lactobacilli are replaced by anaerobic bacteria causing high levels of inflammation and volatile vaginal environments. Considered very common after antibiotics and often misdiagnosed as thrush. Symptoms include: white or gray vaginal discharge, pain, itching or burning, fish-like odour, burning when urinating.

Oral & intra-vaginal probiotics: L. rhamnosus GR-1; L. reuteri RC-14
Lactulose: oral use and intra-vaginal application
Local vitamin C application: highly indicated to reduce severity and also reoccurrence of bacterial vaginosis.

Bugs in your bits - is your vaginal microbiome out of balance?