The Vaginal Microbiome & Probiotics for Bacterial Vaginosis, Yeast Infections, Dryness & Other Symptoms
Tuesday, 15 June, 2021

The Vaginal Microbiome & Probiotics for Bacterial Vaginosis, Yeast Infections, Dryness & Other Symptoms

Got a particularly intimate female health issue? You’re not alone.

From bacterial vaginosis and yeast infections to pH imbalance and dryness, many women will have to contend with at least one common vaginal condition at some point in their lives.

Now, you’ve probably heard of the gut microbiome, possibly even the oral microbiome. Well, every woman also has a vaginal microbiome. These communities of microorganisms play a critical role in the maintenance of a healthy vagina.

So, when it comes to supporting your vaginal flora, can probiotics provide a benefit? What is the evidence that these ‘friendly’ bacteria might be able to alleviate or protect against common vaginal health issues?

Firstly, let’s discuss the vaginal microbiome and vaginal probiotics.

What is the vaginal microbiome and why does it matter?

The vaginal microbiome, also commonly known as your vaginal flora, is a term that describes the communities of microorganisms that reside in your vagina.

Your body is teeming with microbes that thrive in those areas of warmth and moisture — predominantly the gut, the mouth and, of course, the vagina. Collectively, these are known as the human microbiome. It is home to in excess of 10 trillion microbial cells — bacteria, fungi, archaea and viruses.

The vaginal flora is a cluster of several dynamic microbial communities. Their structures can change quickly and can have a big impact on vaginal health outcomes. A balanced vaginal flora must be dominated by Lactobacillus species; these ‘good’ bacteria produce substances like lactic acid, preventing the growth of unfavourable strains of yeast and bacteria.

The importance of maintaining a Lactobacillus-dominated vaginal microbiome for maintaining good vaginal health is unequivocal. A vagina’s ideal pH level is a slightly-acidic 3.8–4.5; when it’s higher (also known as ‘dysbiosis’), you’re at a higher risk of developing a range of urogenital and gynaecological problems like sexually transmitted infections (STIs), yeast infections, urinary tract infections and bacterial vaginosis.

As such, to keep your vaginal microbiome balanced and healthy, you need to ensure the presence of friendly, beneficial lactobacilli bacteria. This is where vaginal probiotics have been touted as a helpful way for keeping our vaginal microbiota in tip-top shape.

What are vaginal probiotics?

Vaginal probiotics are friendly live microorganisms that can be introduced to your body to boost your vaginal health. These work by providing strains of ‘good’ bacteria that improve your vagina’s microbiota composition. The most commonly-touted beneficial type of probiotic bacteria are Lactobacillus.

Many probiotics products have been developed in recent years, marketed specifically for vaginal health. These contain a mixture of these beneficial lactobacilli bacteria strains. Most commonly, vaginal probiotics are available daily oral supplements, but some are applied to the vagina.

When it comes to their role in human health, the use of probiotics to augment our bodies’ bacterial populations is ‘gradually achieving scientific acceptance’. Most often, when women seek out vaginal probiotics, they are doing so to treat or prevent the two most common urogenital health problems — bacterial vaginosis and yeast infections.

Whilst you should always consult your doctor if you’re concerned about vaginal health, what’s the current evidence for the effectiveness of probiotics in preventing, alleviating or treating these common vaginal issues?

How can probiotics help with bacterial vaginosis?

Bacterial vaginosis (BV) is one of the most common vaginal health problems reported by women of childbearing age — it is estimated that one in three will have it at some point in their lives.

Most women know that BV can be characterised by a fishy-smelling vaginal discharge, but many aren’t aware that around half of all BV cases are believed to be asymptomatic.

BV is characterised by an overabundance of ‘bad’ anaerobic organisms in the vaginal microbiome — most commonly Prevotella and Gardnerella vaginalis — with a loss of the ‘good guy’ Lactobacillus bacteria. This results in the vagina losing its ideal acidity, causing its pH level to increase over 4.5.

Interestingly, the precise causes of BV are not yet fully known and it has been described as ‘one of the great enigmas in women’s health’. You’re at increased risk if you’re sexually active, have a contraceptive IUD device or use perfumed products around your vagina. Many women suffer from recurrent BV.

It is most commonly treated with antibiotic creams, tablets or gels. But can probiotics provide a helping hand in avoiding and treating BV?

According to a scientific review, there’s evidence from a range of clinical trials that a daily probiotic supplement helps to prevent and treat bacterial vaginosis. The most promising probiotic strains were Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14, with no reporting of adverse side effects.

An older review reported similar findings — certain probiotic strains of Lactobacillus successfully inhibit the growth of bacteria-causing BV, again highlighting L. acidophilus, L. rhamnosus GR-1 and L. fermentum RC-14.

In a number of clinical trials, these strains were proven to increase numbers of vaginal Lactobacilli and restore a balanced vaginal microbiota.

The consensus amongst scientists seems to be that the effectiveness of probiotics on BV is mostly positive, but further clinical trials are needed to reach a ‘definitive conclusion’.

Another recent overview of peer-reviewed studies into the effectiveness of probiotics on BV concluded that research shows there is ‘rationale for use of proven probiotic strains to maintain vaginal health and reduce the risk of recurrent symptomatic bacterial vaginosis’.

The mode of action of these probiotic strains is still an area of ongoing research. Needless to say, you should always consult your doctor for medical advice if you’re concerned about BV or your vaginal health, but probiotics are proving to be a potentially useful asset.

How can probiotics help with yeast infections?

We’ve all heard of yeast infections — and no surprise, given that approximately three in four women will have one during their lifetime.

Itchiness and discomfort are the main symptoms, but you may also experience burning, redness or swelling of the vagina or vulva, possibly with a thick, white, odourless discharge — similar to cottage cheese.

Like with bacterial vaginosis, a yeast infection is caused by an imbalance of good and bad bacteria within your vagina. They occur when the fungus candida grows out of control, overwhelming our good lactobacilli bacteria. Candida can live passively in your vaginal microbiome, but can become harmful if too dominant.

If you think you have a yeast infection, make sure to consult your doctor. Treatment is usually a course of antifungal medicine.

But given a yeast infection is as a result of an imbalance of vaginal microbiota, can supplementing with friendly microorganisms — vaginal probiotics — help to prevent or treat the development of a yeast infection?

One review of clinical trials has concluded that probiotics can reduce Candida colonisation in the vagina, relieving the signs and symptoms of yeast infection.

Probiotics may also be able to enhance the antifungal effect of conventional treatments for yeast infections. However, the authors of the review note that it is too early ‘yet’ to call probiotics an alternative to antifungals, ‘due to the paucity of available clinical trials’.

  • In one study of 55 women diagnosed with a yeast infection, a lactobacilli probiotic capsule ‘increased the effectiveness’ of antifungal treatments. The two probiotic strains responsible were Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14.
  • In a study of 64 women, a daily oral probiotic capsule of L. rhamnosus GR-1 and L. fermentum RC-14 (you guessed it!) generated no adverse effects. By day 28, the authors had witnessed a ‘significant depletion in yeast’, with an accompanying increase in lactobacilli.
  • In a small crossover trial of patients who consumed yoghurt containing Lactobacillus acidophilus for over one year, a threefold decrease in yeast infections was witnessed.
  • Due to their antifungal properties, the authors of another scientific review suggested that the most promising strains of lactobacilli for the treatment of yeast infections are Lactoballicus rhamnosus GR-1 and Lactoballicus fermentum RC-14.

Whilst probiotics have not been suggested as a primary treatment of yeast infections, clinical trials have promisingly shown that they can be effective, particularly when combined with a traditional course of antifungal treatment — and they certainly present no risks.

How can probiotics help with a woman’s pH balance?

A healthy, balanced vaginal pH level is a slightly acidic 3.8–4.5 on the 0–14 pH scale. That’s the same level as a cup of black coffee, a beer or some tomato juice.

Any higher than 4.5, and you risk the growth of harmful microorganisms within your vaginal microbiome; a high vaginal pH is associated with symptoms like burning, itchiness or unpleasant odour (essentially, bacterial vaginosis, which we discussed earlier) — so you’ll be sure to know if yours is a bit out of whack.

Lactobacilli bacteria help your vaginal pH by creating lactic acid, keeping your microbiome in pH balance and preventing the growth of ‘bad’ bacteria.

Avoiding things that are likely to interfere with your vaginal pH is the most important way to keep it balanced. Unprotected sex and ‘douching’ (the cleaning of the vagina with water, soap or another liquid) are understood to be amongst the biggest culprits.

But can taking a vaginal probiotic also help to maintain this balance, providing your body with these much-needed bacteria? Fortunately, a number of studies have demonstrated the ability of probiotics to help strains of pH-balancing lactobacilli colonise in the vagina.

  • The consumption of a probiotic containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 helped these good bacteria to colonise in the vagina effectively.
  • By working to inhibit the growth of bad bacteria and promote the colonisation of friendly organisms, one review stated that the most useful probiotic strains for managing vaginal pH are L. rhamnosus GR-1, L. fermentum RC-14 and L. acidophilus.
  • A recently-published analysis suggests that lactobacilli probiotics prevented the growth of imbalance-causing bacteria, stabilising vaginal pH.

If you have particular concerns about your vaginal health or the pH of your vagina, make sure to consult your doctor.

How can probiotics help with vaginal dryness?

At some point in their lives, many women will experience things being a bit drier down there than they’d prefer. This is particularly true for women going through the menopause — vaginal atrophy is a common symptom.

So, can probiotics help with vaginal dryness? There is some limited evidence available suggesting that a well-chosen lactobacilli-containing probiotic may be able to help with vulvar vaginal atrophy and dryness. The report’s authors call for a ‘personalised’ treatment, consisting of a ‘rational’ selection of a probiotic based on species-specific appreciation of vaginal ecology.

So, vaginal probiotics: what’s the verdict?

The relationship between probiotics and restoring the vaginal flora is still an ‘area of active research’, although there is a growing body of very promising clinical evidence demonstrating the effectiveness of certain probiotics in alleviating and treating BV and yeast infections, particularly lactobacilli bacteria strains.

For any particular vaginal health worries, always consult your doctor or GP.

At Inspired Health, we provide a leading range of probiotic supplements that help men and women of all ages to live healthier, happier lives.

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