Is your vaginal microbiome impacting your reproductive health?

Pre-note: My approach to my work is heavily supported by science, and I place enormous value on the research. There is some additional reading at the bottom of this post, should you want to muse over any of the studies that have informed this piece of writing.

It’s a bit of a hush hush topic, the vaginal microbiome, and one that a lot of women know little about but the concept that the vaginal tract has a microbiome was classified a little under a decade ago, and the research has continue to shred led on this fascinating subject.

Microbes of the vagina, are unique from the gut in terms of diversity. Most of us are pretty hot on the idea that we want a diverse gut flora, but not in the vagina. Unlike the gut we don’t want lots of species, and a healthy vaginal flora is characterised by low diversity, dominated by a species of bacteria called Lactobacilli. The same one that can be found in your kefir. The fine balance of bacteria inhibits the growth and spread of pathogens.

Having a colony that is rich in lactobacilli will promote an acidic environment. Ideally you’d be after a PH of 3.6 – 4.5. So something like a soap or perfume wash could impact the delicate PH balance here.

Therefore an imbalance will be characterised by a shift in your lactobacilli colony – prime example of how this might present itself would be bacterial vaginosis as you will shift into a more alkaline state as your lactobacilli species become less dominant.

Why is it an issue if there is vaginal dysbiosis?

If there is an imbalances of the vaginal flora, research suggests potential major roles with health outcomes like infertility, frequent miscarriage, successful embryo transplant, pre-term birth, endometriosis, frequent urinary tract infections, thrush, bacterial vaginosis and vagino-vulval itching. Plus, you could be more likely to contract an STI when exposed to it if there is an imbalance of your vaginal flora. Therefore your vaginal flora composition plays a huge role in vaginal, reproductive and overall health. And sadly, as I see in my private clinic, many women are not aware of this connection.

Studies have cited observations which implicate adverse vaginal microbiota composition in early pregnancy with subsequent risk of miscarriage. A bacteria called Gardnerella Vaginalis has been observed as being an important feature in this high risk, as high levels of this bacteria will promote a lactobacillus depleted composition. Other studies have observed that women with recurrent miscarriages frequently had vaginal infections, such as bacterial vaginosis, fungal vaginosis, or mycoplasma infection.

Hormones and the Vaginal Microbiome

Healthy oestrogen levels will support a vaginal flora composition that is Lactobacillus dominant - the bacteria you want to be dominant in this environment.  Compositions will change ever so slightly in the female monthly cycle but it remains fairly stable.

 Low oestrogen states (peri/menopause, PCOS) can see an opportunity for vaginal dysbiosis interlinked to drop/low levels of oestrogen.

On the flip side high oestrogen states (endometriosis, potentially OCP use or some uses of HRT) could be protective for the vaginal microbiome but drive the risk of fungal overgrowths.

 It’s a fine balance!

What can impacts it?

 There are some things that fall out of your control, like age and genetics (although you can impact how you express genetics) but there are lots of ways in which you can positively impact your vaginal microbiome.

 Diet and nutrition being top of the list (in particular blood sugar balance and maximising colourful foods rich in polyphenols), your gut health, improving sleep, reducing stress, embracing positive action, movement and an appropriate personal hygiene routine.

Diving into the nutrition side of things - maximising prebiotic and probiotic rich fermented foods will promote Lactobacillus to grow and thrive. Think kefir, kimchi and sauerkraut. Supplement wise you could seek out a probiotic that contains specific vaginal strains, such as Lactobacillus Crispatus. The bacteria within an oral supplement or food will eventually make their way to your vagina. There are cross-contaminations between your gut, urinary and vaginal microbiomes. This will also be the case of sexual partners.

Hygiene

The vagina is a self-maintaining organ. If there are vaginal symptoms like discharge or foul smell you’re potentially instinctively going to want to use a soap or perfumed wash, but that could drive the PH into a further alkaline state. Don’t do it. Water is key and focusing on changing the ecology of the vaginal flora instead. And always speak to your GP with any odd or smelly discharge.

Sanitary wear should not contain perfumes, pick lubricants that are low in irritants and chemicals, and are unscented and sterilise sex toys and practice safe sex.

It might seem dreamy to stay your active wear all day but you need to let your vagina breath using natural fibres. Think about your underwear and change if you’re in sweaty leggings. 

In my private one to one clinic I often run vaginal ecology functional testing. If you’d like to understand more about your own vaginal microbiome, get in touch to book your free discovery call.

References:

https://pubmed.ncbi.nlm.nih.gov/35008605/

https://pubmed.ncbi.nlm.nih.gov/27657355/

https://pubmed.ncbi.nlm.nih.gov/35090453/

https://sti.bmj.com/content/sextrans/early/2022/03/28/sextrans-2021-055352.full.pdf