The Vaginal Microbiome

Did you know that your body consists of 30 trillion cells? And did you know that in addition to your own cells, the cells of way more than 30 trillion microorganisms are always in and around your body? Sounds scary, but don’t worry – it is not.

In fact, most of these cells are from bacteria and other microorganisms that help you with activities such as protecting you from harmful diseases. The sum of these non-human cells in and around your body is called the body’s microbiome. You might have already heard about the gut microbiome, but many other types of microbiome often get forgotten. One example of this is the vaginal microbiome, or vaginal flora, which is crucial for your intimate health and has the following functions:

1. Protecting your body from infections that can result in bacterial vaginosis, candidiasis, and sexually transmitted diseases;
2. Supporting fertility

An unbalanced vaginal microbiome, or vaginal flora, commonly referred to as dysbiosis, poses several risks and challenges to women’s health. Normally, the vaginal flora is dominated by lactobacilli, which produce lactic acid to maintain a low pH and prevent the growth of harmful bacteria. When this balance is disrupted, it can lead to an overgrowth of other bacteria, resulting in conditions such as bacterial vaginosis (BV). BV increases the risk of sexually transmitted infections (Brotman et al.), including HIV, and can contribute to complications in pregnancy such as preterm delivery (Hillier et al.).

Moreover, an unbalanced vaginal microbiome can lead to recurrent infections, such as yeast infections and urinary tract infections, which can significantly impact a woman’s quality of life. Symptoms like itching, burning, and abnormal discharge are common, causing discomfort and stress. Managing these conditions often requires frequent doctor visits and prolonged use of medications, which can disrupt the microbiome further, leading to a cycle of imbalance and infection (Mayer et al.). Thus, maintaining a healthy vaginal flora is crucial for both reproductive health and overall well-being.

Lactobacillus, how can they help?

The vaginal microbiome can be a complex ecosystem since it is comprised of other various bacterial species that play critical roles in maintaining vaginal health (Franco et al.). These bacteria form distinct community (group of bacterias) structures known as community state types (CSTs), which can vary from person to person and influence overall health outcomes. Research has identified several CSTs, each characterized by the dominant bacterial species present and their relative abundance.

One of the most well-known CSTs is dominated by Lactobacillus species, particularly Lactobacillus crispatus, Lactobacillus jensenii, Lactobacillus gasseri, or Lactobacillus iners. This CST is associated with a healthy vaginal environment due to the production of lactic acid, which helps maintain an acidic pH, thereby inhibiting the growth of harmful pathogens.

Imagine that: Lactobacillus are like the superheroes of your vaginal microbiome, quietly working behind the scenes to keep everything in balance and protect you from nasty infections. They’re masters at maintaining just the right level of acidity down there, which makes it tough for bad bacteria to thrive. Think of them as your personal bodyguards, warding off harmful invaders and keeping your lady parts healthy and happy. So next time you hear about probiotics or “good bacteria,” remember that Lactobacillus is the star of the show, ensuring everything stays in tip-top shape below the belt.

Understand more about the Community State Types:

CST I (Lactobacillus crispatus Dominant):

Dominant Bacteria: Lactobacillus crispatus
Characteristics: High abundance of L. crispatus, maintaining a low pH environment through lactic acid production.

CST II (Lactobacillus gasseri Dominant):

Dominant Bacteria: Lactobacillus gasseri
Characteristics: High abundance of L. gasseri, contributing to acidity and vaginal health.

CST III (Lactobacillus iners Dominant):

Dominant Bacteria: Lactobacillus iners
Characteristics: High abundance of L. iners, but less stable and associated with intermediate vaginal health.

CST IV (Gardnerella vaginalis Dominant):

Dominant Bacteria: Gardnerella vaginalis, Prevotella spp., etc.
Characteristics: Low abundance of lactobacilli, high diversity of anaerobic bacteria, associated with bacterial vaginosis (BV).

CST V (Diverse):

Dominant Bacteria: Diverse mix of bacteria, including Lactobacillus spp., Prevotella spp., Atopobium spp., etc.
Characteristics: Highly diverse community with no clear dominant species, often seen in women of African ancestry.

However, not all individuals have a vaginal microbiome dominated by Lactobacillus species. Other CSTs may be dominated by diverse bacterial species, including Gardnerella vaginalis, Atopobium vaginae, Prevotella spp., and those are considered bad bacterias, like a “villain” of your microbiome, and others. These CSTs are often associated with dysbiosis, an imbalance in the vaginal microbiome that can predispose individuals to various vaginal infections and conditions such as bacterial vaginosis (BV) and yeast infections (Petrova et al.).

Understanding the composition and dynamics of CSTs is crucial for personalized healthcare and the development of individualized interventions to promote vaginal health. Factors such as hormonal fluctuations (specially during MENOPAUSE), sexual activity, antibiotic use, and your diet can influence the composition of the vaginal microbiome and shift individuals between different CSTs, a factor that can also open doors to the prevalence of the “bad bacterias”, causing infections and symptoms such as itching, bad odor, pain during sexual intercourse, and others disruptive symptoms.

By studying the vaginal microbiome and its CSTs, researchers aim to uncover new insights into the complex interplay between microbial communities and host health, paving the way for innovative approaches to prevent and treat vaginal infections and promote overall well-being (Silva-Franco et al.).

Oral probiotics and vaginal health, is there a connection?

Recent studies have shed light on an unexpected connection between oral probiotics and vaginal health, offering new hope for women seeking natural solutions . While traditionally associated with gut health, certain strains of beneficial bacteria, like Lactobacillus, can actually make their way from the digestive system to the vagina, helping to maintain its delicate balance (De Leo et al.). Research suggests that regularly consuming oral probiotics containing Lactobacillus strains can positively influence the composition of the vaginal microbiome, promoting a healthy environment that wards off infections.

For many women, maintaining vaginal health can be a constant concern, with issues like yeast infections and bacterial vaginosis disrupting daily life. However, the emerging evidence on oral probiotics offers a simple and convenient way to support vaginal wellness from the inside out. By bolstering the body’s natural defenses with beneficial bacteria, oral probiotics can help to reinforce the protective barrier of the vaginal microbiome, reducing the risk of infections and promoting overall well-being (Petricevic et al.). 

What can probiotics do for the vaginal microbiome?

Incorporating oral probiotics into your daily routine could be a proactive step toward maintaining a happy and balanced vaginal microbiome, offering peace of mind and empowering women to take control of their health naturally. Food supplements (the famous Probiotics), specifically addressed to the vaginal flora, are currently being used by many women worldwide. Assessing the most prevalent bacteria in each woman’s allows for personalised supplements to be indicated to meet your individual needs.

Dr. med. Virginia Franco, founder of YONI Solutions and a gynecologist specializing in intimate health, states, “It is important for all women to maintain a balanced and healthy vaginal microbiome to promote overall health and well-being”.

Your lifestyle is connected to your vaginal flora balance

To achieve this, she recommends not only the Probiotics but practicing good hygiene, such as avoiding vaginal douching and refraining from wearing tight clothing.
If you’re picking out underwear to sleep in, cotton is a great choice—it’s super comfy! And when it comes to washing, just stick to a gentle, neutral soap—coconut-based ones are awesome. Make sure you let them dry all the way in a spot that’s nice and dry before you wear them again.

Furthermore, women should prioritize vulva hygiene and engage in safe sexual practices, while also limiting stress, alcohol consumption, and avoid smoking to protect the balance of their vaginal microbiome.

Regular visits to a healthcare provider are essential.

Incorporating fermented foods and drinks like yogurt and kefir into one’s diet can help boost the number of beneficial bacteria in the vagina (Maftei et al.).

Don’t forget that staying hydrated helps maintain vaginal lubrication and reduces the risk of infections. Your intimate health is linked to all of your body, make it part of your priorities!!! Women’s health is a huge topic, and you should be part of it! Stay tuned!