Your vagina is full of bacteria, and that’s a good thing! It’s called your vaginal microbiome, and it’s every bit as important as your gut microbiome—except way more specialized. Your vaginal microbiome consists mostly of bacteria from the genus Lactobacillus, who are "vagina specialists." Lactobacilli have the important job of making lactic acid, which stimulates healthy cervical mucus and discourages the growth of unwanted bacteria, yeast, and viruses. It's important to maintain a healthy balance of these bacteria for a number of reasons.
The benefits of a healthy vaginal microbiome.
A healthy vaginal microbiome reduces the risk of sexually transmitted infections (STIs), bladder infections, and cervical cancer. It supports healthy fertility and pregnancy, and may even play a role in the prevention or treatment of endometriosis.
A healthy vaginal microbiome is also how you avoid the annoying symptoms of yeast infections and bacterial vaginosis (BV), the two most common "ecological disorders" of the vaginal microbiome. Yeast infections are an overgrowth of what should be a relatively small population of yeast living in your microbiome. They cause an itchy cottage-cheese type of discharge. BV is an overgrowth of what should be a relatively small population of normal bacteria such as Gardnerella. It causes a watery fishy-smelling discharge. Neither condition should be mistaken for the clear slippery discharge that is normal fertile mucus.
If you suffer recurrent yeast infections or BV, please check with your doctor. You may also want to look at uBiome’s new vaginal microbiome test and consider a vaginal probiotic.
Common saboteurs of the vaginal microbiome.
Your vaginal microbiome is a delicate flower and is vulnerable to disruption. For one thing, your microbiome can be temporarily disrupted by menstruation and by anything that goes into your vagina. That includes diaphragms, spermicide, tampons, IUDs, and sexual activity.
"The risk lies in having sex with a new partner, which is a microbial assault on the vagina," says researcher Janneke van de Wijgert. Sex with a long-term partner is different because the vaginal microbiome can adapt and develop a tolerance. Your vaginal microbiome can also be disrupted by systemic factors that damage lactobacilli. Such factors include antibiotics, obesity, smoking, stress, and the estrogen deficiency that occurs with amenorrhea, menopause, or progestin-only birth control. (Estrogen is good for the vaginal microbiome because it stimulates vaginal cells to make the glycogen that feeds lactobacilli.)
Finally, your vaginal microbiome can be profoundly harmed by douching or any kind of vaginal washing, which depletes lactobacilli. Douching increases the risk of pelvic inflammatory disease, cervical cancer, and BV. In fact, women who douche are five times more likely to develop bacterial vaginosis.
How to support the vaginal microbiome with five easy steps.
Thinking your vaginal microbiome might need a little love? There's a lot you can do. Here are five tips to support the health of your vaginal microbiome:
1. Don't douche or use any kind of feminine hygiene product.
Your vagina keeps itself clean with lactic acid and the normal flow of vaginal discharge. Trying to "help it out" with vaginal washing will only deplete lactobacilli and increase your risk of bladder infections and BV.
2. Quit smoking.
The toxins from cigarette smoke damage the vaginal microbiome and have been found to directly contribute to the "fishy" vaginal malodor of BV.
3. Consider using condoms.
If you’re struggling with recurrent bacterial vaginosis, consider using condoms for a while, especially with a new partner.
4. Maintain a healthy gut microbiome.
As I explain in my book, Period Repair Manual, the microbiome is a whole-body ecosystem. That’s why improving your gut microbiome can result in a happier, healthier vaginal microbiome. Simple strategies include avoiding refined sugar and eating plenty of vegetables or "prebiotics" to feed good bacteria.
5. Take a vaginal probiotic.
Finally, you can look at a "vaginal probiotic." They’re strains of lactobacilli that have been scientifically proven to restore the vaginal microbiome and treat yeast infections and BV. The best-studied product is a combination of Lactobacillus rhamnosus and Lactobacillus reuteri, which can be taken orally and is generally what I prescribe for my patients. Probiotics can also be inserted vaginally as pessaries or capsules like the Swiss vaginal tablets that combine Lactobacillus acidophilus with the gentle estrogen estriol (because estrogen promotes a healthy vaginal microbiome).
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