Fertility Foundations: Fertility and the vaginal microbiome with Debbie Cotton

Welcome to the latest series of Fertility Foundations, where we speak in depth with expert guests about how to prepare the foundations for healthy pregnancy. This week Sandra Greenbank is talking to Debbie Cotton, Head of Clinical Innovation at Invivo Healthcare, about the vaginal microbiome and how this can affect fertility.

In this episode Sandra and Debbie discuss the significance of the vaginal microbiome in fertility, looking at its impact on reproductive health. They highlight the importance of understanding and working with one’s vaginal microbiome for optimal fertility outcomes, and provide insights into the role of nutritional therapy, microbiome testing and the potential harmful effects of conventional period products on not just the vaginal microbiome but also overall health.

You can find more information about microbiome testing at Invivo’s website here: www.invivohealthcare.com

Or find them on Instagram @invivohealthcare

This podcast is sponsored by Invivo Healthcare, a human microbiome company. They specialise in accurate testing of different microbes such as the gut, vagina, oral and urinary, as well as a range of specially curated supplements focused on the microbiomes. They support healthcare providers and their clients navigate the complex world of the human microbiome and it’s one of the most used labs and supplements by our own fertility specialists at the Fertility Nutrition Centre. Visit the Invivo website for more information at www.invivohealthcare.com

Podcast transcript

Sandra Greenbank  00:06

Hello and welcome to the Fertility Foundation’s podcast where we go into detail about how to prepare the foundations for healthy pregnancy. We dive deep into the underlying root causes for fertility issues and natural solutions. I want you to know that you’re not alone and you’re not broken. I hope that by sharing these episodes, it will help you move from feeling overwhelmed and lost to feeling hopeful and empowered to take charge of your own path to parenthood, because there are actually lots of things that you can do to help rewrite your own story. I’m Sandra Greenbank, Nutritional Therapist, Functional Medicine Practitioner, coach and educator specialising in fertility, pregnancy and postpartum health. I’m also the founder of the Fertility Nutrition Centre, where you can find fully trained experts in nutrition, lifestyle and functional approaches to healthy fertility and pregnancy. You can find out more information over at www.fertilitynutritioncentre.org and also begin a free strategy call with one of our experts. 

Today I’m speaking with Debbie Cotton all about the vaginal microbiome.  

This podcast is sponsored by Invivo Healthcare, a human microbiome company. They specialise in accurate testing of different microbes such as the gut, vagina, oral and urinary, as well as a range of specially curated supplements focused on the microbiomes. They support healthcare providers and their clients navigate the complex world of the human microbiome and it’s one of the most used labs and supplements by our own fertility specialists at the Fertility Nutrition Centre. Visit the Invivo website for more information at www.invivohealthcare.com

Now let’s get into today’s interview with Debbie. Debbie, thank you for coming on to the podcast and talking to us about the vaginal microbiome.

Sandra Greenbank  00:04

Hello, welcome to the fertility Foundation’s podcast where we go into detail about how to prepare the foundations for healthy pregnancy. We dive deep into the underlying root causes for fertility issues and natural solutions. I want you to know that you’re not alone and you’re not broken. I hope that by sharing these episodes that will help you move from feeling overwhelmed and lost to feeling hopeful and empowered to take charge of your own path to parenthood, because there are actually lots of things that you can do to help rewrite your own story. I’m Sandra Greenbank nutritional therapist, functional medicine practitioner, coach and educator specializing in fertility, pregnancy and postpartum health. I’m also the founder of the fertility Nutrition Center, where you can find fully trained experts in nutrition, lifestyle and functional approaches to healthy fertility and pregnancy. You can find out more information over at www dot fertility nutrition center.org and also begin a free strategy call with one of our experts. Today I’m speaking with Debbie Cotton all about the vaginal microbiome. This podcast is sponsored by enviva healthcare a human microbiome company. They specialize in accurate testing of different microbiome such as the gut vagina or a urinary tract, as well as a range of specially created supplements focused on the micro biomes. They support healthcare providers and their clients navigate the complex world of the human microbiome. And it’s one of the most use labs and supplements by our fertility specialists. Visit their website for more information at www dot invivo healthcare.com. Now let’s get into today’s interview with Debbie. Debbie, thank you for coming on to the podcast and talking to us about the vaginal microbiome.

Debbie Cotton 01:42

Oh, my pleasure. Thank you for having me.

Sandra Greenbank  01:44

Would you like to give the listeners a brief introduction of who you are?

Debbie Cotton 01:49

I’m sure. So my name is Debbie Cotton. I’m the head of clinical innovation in vivo UK, which is a microbiome company. We specialize in testing the microbiome and everything around the human microbiome. And I’m also a naturopath and a psychotherapist for many years.

Sandra Greenbank  02:07

Oh, great. What an amazing collection of skills. So you mentioned the microbiome. So you know, our understanding is obviously that there are lots of different micro biomes. But what is what is a microbiome?

Debbie Cotton 02:21

That’s a really good question. Basically, a microbiome describes a area or an environment is probably the best word in which there is both an environment and a community of microbes that live within that environment. So the term microbiome is describing both the environment and the microbes together as one. Now, there are lots of micro biomes everywhere. Like if we think about the human body, the most well known one is the gut microbiome. But you’ve also got a nasal microbiome and armpit microbiome and vaginal microbiome, like everywhere in your body is a little kind of environmental niche, which is going to attract to different community and microbes that live there. And those community of microbes are really important, because what they do is they not only are they we’re giving them a home, but in return, they give us lots of benefits for being there. So they make lots of different metabolites and other things that we can use, and it can impact us as a human being as well. And there’s also, you know, microbiomes, outside of your body, in the home, in your bathroom, in your environment around you, depending on what city you live, so on and so forth.

Sandra Greenbank  03:34

Yeah. And these microbiome surfaces shared. So families will share generally, you know, those who live together will share micro biomes and those and partners and you share your microbiome with your children and they can they actually inherit your microbiome as such, when through the vagina when they’re born, and also through the placenta and some some from the breast milk. And they so what but when we’re talking specifically about the vaginal microbiome there, could you explain a little bit more about what that is and what community we’re looking at looking for and the environment? Absolutely.

Debbie Cotton 04:09

So if we had this conversation, probably 1015 years ago, the term vaginal microbiome was not common at all it was either your vagina was okay, or you had thrush. So it was like you had you had bad bugs, or, you know, there was no thought of what was their living on a day to day basis. And what’s kind of happened and exploded in microbiome science in the last kind of 10 to 15 years is we can test the microbiome in very, very different ways. These days. It’s called DNA technology. So it can pick up types of microbes that don’t necessarily like to grow on the old culture techniques that we still use to an extent. But a lot of microbes don’t like oxygen, so they’re not going to grow in sort of a culture technique. So when you use these DNA techniques, you would have heard of PCR are because of COVID. But there’s other ones out there like NGS and others as well. And basically, what they can do is they can pick up the whole story of microbes that are living in environment. So what that has been shown us is an explosion of research into the vaginal microbiome. So it’s a bit like if I kind of revert to the gut microbiome for a moment, because we know a lot more about that, which is, you know, basically, we know there’s communities that live in the gut that do healthy stuff for us known as commensal, bacteria or the good bacteria. And then you’ve got kind of pathogenic bacteria are ones that can cause disease, then you’ve got ones that kind of sit in the middle, they’re neither good nor bad. They’re kind of be there, because there’s room, they only become a problem when they overgrow, and they’re called Path of ions. Now, this same concept applies for the vaginal microbiome, we have what’s known as a commensal, or a healthy vaginal microbiome. And I said that, like I said, that’s something very new that we’ve only just realized in the last 10 to 15 years, we then have a group of bacteria that live in the vaginal microbiome that don’t really cause a problem, but can do if they overgrown, they’re known as the pathway by ants. And then obviously, what people know a lot about is the pathogens that can, you know, live in the vaginal microbiome. And these are generally thought of as sexually transmitted diseases and viruses, and so on and so forth. So it’s really lovely to think that we have got a community of bacteria that live in our vagina that actually are there to protect us to offer sort of metabolites and things that will enhance the actual vaginal environment. And that you know, that by looking after them, that helps to look after our vagina as well. Yeah.

Sandra Greenbank  06:44

And there’s actually quite a bit of research by Thomas miscarriage charity that came out a couple of years ago, that sort of been really helpful to me and sort of help helping clients understand or patients understand that this is not sort of Hocus Pocus, it does have an impact on your risk of miscarriage or, you know, and pregnancy outcomes. And so what, what are the infections that you generally see in vivo that are sort of potentially harmful for fertility, aside from the ones that we know like chlamydia, gonorrhea, those are checked anyway in the sort of conventional setting, but there are this bacteria that we screen for that just is not checked by the doctors or IVF clinics or fertility clinics or in the commercial setting, yet, I’m sure that this is coming. But at the moment, it’s not. So what are the infections that you’re seeing are causing particular problems?

Debbie Cotton 07:48

So I think that’s a really I’m gonna backtrack a little bit and just kind of answer your question in a long winded way, which is, I think the first thing to realize is when we think about fertility and the vaginal microbiome, like you mentioned, the Tommies study that just came out. They weren’t even looking necessarily at infections and the violent vaginal microbiome, they were looking at a lack of the commensal bacteria that can live in the microbiome. And generally in women of reproductive age, the vaginal microbiome is heavily dominated by like to bacilli, bacteria, and why like to bacilli will like to bacilli, tend to make sort of lactic acid and hydrogen peroxide. And you can hear from the names of those two things they rather acidic, and that acidity actually creates an environment which stops the overgrowth of other bacteria, so it’s kind of making it inhospitable to other bacteria growing in there. Now, there will always be a small percentage of other bacteria that just like to live in there that a normal and natural but if they overgrowth electro bacilli go down and they overgrow, you can end up with what we call states of dysbiosis or imbalance, and they’re generally termed medically things like bacterial vaginosis. You may know a thrush, which is, of course a fungal species. And the other one is known as a robic veggie rhinitis, which is, again, it’s a little bit like bacterial vaginosis, but just involves different class of bacteria and can give sort of different symptoms. Now those bacteria involved are all I wouldn’t call them infections. They’re just bacteria that do live in your vagina normally and naturally, but they take an opportunity as soon as you like to facilitate drop to overgrow. And so infertility and what we see the most of here in kind of testing and things like that is kind of imbalances in the vaginal microbiome. Either kind of moving towards a kind of a pattern that could be indicative of something like bacterial vaginosis or aerobic vaginitis. And that in itself creates a vagina microbiome that’s not necessarily hospitable to, to things like sperm, it can train, it can change the pH, you can get damaged to the epithelial barrier of the vagina. So that can result in pain, but sometimes no symptoms at all. But what it can then result in is inflammation in the area. And they inflammation can activate sort of things like your natural killer cells, and your immune system, which obviously is often a big problem when you’re trying to receive an egg. You don’t want your immune system over activated in that area. So and this is then leading back to the Tommy’s research. That’s what they were looking at. They were looking at, well, if we get a group of women that have had a miscarriage, and we screen out the ones that we know it was genetic problems, so they took out all of the ones when you know, the miscarriage was explained by the the embryo and the genetics of the embryo. So they looked at only the unexplained ones, and then they looked for the amount of like two bacilli that these women carried. And what they found is women with low electric bacilli, so more likely to have bacterial vaginosis on so on so forth had a higher, you know, the high increased risk of miscarriage. And this has been replicated in other studies in different ways as well, in different parts of the world. And in coming from different methodologies kind of looking at well, if you’ve got bacterial vaginosis, there’s an increased risk possibly of miscarriage or of preterm birth. And also things like aerobic digestion, itis one of the bacteria that is quite common there is streptococcus B. And strep B is obviously been associated with kind of preterm births and actually can be a bit of a problem in labor. Because sometimes if you pass it on to the baby, that’s not great as well, so often needs to be treated with antibiotics. So these things are getting becoming more well and well documented. And like I said, they’re not necessarily infections, they’re imbalances that can be addressed and can be kind of worked with at those early stages when you’re thinking about conceiving. Yeah,

Sandra Greenbank  12:10

and I just to clarify, for those who don’t know what an epithelial cell is, so it’s basically the lining of the wall of the vagina, and that also has an impact on the health of the vagina. And you mentioned inflammation as well. And actually, the Tommy’s one of the Tommy’s studies, if not both, did also link inflammation levels with risk of miscarriage as well. And that is something that we also measure on your on the it’s called the female ecologists, the test that we use from in vivo. So that’s also shown. And, yeah, you mentioned the bacterial vaginosis and strep bacteria as well. And the conventional treatment is antibiotics. And of course, what does that devotees wouldn’t be able to do. They don’t just wipe out the unhelpful bacteria, it wipes out the lactobacillus as well. So we ended up in a situation where certainly with bacterial vaginosis, I’m going to stop saying bacterial vaginosis and just call it BV.

Debbie Cotton 13:14

Definitely an easier version.

Sandra Greenbank  13:16

So with BV, it tends to reoccur if you take antibiotics, and that’s all you do, because it just doesn’t necessarily the most helpful way to get rid of it and keep it you know, help you stay away is.

Debbie Cotton 13:33

And that’s right. You know, that’s the, you know, antibiotics can be helpful when they’re needed. You know, sometimes some infections are hard to move, and they need a little bit of a push in the right direction. But what is really important, and I think often in conventional medicine and conventional testing, we test for the pathogens, we don’t test for the good guys. So knowing what you’re like to bacilli levels is and then after antibiotic treatment, or whatever treatment when you’ve had working towards improving, restoring supporting your life to bacilli, or your vaginal microbiome in general, you’re giving yourself your own shield, you’re giving yourself your own ability to kind of cause these like to bacilli do lots of things. They also downright regulate inflammation in the area. They, like I said they stopped the overgrowth of other pathogenic bacteria. And there has been some studies in IVF, where even they looked at using like to bacilli on kind of one of the catheters and that kind of improved the outcomes as well. So it’s just realizing that they they probably pay more roles than we even know about basically in the process. And I think that’s the thing of anything that I’d like to kind of get across today is how important it is to take care of your vaginal microbiome. Not necessarily that it’s another thing to panic about treating and kind of trying to decimate something that you think you might have infection why

Sandra Greenbank  15:01

Yeah, absolutely. I think this one, this one organism that does come up that we do tend to go for antibiotics within that’s urea plasma.

Debbie Cotton 15:12

uric plasma. Yeah. So ureaplasma is in a bit of an interesting one, there’s, there’s a few different species of ureaplasma, these your ureaplasma, Parvum, and your plasma urealyticum. And basically, a lot of women carry ureaplasma. And it’s very normal and natural. And, you know, in a lot of cases, they can fall pregnant naturally with it, and it’s not going to be a problem to the microbiome. Sometimes it is a part of a BV picture. So it’s kind of coupled with a whole heap of other bacteria that, you know, it’s just kind of holding on to a BV community. Now, that’s in a kind of, in most individuals, when you’re an individual that’s maybe had reproductive issues in the past or has had miscarriage before ureaplasma become slightly a higher risk when we look at the epidemiology of possibly recurrent miscarriage. So often, if you are having fertility issues, and we see you ureaplasma, kind of in quite high levels in your microbiome in comparison to you like to bacilli, so that’s what is important is how much is there, not just necessarily that you carry it, then you may work with your practitioner to try and reduce it or eradicate it. And so this is kind of quite nice for a subset of people, like I said that more having fertility issues or going for IVF, they might decide to look at reducing or even treating that ureaplasma with antibiotics. But in kind of like I said in the in the majority of the population, a little bit of ureaplasma is normally not too much of a problem. So it’s kind of if there’s already something underlying there, it seems to add into the kind of inflammation pattern that’s going on. And so that’s why we often want to work with eradicating it and then working again with that vaginal microbiome to restore the light to bacilli.

Sandra Greenbank  17:06

Yeah, I mean, obviously, we’re speaking now to those who are trying to conceive, most likely, who’s listening, because that’s what this podcast is about. And the other the other kind of thing to bear in mind is because it’s shared, the male partner is very likely to also carry it. Euro plasma does impact male fertility.

Debbie Cotton 17:30

It can do yeah, there is a possibility that it can impact male fertility as well. And again, it’s just remembering that some of these microbes, it depends on context, it really, really does depend on the context for the person and the couple present. But yes, if the woman is both the if the man and the woman trying to save both carry ureaplasma, and they’re having issues is something I would like to address in both the couple.

Sandra Greenbank  17:56

Yeah, absolutely. And this is simple. I mean, the male, the male seminar microbiome is the sort of, you know, we’re only beginning to explore that galaxy, like, it’s so there’s so much more unknown, but there are things that we do know, and there’s, you know, if you go on PubMed, for example, you can Google certain strains of bacteria, you know, how they might be impacted in their fertility, and there’s some research and what we do tend to do then is actually, if it’s found, in one partner, we tend to recommend that they use a barrier form of contraception until both partners have at least been checked and treated so that it’s not passed back and forth. And, you know, it is really lovely to be able to use natural compounds and sort of test and retest, but often, we simply don’t have time. Because there’s a treatment cycle coming up or, you know, and then, you know, we just have to make the best that we can of the situation with the time that we have, and the resource, the resources that we have. And, you know, it’s all very personalized, isn’t it? Because it does also depend on how healthy how much of a healthy community you’ve got, and what else is going on as well.

Debbie Cotton 19:13

Absolutely, absolutely. And that’s the thing is, it’s that thing, isn’t it, of really reading sort of a vaginal microbiome in light with your symptoms in light with your kind of the whole context of the person and the couple that are trying to conceive? And that’s, you know, just seeing something in a test doesn’t mean oh, I have to treat it immediately. And that’s why it’s really important to work with people like yourself, and, you know, practitioners that are really specialized in this area. So think they can actually go to you know, no, that’s not a problem. We’re not going to address that because of x, y and Zed or yes, that is a problem. And we’re going to address it quickly. And this is why so, you know, and I think that’s really, really important is sometimes especially with patho Bionz, like this, it’s really hard to kind of get a context on them and that’s what your healthcare professional is so good at doing because they put all Have your symptoms together and all of your health history and all of that information. And that’s what makes the key decision at the end of the day, not just because we’ve seen something in a test.

Sandra Greenbank  20:09

And that actually that sort of made makes me think of sort of the way we look at a couple who are trying to conceive and that, you know, it doesn’t have to be a male and female, it could be any combination of Yeah, absolutely. But, you know, we see you as one. And so it’s very holistic, it’s sort of looking at what is going on in the interplay between the two of you and your lifestyle, and everything that you do together, and that you come into contact with, as opposed to your IVF consultant, who literally sees you as like a walking pair of ovaries. And that’s it. And it’s like completely disconnected to anything that’s going on in your world. I think that also, the hormones are very impactful as well on the vaginal microbiome through the age ages, but also through the month. So you talk a little bit more about that as well.

Debbie Cotton 20:59

Absolutely. So the vaginal microbiome is really dependent on the host, which is us. And what we do in our reproductive years, when we’ve got rich amounts of estrogen around, there’s a lot of estrogen receptors that are within your vaginal wall. And also, that’s where you make a lot of mucus from is both in your cervical cells and in your vagina as well. And when we’re under high levels of estrogen and progesterone, but mainly mainly estrogen, what we get is a mucus is really, really rich in glycogen as a fuel source specifically for like, like to bacilli, which they love to eat. So basically, we make we bother to make a fuel to feed the vaginal microbes we want. So there’s a really kind of beautiful two direction relationship there. Now, pre pubertal. And also, after menopause, our vaginal microbiome changes, we still have like two bacilli in there, but it’s not as dominant as it was before. And that’s mainly because because of the lack of estrogen, we haven’t got that rich mucus that’s feeding the light to bacilli anymore, so it’s harder for them to dominate. So you get much more of a sort of a pattern that might even look a little bit like BV, it might not have the symptoms of BV, but it’s a little bit more diverse. Because vaginal microbiome generally isn’t kind of highly diverse. It’s just it’s, it’s, it’s normally got that dominant strain. And this you know, so when we get kind of when we’re looking at fertility in women that are coming up to menopause, or in the perimenopause state, and we’re looking at the vaginal microbiome, that’s one thing we might want to look at is how do we need to feed those like to be selected and keep them there, you know, and that might be around what medications you’re using with your consultant, it might be around what nutrition plans you’re using with your nutritional therapist, it might also be around, you know, certain application of dishes or things like that, that you might be using from the pharmacy that might just help to acidify the area to be able to improve the growth of lactobacillus. So there’s lots of ways that we can approach that. But it’s just really important to kind of realize that is a normal part of the aging process. But when it comes to fertility is something we want to try and protect against as best as possible. Because again, that lovely lactobacilli rich environment is really important.

Sandra Greenbank  23:26

Yeah, and that is more that does become more of a consideration when somebody is trying to conceive when they’re a little older. Because you know, as we know, the perimenopause can take 10 or so years before you sort of reach menopause. And it’s not, it’s not like one day, you fall off a cliff. And hopefully, you know, the transition isn’t so bad anyway. But you know, those changes start to happen, and estrogen starts to sort of perhaps struggle a bit sometimes. And it can, it can be a bit up and down for quite some time. And you might not have any symptoms and and also you might not have symptoms if you’ve got it. And I think it’s important to mention that as well. If there is an imbalance in the bacteria, you you don’t necessarily have any symptoms you wouldn’t necessarily know.

Debbie Cotton 24:12

Yeah, some people do, and some people don’t. And that’s the thing is some people might just have symptoms coming up to you know, when drops of estrogen are at their lowest so coming up to their period or just after some people might realize they get BV and fresh trash, because they noticed a change in smell. And like you say some people may not realize and that might be why your professional is asking you to kind of test currently, especially in a kind of fertility workup, because they just want to give you that kind of the overview of, you know, what are the positive steps that you can make to try and protect that area as much as possible?

Sandra Greenbank  24:47

Yeah, absolutely. In terms of looking after your vaginal microbiome, what are some of the things that people can start doing at home? Yeah,

Debbie Cotton 24:59

absolutely. It’s quite a lot you can do kind of. So first and foremost is wearing breathable knickers, it’s a really good start. So just you know, it’s so we all wear sports gear and stuff sometime. But it’s really important to change that and kind of, you know, because sweat can change the pH of the vaginal microbiome. We also want to think about eating a diet that’s really, really rich in lactose bacilli fuel sources. So if we feed the lactobacilli, and the guards, there is some translocation that happens from the gut into the vagina. So using lots of fermented foods using prebiotics that like to bacilli like to eat all of you know, foods that contain like to bacilli, like fermented. If you’re okay with dairy, that is like fermented yogurts and things that are rich in lactose bacilli, all of these things are going to contribute. The other thing is to avoid using things, anything in the area that will wash out the vaginal microbiome. So you don’t need any harsh Schoeps inside your vagina, you don’t need any dishes in your vagina to make it smell nice, unless you’ve been kind of advised by a healthcare professional to do it under a certain kind of amount of time. But you know, none of those smelly sprays any of those things, because they’ll contain chemicals, again, that will change the pH of the vagina. Another really important one is not smoking, but hopefully you’re not doing that anyway, if you’re conceiving, because that can impact the vaginal microbiome as well. And also things like, you know, with intercourse, it’s kind of thinking about, if you’re using sex toys, making sure you’re cleaning them and sterilizing them regularly. If you are going, you know, doing a lot of vaginal sex, maybe do it the other way around vaginal train or so you’re not spreading microbes into the vagina as much as possible. You also want to think about kind of same sex couples might want to think about the oral sex can change the pH of the vagina as well. So it might mean sometimes, after oral sex, if you find that you’re, you’re getting a little bit of BV, it might be using kind of a lactic acid pessary in the vagina, just just to kind of combat that and things like that, as well. So there is quite a lot you can be thinking about and doing. And again, your healthcare professional might have some more quite specific advice for you around that too. And the other thing, oh, also that I haven’t mentioned is things like tampons and pads and things like that. And if possible, you know, try to make sure you change them off and make sure you’re using organic versions that have got no chemicals in because all of those can have an impact on the vaginal microbiome too.

Sandra Greenbank  27:45

Absolutely, I think, because you mentioned perfumes and I mean, I only use the organic kind of some brands or think natural care. And I can’t think of any other sorts of top of my head, but I’m

Debbie Cotton 28:00

not sure care Dame is one as well. And Sisters is another really nice brand as well of kind of all of those kind of organic period care, which you can get in kind of most major supermarkets now.

Sandra Greenbank  28:15

And now Yeah, but I mean, every so often, I’m sort of forced to get a conventional product, and it’s, it’s actually so different, that perfumed, and they’re made from plastic,

Debbie Cotton 28:30

yeah, they feel different. Yeah, it’s just awful.

Sandra Greenbank  28:34

And I’m thinking this is causing so much damage, and just think of wearing these every month from the age of 1314 15. And then by the time you come to try to conceive 20 years later, you know, it actually could really have disrupted something over the long period of time. And it’s just so unnecessary to you know, why and also, I just think young, young women, young girls should not be taught that it’s, there’s something that needs to be changed or perfumed, or that there’s something wrong with the smell like, I don’t feel so strongly about this industry. And it’s so good, you know, so good with all of these organizations now that are sort of trying to raise awareness.

Debbie Cotton 29:17

Yeah, absolutely. And you know, there’s been an explosion hasn’t there in the last five years of good period care underwear and stuff as well. So you know, there’s lots of lovely options out there now. What

Sandra Greenbank  29:29

Yeah, and I think what about period pants? Yeah, to try those actually. But you know, there’s so popular but I’m, I know that some of them can also contain some toxic potentially toxic ingredients.

Debbie Cotton 29:45

Yeah, it’s not again, some of them can contain some toxic ingredients, like anything that’s made you without really being thought about and the plastics that have been put in them. But as long as you again looking at Black brands that have thought about their period care and I, I kind of made from organic cotton and those sort of things, they can be really, really helpful. Again, the main major thing is, is changing them regularly, because you’re kind of sitting in menstrual blood, either your pads or soft for too long, that’s going to change the pH and the microbiome as well. So we definitely want to make sure that you know that you’ve, you’ve got to kind of a good supply to change them and wash them well.

Sandra Greenbank  30:23

Yeah, because that’s the that’s the thing, isn’t it, it’s the pH of the menstrual blood that can actually and those who have symptoms after that period, or in conjunction with the period, or after sexual intercourse, without a barrier barrier contraception are the ones that probably would like to just get, you know, investigate whether they’ve got potentially BV, because it’s the pH. diff, right? That’s causing the opportunity for the bacteria to grow.

Debbie Cotton 30:55

Yeah, absolutely. And that’s the thing is, you can think you’re picking up something off your partner, but actually, it’s more likely, it’s just the change in pH at that time. And also, you know, the friction, sometimes if you are not producing a lot of mucus, because your estrogen is a bit low, and you’ve produced some friction and damage themselves, that’s also going to create inflammation, which is going to change the microbes as well. So it’s kind of a picture of all of it. So it’s just making sure you’re comfortable. And that would be the other thing I would say is you know, if you’re using lube, and actually do use lube, if you need it, because you want to prevent that sort of damage. Just making sure it’s something that’s pH suitable. And again, not containing lots of petroleum or anything along those lines, you want kind of something very natural and pH balanced for the vagina so that it’s going to be helpful for you.

Sandra Greenbank  31:45

Yeah, that’s the smoke on Yes. Yes, baby, which is fertility friendly, that we don’t recommend. Yeah, absolutely. That’s really important to look after the tissue on the inside as well. What about wearing thongs

Debbie Cotton 32:02

not a great kind of thing, because it kind of can help translocation of, of the microbes kind of from the, from the gut to the vagina. And if they’re not the microbes you want that’s not super helpful. But again, probably itching to change them more often than you think if not necessarily if you’re having problems, but preferable not to wear them if you can, if you can avoid them, but you know, every now and again, because that dress requires it then fair enough. Oh, yeah. But on a sort of daily basis. daily basis. Yeah, Granny undies the whole way.

Sandra Greenbank  32:35

That’s one organism that comes up. Sometimes it’s called Central caucus to Carlis. I think

Debbie Cotton 32:39

that’s right. And Enterococcus faecalis often can move from lots of places, the Garton fingers and other you know, places around the body and leaves everywhere. And but if that starts to, that can really kind of increase translocation from other places. So yeah, that’s something we want to try and avoid.

Sandra Greenbank  32:57

And that’s also one that then put them our partners can be very unhelpful. Absolutely. What about menstrual cups,

Debbie Cotton 33:05

menstrual cups are fine. Again, just making sure you’re changing them often. And I would always recommend that you have to, because what people tend to do is use them and quickly rinse them out and pop them back up again. But they’re not necessarily sterilizing them. So like anything that goes up in your vagina is worth sterilizing it. So it is having, you know, comb one new way one day, and then you can sterilize the other one by kind of the boiling method or something along those lines. Just don’t over boil it and boil your pot dry, you’re going to damage your cup, but um, you know, and just kind of just having one to making sure that you’re doing that and the same with any silicone sex toys and stuff like that. They should really be

Sandra Greenbank  33:47

sterilized with mountain tabs type thing, or you

Debbie Cotton 33:50

can use Milton tabs. I tend just the boiling method is fine. So just struck

Sandra Greenbank  33:55

up and I burnt it out it Oh, hang on, was that? No, hang on. That was never my diaphragm. Something like that. It’s something I can’t wear a menstrual cup anymore. Anyway, so I’ve got endometriosis and the pain is indescribable. So yeah,

Debbie Cotton 34:10

I’ve never got on with a menstrual cup either. But I know some women really, really do prefer to use it. And so you know, it’s again, it’s choice. It’s what was best for your body. So

Sandra Greenbank  34:21

how often should you wear tampons? If you’re if that’s your preferred type of product?

Debbie Cotton 34:27

How often you should change them. And just the main thing is I wouldn’t recommend sleeping in tampons overnight. You know mean like you want to prevent toxic shock syndrome was something that we all got kind of taught years ago, but that’s actually from something like streptococcus that can grow on tampons if you leave them in for too long. So you do want to change them regularly. If you are having a bowel movement, change the tampon like make sure you clean one up so you know And so they’re the sort of things that you want to think about. And like I said, overnight, I would use period undies, or I would use a pad or combination of both. So

Sandra Greenbank  35:10

what about cleaning? Like how? What should you use to clean your

Debbie Cotton 35:18

water, basically, and I know people get a bit shocked by this, but your vagina doesn’t need it especially and when we, let’s just take it in anatomy and anatomical break, your vagina is the bit inside that we’re talking about. Okay, so you’ve evolved the top of your vulva, possibly, you might need a little bit of, you know, very pH balanced soap occasionally, you know, in your period, or whatever it might be, but you don’t need to clean inside your vagina, it’s a self cleaning mechanism. So it’s just all it requires is water. Because, you know, soaps can really really disrupt the vaginal microbiome, they can strip the vaginal microbiome in some cases as well. And you know, then you’ve, again, you’re gonna create pH problems, which can, you know, you might feel better for a minute, but actually, what you’re actually doing is creating the overgrowth of bacteria that can then change the smell. So, you know, that’s what we want to kind of avoid as best as possible.

Sandra Greenbank  36:13

Where I come from in Sweden, there’s lactic acid soaps that are lovely, and centered, and you know, they’ve been around for years, but and also, when you go to pharmacies in Europe, you can find them but for some reason, they’re just not around here. I don’t know why. No,

Debbie Cotton 36:28

they’re not very common here. But lactic acid. I know it sounds again, scary because it’s an acid. But actually, that’s what the the lactic bacilli make. So using lecture that lactic acid is going to kind of match the vaginal pH.

Sandra Greenbank  36:43

And so there was some, there was some of that another question I wanted to ask you. I sort of talked about cleaning, we’ll talk about period products. You mentioned diet, and you said prebiotics was the key give.

Debbie Cotton 36:56

So prebiotics are basically a special class of fiber. So all fiber is really good for your microbiome full stop, okay, because it kind of gives it fuel that it can use in different ways, or sometimes it just helps to move things through or whatever it might do. There are some types of fiber known as prebiotics. And that’s because we know specifically if you eat those types of fiber, it will feed certain communities of bacteria. So things like lactobacillus and Bifidobacterium, like short chain, sort of fibers, little little fibers, one that we know of quite well as galacto oligosaccharides, sometimes called gos for short, which were kind of a copy of what’s found in breast milk, which a human milk Milk oligosaccharides. So that’s how clever we are in breast milk, we actually make and spend a lot of time making fibers that are specifically to feed the microbiome we want. And in breast milk, it’s ones that often feed Bifidobacterium and a little bit of light to bacilli as well. So often, you know, if we’re trying to look after vaginal microbiome, we do want to think about eating lots of fiber in our diet, and especially prebiotic fiber as well, without causing too much bloating or gas. You know, it’s a balance, but it but it’s really, really important for the health of all of your microbiomes.

Sandra Greenbank  38:17

And so foods that quote that are classically known to cause gas that they’re kind of the helpful ones to include. A lot of

Debbie Cotton 38:25

the times they can be Yep, so things like beans, lentils are often quite rich in types of gos, the alpha gos, you’ve also got they’ve also got different types of fiber in there as well. foods that are rich in Ulan are really really good, because they contain fructose oligosaccharides, but they are the ones that for some people can cause a little bit of bloating as well. But that’s things like bananas, Jerusalem, Jerusalem, artichokes, chicory, all of that, all of those sorts of things as well. So again, it’s working with your nutritional therapist, I think in kind of finding what’s the most tolerable prebiotic fibers for you? Because not everyone’s going to be the same onions and garlic are a great source of fiber. These particular types of prebiotic fiber, but again, it just depends what what’s your what’s the amount? That’s your medicine and not your poison?

Sandra Greenbank  39:22

Yeah, I mean, I think you can build up a tolerance to those foods, but you might not want to go in with sort of all of them on one go and sort of really high mass. Yeah,

Debbie Cotton 39:29

exactly. And you build up a tolerance by building up your microbiome, basically, that’s what you’re doing is you’re feeding a microbiome that can can really kind of digest them well.

Sandra Greenbank  39:41

And so just very briefly, because we’re doing a separate episode on the gut microbiome, but within vivo, so you have a number of tests that test the different microbiome and actually we use them all with our fertility cards because they are all impactful when we’ve already interviewed Dr. Victoria Sampson. About the oral microbiome. So that’s, that’s available to listen to anyone is interested in that. And that’s that, what to me when that kind of when we started doing that was just mind blowing. And the links between the oral microbiome and fertility is like, It still blows my mind. And it’s so it’s such an interesting place to work. So we’ve got the test for the oral as well, and the vagina and then the urinary microbiome as well.

Debbie Cotton 40:30

Yeah, the urinary microbiome. Because in a lot of women that have chronic urinary tract infections, and again, this is only very new this kind of science that actually, when we used to talk about the urinary bladder, we used to talk about it as sterile. But actually, now that we’ve got these new testing methodologies, we realize, actually, there is a bit of an indigenous population that lives in the bladder in healthy women. And again, it’s generally like to bacilli, again, and which is kind of no surprise, really, if you think about the communication with the vaginal microbiome. And that tends to offer protection against sort of pathogen Ingress, and overgrowth, and those sort of things. So that is another kind of microbiome site that we do test. And for some women with chronic urinary tract infections, they might choose to test both vaginal and urinary together, because obviously, they both can communicate with each other quite strongly.

Sandra Greenbank  41:25

And I have actually found that women who have recurrent urinary tract infections who have come to see me because they’re trying to conceive, I found that often it’s actually something that’s passed on from the male partner again. So it’s, it can be all very much interlinked. Absolutely.

Debbie Cotton 41:47

And there’s that thing isn’t it is remembering, you know, there’s so much communication that goes on there. And especially with male or female sex, you get a lot of trauma of kind of things being pushed up into the urethra, so it could be something from the vagina that gets pushed up in the process or something from the semen. So it’s just being aware that if you have got a bit of a weakness, they’re kind of thinking about, well, how can I protect that area and work with the microbiome and protect it as much as possible as

Sandra Greenbank  42:15

well. And if you have a short urethra, that tends to be those people tend to have more of a risk of infections, I suppose. And also in pregnancy, that tends to sometimes get a bit worse, because there’s lots of changes that happen.

Debbie Cotton 42:31

Yeah, yeah, absolutely. And like you say, UTIs, do sometimes kind of crop up in in pregnancy as well. And it’s something that again, looking after you like to bacilli, maybe what I haven’t mentioned is you can take live bacteria orally, both for the vaginal microbiome for the bladder microbiome, because even taking them by mouth, they do make it there, which is quite amazing. So and that can have a really big kind of impact on on kind of being a source of life bacteria that you can kind of influence your vaginal and urinary microbiome with.

Sandra Greenbank  43:05

And we’ve mentioned pregnancy. And, you know, I prefer to work with people before they get pregnant to, quote unquote, fix the vaginal microbiome, because what are the we’ll talk a little bit more about the implications in pregnancy of working on changing the health of the vaginal tract? Yeah, so

Debbie Cotton 43:29

once in pregnancy, a lot of the anti microbials that may be a natural health practitioner would like to use a kind of Contra indicated. But also, we don’t really want to keep disrupting the the all the microbiomes in pregnancy with taking antibiotics if we can help it. So you know, if they’re needed, absolutely. But you know, if it’s kind of best to avoid them where we can. So in pregnancy, generally, we really want to concentrate on kind of diet as a good intervention, your life bacteria. So probiotics are safe to take in pregnancy. You know, these are the things that we can make an influence in in when you’re already in a kind of a pregnant state. And the reason we want to kind of keep away from kind of infection is because it can start the inflammatory pathway that can then increase the risk of preterm birth, because we don’t want your cervix ripening too quickly, basically, because of, you know, cytokines, which are inflammatory molecules being released, which normally is what signals birth. So that’s one of the reasons we want to try and keep on top of infections. And, you know, like I said, If antibiotics unnecessarily absolutely use them, it’s really important because we want to prevent that kind of inflammatory cascade. Yeah,

Sandra Greenbank  44:40

I mean, what does happen in pregnancy is if you go for a swab, and they find either BV bacteria or group B strep, you will be given antibiotics. Yeah, absolutely. And of course, that has an impact on that the lactobacillus and and the knock on it. factors potentially the your baby during birth and doesn’t get, you know as much, you know as much of a benefit from your vaginal tract as they could or would have done. So, you know, it’s really nice thing to work on before pregnancy isn’t it and I’m in Group B strep is transient, but I had this I had it isolated during pregnancy actually on a on a swap. And no matter what you will be put on antibiotics and IV antibiotics during birth, which means that you’re not allowed to go into in the midwife read center, you have to go and have a medicalize or more of a medicalized birth situation. So it does change your birth plan as well, which can be very upsetting.

Debbie Cotton 45:47

Yeah, the NHS has got a bit of an interesting, they’ve got kind of It depends, they’ve got a kind of a new guideline, not on that at the moment. And basically, you know, if your waters break early, they within kind of 24 hours, you’ve got a 24 hour window, where they’re going to encourage just sort of a normal birth, but what they’ll do is they’ll watch you for temperature, and they’ll watch the baby’s temperature really often. And if there’s a spike in either, then they’re gonna come in with the antibiotics then. And again, they probably don’t generally jump in with the antibiotics, they keep her they keep a watch on temperature for looking for infection. And so it gives a little bit more of a leeway. But yes, if you go over that 24 hours, you’re gonna be on IV antibiotics and go,

Sandra Greenbank  46:29

I mean, I find was, I think, it seems that the NICE guidelines might change, but then it can take years for each hospital to actually

Debbie Cotton 46:40

just about to say that you’re gonna, this is gonna vary borough from borough, unfortunately. So there might be guideline changes, but there’s not necessarily implementation of them. So, yeah, yeah.

Sandra Greenbank  46:50

But I mean, I found that quite upsetting because I had home births with my first home, and then I, it was like, strapped up onto a bed lie on your back. And you know, all the things that, you know, are then sort of potentially going to, you know, it’s that sort of cascade of intervention. But they actually, as they were going to get the antibiotics for me, I give birth in that time, she came up really quickly. And then what happened was, like you said, they watched, they kept me in and they watched her and she was fine. So but you know, it’s not it’s not an infection that you want to sort of mess around with? I think it is, you know, the risks can be quite high.

Debbie Cotton 47:30

Yeah, the risks are very, very high. So it is something that it found at 3640, you know, 38 weeks, it’s something you want to deal with it immediately and to the best of your ability. So, yeah.

Sandra Greenbank  47:43

So okay, well, I mean, thanks so much for that kind of quick whistlestop tour of the vagina. Pleasure. Is there anything else you want as a parting advice for somebody who’s trying to conceive and thinking could this? You know, could this be something that I need to look into? Yeah, look,

Debbie Cotton 48:02

I would say definitely talk to your natural health care practitioner about this and what you could be doing, you know, testing is great, if you can see making sure it’s not just a test for pathogens, but testing for kind of the healthy like to bacilli as well. But again, depends on your sort of your scope, and your funds, and all those sort of things. But you know, working with your healthcare professional, your natural one, there’s, like we mentioned, there’s so many things that you could be putting into place anyway, that could be protective of your vaginal microbiome. So you could be working on in that space anyway, and working towards that goal. It just gives people

Sandra Greenbank  48:41

another another area where they can actually take charge and sort of this sort of empowering you to do something that might be positive for your fertility,

Debbie Cotton 48:53

and fertility, but also it’s going to be positive for your sex life, it’s going to be positive for how you feel about yourself. Like, you know, the vagina plays a quite a big role in our lives. So I think as a part of that, I think it’s really important to take ownership and and kind of know your microbiome and work with it in the way that works for you.

Sandra Greenbank  49:12

Absolutely. Thank you so much.

Debbie Cotton 49:15

My pleasure. Thank you for having me.

Sandra Greenbank  49:21

I really enjoyed this chat with Debbie and I hope you enjoyed listening to this episode. Please like share, save and read this podcast if you find it useful, as it helps us reach more people. And if you’re looking for a fertility specialists to support you, our practitioners can be contacted over at www.fertilitynutritioncentre.org. They offer a free strategy call to help you decide when your best next steps on your journey. Thank you for listening.

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The Fertility Nutrition Centre was founded by Sandra Greenbank, an expert in proven nutrition strategies to help couples conceive naturally. After 12 years of helping hundreds of couples successfully conceive naturally, she is making it possible for more couples to receive nutrition consulting by creating a network of nutrition expertswho have committed to a unique and in-depth training program in the field of fertility.