What is the Vaginal Microbiome?

Ladies, did you know that you have a vaginal microbiome? 

Similar to your gut, the vaginal microbiome (VMB) is home to a variety of different bacteria, viruses and fungi that live inside the vagina.  Although the types of bacteria found in the vagina will differ from woman to woman depending on ethnicity and geographical location, a healthy VMB is made up of mainly Lactobacillus. (1).  This bacteria keeps the vagina acidic and therefore prevents the growth of unfavourable or ‘pathogenic’ strains of bacteria and yeasts, fights off infections and prevents sexually transmitted infections.  It can also help support a healthy pregnancy and vaginal delivery.  

When this ecosystem is imbalanced, it may contribute to fertility issues, miscarriage, endometriosis, urinary tract infections and bacterial vaginosis. 

What impacts the Vaginal Microbiome?

Did you know that the vagina is self-cleaning? How incredible is that! Therefore internal douching is not required.  Also, a healthy vagina may have a natural odour but should not smell offensive.  There is no need to use perfumed bath and shower products as these can disrupt the balance of the vaginal flora.  The type of lubricant, washing powder and scented toilet paper can all impact this delicate microbiome.  A high sugar diet may contribute to overgrowth of pathogenic bacteria.  A course of antibiotics can also reduce Lactobacillusspecies in the vagina.  Stress particularly that which persists on a long term basis may even negatively impact the VMB (2).  Other practices like depilation (hair removal) (3) and intimate piercings (4) may also cause imbalances in the VMB.  Smoking can also reduce the amount of Lactobacilli in the VMB (5). Diets that are low in Vitamins such as A, C and E and iron are associated with vaginal dysbiosis. (6,7,8). 

If the VMB is disrupted, it can become the ideal breeding ground for infections such as bacterial vaginosis (BV) and yeast infections such as thrush. 

Can the VMB affect your chances of a successful conception?

Dysbiosis of the VMB has been associated with infertility and adverse pregnancy outcomes such as miscarriage and premature birth (9).   Research has shown that those women with BV are more likely to have tubal infertility (a blockage in one or both of the fallopian tubes) (10).  Another study comparing women with infertility issues undergoing IVF with fertile women saw the presence of large amounts of Ureaplasma in the vagina (11).  This bacteria may not be beneficial for fertility.  Women undergoing IVF with a low amounts of vaginal Lactobacillus species were less likely to have successful embryo implantation than those with a higher prevalence of Lactobacilli (12).  Another study found that a VMB dominated by Lactobacillus produced the most successful outcome in an IVF cycle (13).  Urinary tract infections and yeast infections can be the cause of damage to the reproductive tract in women for example damage to the fallopian tubes or pelvic inflammatory disease and result in infertility (14).  

Keeping your vagina healthy and happy

• Use warm water to gently wash the area around the vagina (the vulva).
• Avoid using perfumed shower gels, powders, deodorants, vaginal washes to clean the vaginal area.  
• Use a natural lubricant during sex that is sperm friendly if trying to conceive.  Avoid any flavourings or scents (these often contain sugar which may encourage yeast infections), glycerine and glycerol (both may damage the vaginal lining).  Ensure that the pH of the product is similar to the vaginal itself (3.8-4.5).  
• Consider taking a probiotic containing bacterial strains that support vaginal health.  A nutritional therapist is best placed to advise you in relation to this.
• Include food sources of probiotics (sauerkraut, kimchi, kefir, miso) and prebiotics (onions, garlic, artichokes, green bananas) to help feed and maintain the beneficial bacteria.
• Change underwear and leggings as soon as possible after exercising.
• Sterilise menstrual cups and sex toys regularly in boiling water.
• Maintain balanced blood sugar levels by eating a diet rich in a variety of fruit and vegetables and good quality sources of protein and fat.  
• Talk to your nutritional therapist about doing a vaginal microbiome test which will assess if the VMB is imbalanced and ensure that a tailored approach is used to rebalance the ecosystem.
• During the healing period following waxing or intimate piercings, it is important to take care of the area and follow professional advice from the waxing or piercing professional.
• Always report any symptoms of vaginal dysbiosis such as an unusual smell, unusual discharge, burning, itching to your healthcare professional.  

References

1. Anahtar M.N., Gootenberg D.B., Mitchell C.M., Kwon D.S. Cervicovaginal Microbiota and Reproductive Health: The Virtue of Simplicity. Cell Host Microbe [Internet].2018;23:159–168. Available here. 
2. Amabebe E. and Anumba D. Psychosocial stress, cortisol levels and maintenance of vaginal health [Internet]. 2018.  Available here. 
3. Romero-Gamboa Daniel Giovanny, Díaz-Martínez Luis Alfonso, Díaz-Galvis Marta Lucía, González-Blanco Diana Paola. Impact of genital hair removal on female skin microenvironment: barrier disruption and risk of infection, a literature review. Medicas UIS [Internet]. 2019 32(3): 27-33. Available here. 
4. Dalke, KA., Fein, L., Jenkins LC., Caso JR., Sasgado CJ. Complications of genital piercings.  Journal of sexual medicine. 2013 12(5).  Available here. 
5. Brotman RM, He X, Gajer P, Fadrosh D, Sharma E, Mongodin EF, Ravel J, Glover ED, Rath JM. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infect Dis [Internet]. 2014 Aug 28;14:471. Available here.
6. Tohill BC, Heilig CM, Klein RS, Rompalo A, Cu-Uvin S, Piwoz EG, Jamieson DJ, Duerr A. Nutritional biomarkers associated with gynecological conditions among US women with or at risk of HIV infection. Am J Clin Nutr [Internet]. 2007 May;85(5):1327-34. Available here.
7. Verstraelen H, Delanghe J, Roelens K, Blot S, Claeys G, Temmerman M. Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancy. BMC Infect Dis [Internet]. 2005 Jul 6;5:55. Available here.
8. Thoma ME, Klebanoff MA, Rovner AJ, Nansel TR, Neggers Y, Andrews WW, Schwebke JR. Bacterial vaginosis is associated with variation in dietary indices. J Nutr. 2011 Sep;141(9):1698-704.  Available here.
9. Moreno, I.; Simon, C. Deciphering the effect of reproductive tract microbiota on human reproduction. Reprod. Med. Biol [Internet]. 2018, 18, 40–50.  Available here.
10. van Oostrum N, De Sutter P, Meys J, Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum Reprod [Internet]. 2013 Jul;28(7):1809-15. Available here.
11. Wee, B. A., Thomas, M., Sweeney, E. L., Frentiu, F. D., Samios, M., Ravel, J., et al. A retrospective pilot study to determine whether the reproductive tract microbiota differs between women with a history of infertility and fertile women. Aust. N. Z. J. Obstet. Gynaecol [Internet]. 2018; 58:341–348. Available here. 
12. R Koedooder, M Singer, S Schoenmakers, P H M Savelkoul, S A Morré, J D de Jonge, L Poort, W J S S Cuypers, N G M Beckers, F J M Broekmans, B J Cohlen, J E den Hartog, K Fleischer, C B Lambalk, J M J S Smeenk, A E Budding, J S E Laven, The vaginal microbiome as a predictor for outcome of in vitro fertilization with or without intracytoplasmic sperm injection: a prospective study, Human Reproduction [Internet]. 2019; 34(6):1042-1054.  Available here.
13. Hyman RW, Herndon CN, Jiang H, Palm C, Fukushima M, Bernstein D, Vo KC, Zelenko Z, Davis RW, Giudice LC. The dynamics of the vaginal microbiome during infertility therapy with in vitro fertilization-embryo transfer. J Assist Reprod Genet [Internet]. 2012; 29(2):105-15. Available here.
14. Mastromarino P, Hemalatha R, Barbonetti A, Cinque B, Cifone MG, Tammaro F, Francavilla F. Biological control of vaginosis to improve reproductive health. Indian J Med Res [Internet]. 2014 Nov;140 Suppl(Suppl 1):S91-7. Available here.

Carla Buckley

This article was written by Carla Buckley. Click below to find out more by talking to one of our Practitioners.

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