The Vaginal Microbiome
WHAT IS THE VAGINAL MICROBIOME?
A similar concept to the gut microbiome is the vaginal microbiome. The vaginal microbiome is a diverse group of microorganisms that coexist in the vaginal tract to protect against infection and spread to the reproductive organs like the uterus and ovaries. The vaginal microbiome is dominated by Lactobacillus species, which help protect and influence the presence of “bad” bacteria in that area. The vaginal microbiome is very dynamic and can undergo drastic shifts due to things like menstruation, pregnancy, menopause, sex, etc.
WHY IS IT IMPORTANT?
Imbalances in the vaginal microbiome (aka dysbiosis) from sexually transmitted infections (STIs), bacterial vaginosis (BV), yeast infections, group B streptococcus (GBS), and urinary tract infections (UTIs) can lead to infertility and increase the risk of spontaneous abortions, preterm labor, and post-partum complications. The vaginal microbiome during pregnancy also influences the health of your child and their risk of developing chronic diseases and mood disorders throughout life.
VAGINAL MICROBIOME AND PREGNANCY
Typically the vaginal microbiome becomes less diverse during pregnancy. Changes to the vaginal microbiome during pregnancy and post-delivery can result in significant issues such as postpartum endometritis and sepsis. 40-50% of preterm births are associated with ascending bacterial infections. Unexplained spontaneous preterm births is another fairly common issue that may occur as a result of an imbalanced vaginal microbiome. It is unclear which species may be at play causing the spontaneous preterm birth but it appears there is a correlation between this issue and low microbial diversity.
VAGINAL MICROBIOME AND INFERTILITY
The vaginal microbiome has potential implications in regards to fertility. BV is fairly common in infertile women and may affect nearly 20% of those who are infertile. BV does not always cause acute symptoms that would warrant you to see a doctor and get treated. BV can be fairly subtle and is due to a change in the vaginal microbiome resulting in lower levels of Lactobacillus and a higher pH.
WHAT CREATES A HEALTHY VAGINAL MICROBIOME?
The vaginal microbiome is highly controlled by estrogen levels and external factors. The epithelial cells that line the vaginal tract release local chemical signals to help protect against pathogens and reduce inflammation. Estrogen plays a major role because it triggers the vaginal epithelial cells to produce glycogen (a type of starch). This glycogen “feeds” the lactobacilli and metabolizes it into lactic acid. Lactic acid is acidic, which lowers the vaginal pH to 3.7-4.5. Most pathogenic bacteria cannot survive in acidic environments. Therefore, the acidic nature of the vagina helps to protect against harmful bacteria. Estrogen’s role in maintaining a healthy microbiome is why women are more susceptible to vaginal and urinary tract infections throughout menopause and/or near the end of their cycle.
WHAT NEGATIVELY IMPACTS THE VAGINAL MICROBIOME?
Using personal hygiene products in the genital region
Soaps
Perfumes
Douches
Scented tampons
Vaginal sprays
Bubble bath
Wearing tight, non-breathable underwear
Not keeping the genital area dry after bathing or swimming
Not changing out feminine hygiene products frequently enough
Not engaging in safe sex practices
Eating an inflammatory, processed, high sugar diet
Living a high stress lifestyle
And many others
HOW TO MAINTAIN A HEALTHY VAGINAL MICROBIOME?
First of all, make sure you seek medical attention if you suspect you may have an acute vaginal infection. If you are prone to chronic vaginal infections such as BV or yeast infections, I would start by trying to remove things that could negatively impact your vaginal microbiome. If you do not see a response with those changes, you may need a more personalized plan to help build a healthier microbiome and potentially address biofilms. In general, the right probiotics can go a long way in maintaining a balanced microbiome, as well as checking for a proper vaginal pH.
Disclaimer: Not medical advice. Please contact your doctor before making any changes.
References:
Collado, M., Rautava, S., Aakko, J. et al. Human gut colonisation may be initiated in uteroby distinct microbial communities in the placenta and amniotic fluid. Sci Rep 6, 23129 (2016). https://doi.org/10.1038/srep23129
Haahr T, Jensen JS, Thomsen L, et al. Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod. 2016;31(4):795-803.
Morris, A. The Vaginal Microbiome: Its Role in Fertility, Pregnancy, & Preterm Labor Risk. Natural Medicine Journal (2016).
Witkin SS. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth. BJOG. 2015;122(2):213-218. doi:10.1111/1471-0528.13115