Your Vaginal Microbiome
Everything You Need to Know to Prevent Infections & Stay Healthy "Down There"

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Today, we’re gonna talk about… your vagina!

I know, not the most common way to start a conversation, but it’s the truth.

And while I don’t love that word because of the meaning behind it (vagina = sheath for a sword) and many folks I connect with use a word like “yoni” instead, which is a sanskrit term that essentially can be translated to sacred space or source of generative power and includes the vagina, I may go back and forth between using the terms. 

So, at this point I’m going to assume we’ve all heard of the gut microbiome. The popularity of gut health and probiotics and prebiotics and more in the past ten years has exploded.

But not as many people talk about the other microbiomes we have in and on our body, and the vaginal microbiome is one of those things we don’t talk about (yet).

Unless you’re a clinical practitioner and this is a way you approach your work with patients, or you’ve had your nose in the research literature over the past five years

But the truth is, your vaginal microbiome plays a huge part in your sexual health. 

By this point in your life, you’ve probably had some kind of vaginal symptoms at SOME point… whether that’s itching, redness, yeasty smelling discharge from a yeast infection, fishy odor from BV, weirdly colored discharge or other challenging symptoms from other sexually transmitted infections, dry tissues that cause discomfort, etc.

Or perhaps, the challenge of recurrent vaginal infections.

There’s a lot that can happen down there. 

Your BV, yeast infections, genital herpes or run-in with gonorrhea is more common than you think... and a healthy vaginal microbiome can support you to prevent future infections, or even in some cases, treat current ones. 

 

So, let’s start with the basics before we go on – 

What IS your vaginal microbiome anyway?

Well, in case you need a refresher, your vagina (or yoni) is the internal, soft tissue, mucous-lined canal from your vulva all the way to the cervix (which is the base of your uterus).

It's very flexible, and as we all know can fit an entire baby’s head and shoulders out, so clearly can expand significantly. In other words, it’s not some tight friable structure.

And along the lining of the vagina, just like along the lining of the intestines, we have a very healthy microbial community living there, and this is a very good thing.

Your vaginal microbiota constitutes about 9% of our total microbiota in our body!

But the vaginal microbiome has only really been studied in earnest in the last ten years or so, and more intensively in the past few years, so there's a lot we still don't know.

What we do know, however, is that there' s not ONE version of a healthy yoni ecology.

 

In fact, there are variations between regions of the world, between ethnic backgrounds, between times of our lives, etc.

This is a dynamic, ever-changing environment… and while there MAY be some genetic components, it’s not necessarily true that our vaginal microbiomes reflect our parents'.

What is known is that many people have lactobacillus dominant microbiomes and some don’t, and both can be asymptomatic and potentially healthy versions of normal.

However those with lactobacillus dominant microbiomes do SEEM to be more resistant to BV and more protected from some other sexually transmitted infections.

Interestingly, folks who are white European descent seem to have more dominant lactobacillus species than folks who are black or hispanic who have MORE diversity and sometimes less lactobacillus.

So basically those with MORE diversity and LESS lactobacillus are at a higher risk of imbalances.

Your vaginal microbiome is much LESS diverse than your gut microbiome, which means there are just FEWER species themselves, and that’s a good thing.

The normal pH of the vagina (which is caused by the lactic acid that the lactobacilli produce) is around 3.5.

This low pH prevents the takeover of other species which can cause things like BV.

Lactobacilli also produce bacteriocins that are actively antimicrobial.

So between the low pH from the lactic acid and the enhanced antimicrobial activity from the bacteriocins they produce, lactobacilli are clearly something you're gonna want to encourage in your yoni.

So, now you may be wondering, what are some signs of imbalance?

• Vaginal infections like BV (which thrives in a more alkaline environment), 
• Chronic yeast infections
• Drier vaginal tissues, burning, irritation, itching, potentially could be causing painful sex
• Chronic infections, possibly leading to chronic pevic pain
• Recurrent UTI’s
• Preterm labor
• Possible infertility
• Need for chronic antibiotic or antifungal use

 

Okay, but why does this even matter?

Well, vaginal dysbiosis (which is the technical term for an imbalance of the vaginal microbiome) has been shown to:

• be more common in folks with PCOS (especially associated with higher testosterone levels)
• potentially increase a person’s risk of endometriosis
• increase risk of transmission of HIV, HSV2, Gonorrhea, Chlamydia, Trichomonas, BV, and Pelvic Inflammatory Disease (which may be the result of changes in barrier functions from the dysbiosis)
• increased risk of unexplained infertility and preterm labor
• increased risk of gynecologic cancers
• be an indicator of our greater microbiome health/gut health

 

So what could cause this imbalance in the first place?

• Chronic antibiotic or antifungal use
• Douches or scented vaginal hygiene products
• Some IUD’s have been associated with higher incidence of BV
• Some other birth control methods (diaphragms, spermicides - often on condoms)
• Hormonal changes (decreases in estrogen, such as post-menopause are associated withless lactobacillus dominance) 
• New sexual partners, and/or increased sexual activity (introduction of bacteria AND sperm can change pH)
• Bleached or chemical sanitary products (including tampons)
• Smoking
• Many lubes can change vaginal pH
• Menstruation - menstrual blood changes pH and contains more iron which BV loves!
  
  

There are lots of reasons you might end up with vaginal dysbiosis (aka microbiome imbalance), but thankfully there are many things you can do to both prevent future imbalance, and even restore a healthy and robust vaginal microbiome now.

So what can you do to prevent future imbalances?

• Wipe from front to back, always
• Clean hands (or sex toys, or anything going in) in the vagina
• Avoid bleached or chemically laden products (use organic unbleached pads, reusable cloth pads, etc)
• Take vaginal probiotics (orally) during menstruation, perimenopause and pregnancy 
• NO DOUCHING
• Always use condoms with new or many partners, whenever you have symptoms going on and AVOID spermicides
• Avoid unnecessary antibiotic and antifungal use and if you do need them, take probiotics for 3 months afterwards

 

So... how can you restore a healthy, robust microbial balance in your vagina if you've currently got something going on?

1) Vaginal probiotics.

This can be tricky, because everyone's "normal" is unique to them, so you may need to try different strains of vaginal probiotics, but you can start with L. reuteri, L. rhamnosus, and L. crispatus (taken orally) which are all shown to have a very beneficial effect on the vaginal microbiome.

You may even want to try different brands that contain these species, since they may even contain different patented strains. Some reputable brand options are Integrative Therapeutics (look for Reuteri & Rhamnosus) and Jarrow Femdophilus. 

Try them for a few weeks, and if you don't notice a difference, switch it up! You may need different strains altogether. Consider trying refrigerated versions of vaginal probiotics (taken orally) that you can find at your local natural food store or co-op.

2) Air yourself out.

Go underwear free whenever you can, and get some outdoor air, and maybe even some sun down there if you have a private enough space for it. Be careful not to get sunburned, though!

3) Movement.

Get regular exercise or movement, especially if you sit all the time. Explore how you can move your pelvis more. Consider bellydance, walking, yoga poses that encourage enhanced circulation down there.

4) Consider Maya Abdominal Massage.

Whether you are having a practitioner work on your or learning self-massage techniques (which practitioners will teach you), this can help to enhance circulation, encourage optimal immune function and generally help you connect more deeply with this part of your body. 

5) Eat well.

Prioritize eating a nutrient, vitamin and mineral rich diet to support tissue integrity and function. Your vaginal mucosa will be healthier with a whole foods, vegetable and fruit rich nutrition plan. If you feel like you may not be eating optimally, add in a high quality multivitamin.

6) Work on your gut microbiome.

Oftentimes, your vaginal microbiome reflects the health of the microbiome of your gut. This can take a lot of forms, but starting by paying attention to your digestive symptoms, seeing if sugar or fruit might be a challenge for you (and if so, limiting or taking those out), and exploring an elimination diet may be good options to start with. 

7) Connect with your yoni.

Cultivate a personal and loving relationship with your vagina. Honor the miracle of your body, and trust that healing will happen, even if it takes time. 

 

 

 

Super Nerdy References

Ceccarani, C., Foschi, C., Parolin, C., D’Antuono, A., Gaspari, V., Consolandi, C. Laghi, L., Camboni, T., Vitali, B., Severgnini, M., Marangoni, A. (2019).. Diversity of vaginal microbiome and metabolome during genital infections. Scientific Reports 9, 14095 . https://doi.org/10.1038/s41598-019-50410-x

Champer, M., Wong, A.M., Champer, J., Brito, I.L., Messer, P.W., Hou, J.Y., & Wright, J.D. (2017). The role of the vaginal microbiome in gynaecological cancer. BJOG, 125(3), 309-315. doi: 10.1111/1471-0528.14631. 

Chee, W.J.Y., Chew, S.Y., & Than, L.T.L. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact 19, 203. https://doi.org/10.1186/s12934-020-01464-4

Chen, X., Lu, Y., Chen, T., & Li, R. (2021). The female vaginal microbiome in health and bacterial vaginosis. Frontiers in cellular and infection microbiology, 11, 631972. https://doi.org/10.3389/fcimb.2021.631972

DeSeta, F., Lonnee-Hoffmann, R., Campisciano, G., Comar, M., Verstraelen, H., Vieira-Baptista, P., Ventolini, G., & Lev-Sagie, A. (2022). The vaginal microbiome III: The vaginal microbiome in various urogenital disorders. Journal of Lower Genital Tract Disease, 26(1), 85-92. doi: 10.1097/LGT.0000000000000645

Freeman, C. (n.d.). Probiotics and vaginas [Lecture notes & PowerPoint slides]. 2019-2021 Webinar Library. https://academy.camillefreeman.com/courses/2019-21library/contents/61abecb5adc0b

Graham, M.E., Herbert, W.G., Song, S.D., Raman, H.N., Zhu, J.E., Gonzalez, P.E., Walther-António, M.R.S., & Tetel, M.J. (2021). Gut and vaginal microbiomes on steroids: implications for women's health. Trends in Endocrinology and Metabolism, 32(8), 554-565. doi: 10.1016/j.tem.2021.04.014.

Greenbaum, S., Greenbaum, G., Moran-Gilad, J., & Weintraub, A.Y. (2019). Ecological dynamics of the vaginal microbiome in relation to health and disease. American Journal of Obstetrics & Gynecology, 220(4), 324-335. doi: 10.1016/j.ajog.2018.11.1089. 

Moosa, Y., Kwon, D., de Oliveira, T., & Wong, E.B. (2020). Determinants of vaginal microbiotacComposition. Frontiers in cellular and infection microbiology, 10, 467. https://doi.org/10.3389/fcimb.2020.00467

Muhleisen, A.L., Herbst-Kralovetz, M.M.. (2016). Menopause and the vaginal microbiome. Maturitas, 91, 42-50. doi: 10.1016/j.maturitas.2016.05.015.

Raimondi, S., Candeliere, F., Amarett,i A., Foschi, C., Morselli, S., Gaspari, V., Rossi, M., & Marangoni, A. (2021). Vaginal and anal microbiome during Chlamydia trachomatis infections. Pathogens, 10(10):1347. doi: 10.3390/pathogens10101347. 

Romm, Aviva. (n.d.). Vaginal ecology: How to keep things healthy down there. https://avivaromm.com/vaginal-ecology-down-there/

Saraf, V.S., Sheikh, S.A., Ahmad, A., Gillevet, P.M., Bokhari, H., & Javed, S. (2021). Vaginal microbiome: Normalcy vs dysbiosis. Archives of Microbiology, 203(7), 3793-3802. doi: 10.1007/s00203-021-02414-3. 

Torcia, M.G. (2019). Interplay among vaginal microbiome, immune response, and sexually transmitted infections. International Journal of Molecular Sciences, 20(2), doi:10.3390/ijms20020266

 

Links mentioned in this episode:

Listen to episode 5 for more info on your cervix and how to tell if you're ovulating: 
https://www.herbalwomb.com/episode5

Download the Natural Cycle Tracking Guide where you can learn the Fertility Awareness Method for body literacy, contraception or conception: https://www.herbalwomb.com/trackyourcycle

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