Published January 23, 2024 Due to the gender health gap, research on the vaginal microbiome is scant. Fortunately, more and more scientists are becoming interested in this complex, dynamic system and its relationship to other microbiomes and body systems. So let’s demystify the vaginal microbiome, how it can get out of whack, and what to do when this (inevitably) happens in your lifetime. What is your vaginal flora? Your vaginal flora, also known as your vaginal microbiome, is the ecosystem of different species of microbes that exist in your vagina at any given time. This includes beneficial bacterial strains like the Lactobacillus species and harmful strains of bacteria and yeast. Just like any other microbiome on or in your body, your vaginal microbiome is constantly changing and adapting to your environment, stress, diet, and more. What is “normal” vs unbalanced flora? There is a veryyy fine line between a balanced and unbalanced vaginal microbiome and it all lies in the pH. You ideally want your vaginal pH to be somewhere in the 3.8-4.5 range for a healthy level of acidity. When your vaginal pH starts creeping up to a more basic state, you’ll likely start to notice symptoms like itching, discomfort, or odor. One of the many reasons Lactobacillus strains are so important to your vaginal health is that they produce lactic acid that not only fends off pathogenic bacteria but also keeps your pH in that optimal zone of acidity. While diversity is an important predictor of gut and mouth microbial health, it’s quite the opposite when it comes to the vagina. According to the research, you actually want a lower diversity of species with a predominance of Lactobacillus strains, especially Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners and Lactobacillus jensenii (1). Lactobacillus crispatus are particularly critical in maintaining low diversity as they generate the most hydrogen peroxide (H2O2) which in turn helps to preserve optimal pH levels (2). An imbalanced vaginal microbiome can lead to a number of symptoms and conditions, depending on the type of microbe(s) present. For instance, an overgrowth of anaerobic bacteria like Bacteroides species, Peptococcus species, and Eubacterium species typically manifests as bacterial vaginosis (BV) and atrophic vaginitis (AV). Similarly, high levels of the yeast Candida albicans cause yeast infections including vulvovaginal candidiasis (VVC), Neisseria gonorrhoeae when left unchecked leads to gonorrhea, and Chlamydia trachomatis can eventually become pelvic inflammatory disease (PID) (3). The takeaway here? A healthy, balanced vaginal microbiome is able to stave off any introduced pathogens naturally but once it’s gotten out of balance, harmful bacteria can get a foothold and things will start to compound rapidly. How does vaginal flora impact your health? A body of emerging evidence suggests that an imbalanced vaginal microbiome may affect pregnancy and delivery. One study concluded that bacterial vaginosis (BV) more than doubled the risk of preterm delivery in asymptomatic patients as well as increased the risk of miscarriages late in pregnancy (4). Researchers have identified correlations between certain vaginal microbes and preterm birth occurrence, most notably Mycoplasma hominis, Gardnerella vaginalis and Atopobium vaginae (5). In another study on natural reproductive success and the vaginal microbiome, women who experienced one bout of BV reported a 17% decline in their ability to conceive naturally and chronic BV reduced the rate of natural conception by a staggering 43% (6). In the context of artificial reproductive success, several studies have shown that women with fewer Lactobacillus species in their vaginal flora are less likely to have successful embryo implantation with IVF (7, 8). Unsurprisingly, the ecosystem of bacteria and yeast in your vagina also affects your urinary system health. If pathogenic bacteria colonizes your vaginal microbiome, it can quite easily travel up into your urethra and, ultimately, kidneys causing painful UTIs. Some women may even find themselves in a cyclical pattern of chronic UTIs and yeast infections. You can read our in-depth post about UTIs, the bacteria responsible for them, and how to prevent them from happening here. Bacterial vaginosis (BV), which we briefly touched on earlier, is the most common inflammatory condition caused by vaginal dysbiosis, affecting 25% of women worldwide (9). It’s specifically characterized by a deficiency of lactic-acid producing Lactobacillus species and increased numbers of anaerobic bacteria like Gardnerella, Atopobium, Megasphera, Prevotella, and Sneathia. Typical indicators of BV include thin white/gray discharge, a fishy odor, vaginal irritation, pain during urination and a vaginal pH of over 4.5. Due to these conspicuous and often unpleasant symptoms, 80% of women report feeling embarrassed, ashamed or self conscious and avoid intimacy with their partner (10). Our vaginal health even plays a role in our mental health! The other frequently experienced vaginal affliction stemming from a microbial imbalance is vulvovaginal candidiasis (VVC), a type of yeast infection. Many of us know this all too well – the intense vaginal itchiness, thick white discharge and redness or swelling of the vulva. It’s estimated to affect about 70% of women in their lifetime, but that number may actually be higher due to people seeking over-the-counter care and, therefore, not reporting their condition. The organism to blame? Candida albicans, an opportunistic pathogenic yeast that exists naturally in our mouths, guts, and other parts of our bodies (11). Like most microbes that make up the human microbiome, its presence doesn’t usually cause any symptoms unless something throws off the entire ecosystem and candida gets out of balance. Things like antibiotics, estrogen use, pregnancy, immunosuppressants, diabetes, hormonal IUDs and diet and lifestyle factors can deplete Lactobacillus species and allow Candida albicans to invade the vaginal mucosal lining and cause inflammation. You’re probably sensing a trend here… Lactobacillus strains get depleted and opportunistic bacteria take over. It really is as simple as that! Factors that affect your vaginal flora Soaps and body washes Contraception methods Scented products Antibiotics Hormonal shifts, i.e. pregnancy and menopause Clothing Race and ethnicity Stress Smoking Age Diet, most notably sugar intake Douching Lube, especially spermicidal lubes Probiotic supplements and foods Sexual health How to maintain balance of your vaginal microbiome: Take a targeted probiotic – Not all probiotics are created equal here! Especially if you find yourself with chronic symptoms, it’s critical that you supplement with a vaginal-specific probiotic strain to ensure that you’re populating your vagina with Lactobacillus species. On the flip side of that same coin, try to only take antibiotics when necessary. Limit your sugar consumption – Yeast and pathogenic bacteria feed off of sugar, allowing them to multiply and get out of control. This can lead to yeast infections and BV. Try our vaginal health formula *COMING SOON* – We combined vaginal-specific probiotic strains like L. gasseri, L. rhamnosus and L. reuteri with concentrated whole food cranberry in our novel vaginal formula, Flora V. This jack-of-all-trade supplement supports urinary tract health, maintains optimal pH levels, targets odor and keeps yeast in check. Sign up here to be the first to know when we launch. Practice proper hygiene – Wipe from front to back after going to the bathroom to reduce the spread of E. coli bacteria. Also, be sure to change out of sweaty gym clothes or wet swimsuits as soon as you can! Opt for a menstrual cup – Prolonged contact with old blood both in and against your body can lead to bacterial growth, especially if you forget to change your pad or tampon. By catching as opposed to absorbing, a menstrual cup removes blood from what is known as the “vaginal vault”. Avoid scented feminine products – As tempting as they may seem, artificial fragrances are loaded with chemicals that can throw off the delicate pH of your vagina or cause irritation. Only use gentle soap or warm water – Your vagina is a self-cleaning organ that needs minimal intervention. Water really is the best cleanser, but if you want something a little extra just make sure it’s a vagina-friendly as to not disrupt your pH. Wear cotton – Synthetic fabrics trap moisture which is a recipe for bacterial and yeast infections. Cotton, on the other hand, is absorbent, breathable and usually pretty affordable as an added bonus.