Keeping a healthy vaginal microbiome

The vagina has its own distinct commensal microbiome which differs from the other microbiomes in the body. The composition of the microbiome in the vagina plays a role in vaginal, reproductive and maternal health. Imbalances of the vaginal flora can play a large role in infertility, frequent miscarriage, endometriosis, pre-term birth, frequent urinary tract infections, bacterial vaginosis, thrush, and vagino-vulval itching and discomfort..

General Vaginal Ecology Considerations

1. The vagina is self-cleaning, so there is no need to use perfumed sprays, strong soaps or douches. Excessive use of these may lead to irritation from the chemicals, and disturbance of the microbiome and pH of the vagina.

2. For people with current or chronic infections, try to avoid the use of G-string (thongs) underwear on a daily basis, as the contact between the anus and the vagina may aid the migration of gram-negative bacteria.
Try to choose breathable natural fibres to improve air flow in the area (i.e. cotton, bamboo) over synthetic fabrics.

3. After toileting, always practice wiping away from the vagina.

4. Change tampons and vaginal cups after bowel movements. If using vaginal menstrual cups, sterilise them by boiling in water between use.

5. Avoid using soap in the vuvlo-vaginal area, wash with water only, or a pH neutral soap, if needed.

6. Be aware that any courses of antibiotics mayimpact the vaginal microbiome. Whilst taking antibiotics, consider using Lactobacillus species probiotics, eating cultured foods and continuing to do so for a month or two post treatment to prevent post-antibiotic symptoms.

7. Choose personal lubricants that are low in irritants and chemicals, are unscented and do not alter the pH of the vagina. Oils such as coconut and almond can be ok in some situations, but not when using a condom as it may cause the rubber to perish. Water based and silicone-based lubricants are both available. We like YesWB or Olive & Bee – please let us know and we can write you a script via Vital.ly.

8. Clean sex toys between use and try to avoid using vaginally after using anally without first cleaning to prevent cross contamination.

9. Diets high in excess sugar may contribute to an overgrowth of vaginal dysbiosis. Avoiding excessive simple carbohydrates, and excessive alcohol intake may restore the microbiome, but equally it doesn’t need to be overly restrictive as that might cause fungi to produce hyphae, which is more damaging to the epithelial lining.

10. Cigarette smoking directly secretes nicotine into the vagina and impacts negatively on the vaginal microbiome.

11. It may be necessary to investigate your gut health as a reservoir for infection transmission and support healthy intestinal flora through a diet high in various fibres, prebiotics and polyphenols. The use of oral probiotics (especially Lactobacilli) have been shown to have an impact on vaginal flora.

12. Changes in hormones, especially oestrogen and progesterone, can alter the secretions of the vagina, which can have an impact on the microbiome. Low oestrogen states can be a risk for bacterial vaginosis, and high oestrogen states can increase the risk of recurrent thrush. We may need to consider hormonal testing in cases of vaginal dysbiosis that is hard to shift. Frequent urinary tract infections may be another source of cross-contamination of the anaerobic or facultative anaerobic bacteria so should be treated.

13. If having sex with multiple partners, use barrier methods such as condoms to prevent microbial transmission. Choose condoms that are paraben, spermicide and glycerine free.

14. Saliva and semen can both cause the pH of the vagina to become more alkaline, which may worsen symptoms of bacterial vaginosis and other conditions associated with a lack of acidity. Consider using barrier methods or changing types of sexual activity in the short term, whilst correcting any microbial dysbiosis that is acute.

15. Stress and HPA-dysfunction can play a major role in microbial balance and immune dysfunction. If necessary we can discuss providing more stress relief.

16. In all cases of vaginal dysbiosis, it is important to make sure the diet has a diverse range of prebiotic and probiotic foods to support Lactobacilli growth and to encourage diversity. Consider a diet rich in polyphenols and fermented foods, and soluble and insoluble fibres.