Did you know that just like our gut, which is populated by beneficial bacteria, so too the urogenital tract of women contains valuable microbiota?1 These are mostly of the Lactobacillus species (spp. or group) of bacteria, and are responsible for maintaining the health of the vaginal tract.2 Probiotics containing these beneficial bacteria can be taken orally, but may also be applied locally in a ‘pessary’ form, and can be helpful in maintaining the balance of good bacteria in the vaginal tract.1-3
The healthy vaginal environment
The healthy vaginal microbiota is dominated by the beneficial bacteria of the Lactobacillus spp., although many other bacteria may be present in significantly reduced numbers.1,2 Lactobacilli are involved in maintaining the health of the vagina by making the environment inhospitable for opportunistic and harmful organisms to grow, and they do this by:
- Competing with harmful organisms for nutrients and sites to adhere to the vaginal wall
- Maintaining a normal healthy vaginal pH* by producing lactic acid
- Producing substances such as hydrogen peroxide
- Supporting the immune system.1,2
*The pH of a substance is a measurement of how acidic or basic it is, on a scale of 0 to 14, with the lower numbers representing greater acidity.
Changes in the healthy vaginal ecosystem
Healthy oestrogen levels have a positive effect on vaginal microflora, and situations where there are fluctuations in oestrogen such as menopause, times of the menstrual cycle and pregnancy can result in changes to the vaginal ecosystem.1,2 Sexual activity and hygiene practices can also change the make-up of the microbiota of the vaginal tract.1,2 This change in the balance of bacteria in the urogenital tract can affect the health of the vaginal environment.1 This imbalance may manifest in some individuals as general vaginal discomfort, while other individuals may not have any symptoms. However, it’s best to see a healthcare practitioner when symptoms are new or continue.
Things you can do to support healthy vaginal microflora
Beneficial hygiene practices can be performed to support healthy vaginal microflora balance; such as wearing breathable underwear, avoiding excessive douching and ensuring your immune system is in tip-top shape with plenty of rest and a healthy whole food diet. Including fermented foods in your diet such as yoghurt, kefir, sauerkraut and kombucha, which contain beneficial bacteria, may also be helpful.
Probiotics (in a pessary form or taken orally) which replenish the levels of Lactobacillus spp. naturally present in the vaginal tract, such as the L. plantarum strain, may also be beneficial for vaginal health.3 The Lactobacillus spp. collectively may help to increase lactic acid production,4,5 while the L. acidophilus strain may help to increase both lactic acid as well as hydrogen peroxide production.6
Why use a pessary alongside oral probiotics?
Probiotics can be administered vaginally or orally because the bacteria can travel passively from the rectum to the vagina once they have passed through the gastrointestinal tract.2 Probiotics delivered in a pessary form (a capsule inserted locally into the vagina) may work more quickly than those taken orally as oral probiotics need to pass through the gastrointestinal tract first before reaching the urogenital tract.2
Speak to your healthcare practitioner for more information about supplementation. Make sure to always read the label and use only as directed. If symptoms persist, see your healthcare practitioner.
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1. Mastromarino P, Vitali B, Mosca L. Bacterial vaginosis: a review on clinical trials with probiotics. New Microbiol 2013;36(3):229-238.
2. Borges S, Silva J, Teixeira P. The role of lactobacilli and probiotics in maintaining vaginal health. Arch Gynecol Obstet 2014;289(3):479-489.
3. De Seta F, Parazzini F, De Leo R et al. Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2014;182:136-9.
4. Juárez Tomás MS, Ocaña VS, Wiese B et al. Growth and lactic acid production by vaginal lactobacillus acidophilus CRL1259, and inhibition of uropathogenic Escherichia coli. J Med Microbial 2003;52:1117-1124.
5. Aroutcheva A, Gariti D, Simon M et al. Defense factors of vaginal lactobacilli. Am J Obstet Gynecol 2001a;185:375–379.
6. Eschenbach DA, Davick PR, Williams BL et al. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol 1989;27:251–256.