The idea of probiotics has been around since the early 1900s when Russian Nobel laureate Élie Metchnikoff theorised that Bulgarian peasants who ate yoghurt lived longer than those who didn't.
The benefits of probiotics were also recognised in 20th century Japan, where the probiotic-rich miso soup is a foundation of the famed Okinawa diet. Whether in pickles or sauerkraut, kimchi or kombucha, probiotics have long been associated with good gut health.
Since then, probiotics have become the subject of many studies into their positive effects on our digestive systems.
In recent years, researchers have begun to investigate the possibility of using probiotics to maintain the health of another complex and essential system within the body: the vaginal microbiome.
While the studies are small, there are some positive signs that probiotics could function as a valuable treatment and preventative for vaginal infections.
How does the vaginal microbiome work?
Also known as vaginal flora, the vaginal microbiome refers to the bacteria present in the vagina that help to protect against infections.
An imbalance of these bacteria can have a huge impact on your health, leading to painful conditions like bacterial vaginosis, urinary tract infections and yeast infections.
Lactobacilli are the main beneficial bacteria in normal vaginal flora, but there are often others present in smaller numbers. The job of lactobacilli is to produce lactic acid which keeps the pH of the vagina at an acidic level (less than 4.5) and does not allow for the growth of harmful bacteria [1].
In fact, the pH in the vagina should be similar to that of black coffee, but this isn't always the case. Below, we explore a range of factors that influence this delicate balance of vaginal health.
What's the deal with vaginal imbalances?
The presence of a healthy vaginal microbiome can depend on hormone levels, nutrition, hygiene and sexual practices, as well as bacterial interactions and the body's ability to defend against infections at any particular time [2].
While it's not an exact science, keeping the vaginal bacteria in balance helps to protect your body against all sorts of nasties.
When the balance of good bacteria and bad bacteria is disturbed, the pH of the vagina can become less acidic and therefore more hospitable to infections. There are 3 particularly common issues that stem from vaginal imbalances that we'll explore here.
Bacterial vaginosis (BV)
Between 12-30% of Australian women currently have bacterial vaginosis but many may be unaware of the differences between bacterial vaginosis and a yeast infection [3].
Bacterial vaginosis is caused by an imbalance in the vaginal microbiome that allows too many harmful bacteria (especially Gardnerella and Prevotella) to grow, while thrush is caused by a fungus called candida. Each condition responds differently to treatment so it is important to recognise the signs and symptoms of these infections.
Although BV can be asymptomatic, it is associated with pelvic infection and can increase the risk of premature delivery, miscarriage and low birth weight for pregnant women. It can also increase the chances of getting sexually transmitted diseases (STD), which means treating it as soon as possible is recommended.
Unfortunately, this association with STDs has contributed to a stigma around BV that has impacted women's ability to identify and treat it.
The symptoms of bacterial vaginosis include greyish, watery vaginal discharge, an unpleasant or ‘fishy’ odour and mild irritation around the vagina and vulva, but these may be intermittent. (BV symptoms often flare up during your period or after having sex.) If you notice any of these symptoms, your doctor will be able to test for bacterial vaginosis and other STDs.
The good news is that bacterial vaginosis is easily treatable with antibiotics. Once you've recovered, there are some things you can do to support vaginal health; like stopping smoking, avoiding douching or using any perfumed products and using condoms. Unfortunately, some people suffer recurrent bacterial vaginosis requiring prescription medication.
Urinary tract infection (UTI)
While not technically affecting the vaginal microbiome, a urinary tract infection occurs when harmful bacteria enter the bladder, urethra or kidneys. This can happen in people of all genders but is more common for those who have a vagina.
In fact, nearly 1 in 3 women will have a UTI that requires treatment before the age of 24 [5]. Untreated urinary tract infections can cause serious kidney infections, so it's important to get them sorted early.
Symptoms of a UTI include passing small amounts of urine, a frequent urge to urinate and pain or stinging when urinating. If the infection becomes more severe, it can cause nausea, fever, confusion and lower abdomen pain.
Like BV, UTIs are usually treated with antibiotics. Urinary alkalinisers, including bicarbonate soda, can also help relieve discomfort when dissolved in water and taken orally.
You may already know that wiping front to back and peeing immediately after sex helps to prevent UTIs, but you should also try to stay hydrated, wear cotton underwear and avoid perfumed products around the vagina to prevent bacteria entering the urethra and maintain urinary tract health. Plus, cranberry juice has been shown to be helpful too!
Yeast infection
Around 75% of women will experience a yeast infection at least once in their lifetimes [6]. A yeast infection (also known as thrush and candidiasis) is caused by a fungus rather than a bacteria.
However, it is similar to BV in that the candida fungus is normally present in the vagina in small numbers, but can cause problems if it becomes too numerous. The most common symptoms are itchiness and irritation around the vagina, although up to 1 in 5 women do not experience symptoms.
The risk of yeast infections increases when taking antibiotics, during your period or pregnancy, and in people with a vulnerable immune system.
Thrush can be treated using over-the-counter pessaries, creams or tablets. If it does not clear up after using one of these methods, make sure to consult your doctor to rule out the possibility of vaginal infections or STDs.
There are a couple of things you can do to help keep candidiasis under control. Like with BV and UTIs, cotton underwear is a must and douching and scented products should be avoided.
Very hot baths or spending long amounts of time in wet clothes can increase the risk of thrush as can unnecessary antibiotic use.
What are vaginal probiotics?
The pain and discomfort caused by these conditions have led many women to seek alternative treatments, including vaginal probiotics, that are less invasive and more accessible.
Probiotics are live beneficial bacteria and fungi that can be found in foods like yoghurt, as well as in supplements, and they have become increasingly popular in recent years as a protective measure against vaginal infections.
Although general probiotics are commonly used to treat problems in the digestive system, they are increasingly being targeted towards vaginal health in the form of vaginal probiotics. These can be formulated as oral tablets or as suppositories designed to be inserted into the vagina.
While vaginal probiotics are a relatively new remedy, they are beginning to be researched as a gentler form of treatment for BV when compared to antibiotics.
What do vaginal probiotics do?
Vaginal probiotics aim to rebalance the vaginal microbiome to treat and prevent BV and other infections. The use of probiotics can improve vaginal flora, increase beneficial bacteria and reduce the number of harmful bacteria by delivering lactobacillus directly to the vagina [7].
Like probiotics for your gut, they may help with regaining a healthy balance of bacteria when things get thrown out of whack.
Can they treat vaginal infections?
The short answer is maybe. The jury is still out on probiotics' ability to influence the vaginal microbiome; their effectiveness has not been conclusively proven by research on a large scale.
However, there is increasing evidence that probiotics are useful in the treatment of BV, especially in preventing its reoccurrence once treated with antibiotics [8].
When treating yeast infections and UTIs, vaginal probiotics could again be helpful but much more study is needed. There is also no clear answer about whether oral tablets or suppositories are more likely to provide health benefits.
Are probiotic supplements good for vaginal health?
When it comes to promoting a healthy vaginal microbiome, you'll want to look for probiotics that include Lactobacillus crispatus and Lactobacillus rhamnosus as these are the most common strains naturally found in the vagina.
Probiotics are unlikely to have any negative side effects that you need to worry about, but if you have ongoing issues with yeast infections, BV or UTIs you should consult your doctor about long-term treatment options.
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