The Role of the Vaginal Microbiome

Whilst the gut microbiome is a hot topic - one microbiome that is less talked about is the vaginal microbiome. As a fertility nutritionist, I routinely request all my clients test their vaginal microbiome via easy at home tests. Why does a nutritionist look at this?! Because we can help foster a better vaginal microbiome through your the use of specific strains of probiotics through supplementation, diet as well as other lifestyle factors. We know that a balanced vaginal microbiome with good levels of Lactobacillus correlates with better pregnancy outcomes, IVF outcomes and less allergies/intolerances in the offspring too.

There are numerous links with vaginal health, the vaginal microbiome and pregnancy outcomes, of which I would love to share with you. It is very much evidence based with a huge body of research to support this.

Why might a nutritionist be involved in this?

Well, it is Lactobacillus crispatus in particular that is the most beneficial strain of bacteria found in the vaginal microbiome. In every fertility client, I insist on testing their vaginal microbiome with a simple at home swap during their follicular phase of their cycle and up to ovulation. Following the results, we can then go in with targeted nutritional support in the form of probiotics or even antimicrobials should there be a presence of detrimental bacteria, thrush or BV in the area. It is particularly relevant as some bacteria can be associated with poor outcomes in IVF cycles and may even result in poor semen parameters. Unless we address the vaginal microbiome, we cannot be sure we have truly optimised their health and wellbeing ahead of conception.

These days, the microbiome seems to be everywhere, but understanding its role in your vaginal health is crucial for overall well-being. Let's delve into why a balanced vaginal microbiome is essential and how you can nurture it naturally.

Firstly, the low pH of the vagina is incredibly important. The vagina is a self-regulating ecosystem teeming with bacteria – some beneficial and some not. A key player in maintaining this harmony is the slightly acidic environment (low pH) created by lactic acid produced by friendly bacteria like Lactobacillus. This acidic environment acts as a natural barrier, keeping potentially harmful bacteria in check. Within this ecosystem, Lactobacillus reigns supreme yet they are not all equal and this is why bespoke support is needed. We know that different Lactobacillus strains offer varying levels of protection. For example, research confirms that Lactobacillus crispatus is particularly effective in preventing bacterial vaginosis (BV), a common condition caused by an imbalance in vaginal flora. In contrast, other Lactobacillus strains, like Lactobacillus iners, are less protective.

A balanced microbiome not only guards against harmful bacteria but also keeps yeast, like Candida albicans (responsible for thrush) in check.  Lactobacillus produces lactic acid which discourages the growth of Candida. Additionally, a healthy microbiome helps prevent the overgrowth of bacteria associated with BV, like Gardnerella vaginalis and Prevotella.

So, how do you know if your vaginal microbiome is out of whack?  Signs like recurrent yeast infections, BV, itching, and burning could indicate an imbalance.  However, some women may be completely asymptomatic, which is where testing comes in. I routinely test my clients via simple at home tests which are swabs they can use themselves and send off to explore their vaginal microbiome composition. 

The good news is, there are also simple ways to support a healthy vaginal microbiome. Firstly, your vagina is self-cleaning. Douching or using harsh soaps disrupts the natural balance. Avoid soaps or even gentle, fragrance-free cleansers and avoid excessive washing. Simply letting the water run off you in the shower is enough. When it comes to underwear, cotton is best.  Synthetic fabrics and thongs can trap moisture, creating an environment conducive to unfriendly bacteria or yeast growth.

Another thing to note is that hormonal fluctuations can disrupt the microbiome, particularly oestrogen levels. For example, when these levels naturally decline like is the case during breastfeeding or during perimenopause/menopause, Lactobacillus populations often decline. Consulting a healthcare practitioner/nutritional therapist about additional support during these times might be beneficial.

Surprisingly for some, diet plays a vital role too.  To keep yeast at bay, avoid refined sugar, ultra processed foods and yeast-containing foods such as bread, beer and marmite. Consuming probiotic-rich foods like yoghurt, kefir, kimchi, and sauerkraut introduce beneficial bacteria strains that can migrate to the vagina. Prebiotics, found in foods like chicory root, onions, and garlic, act as food for the good bacteria already present, promoting their growth. Finally, if you want to ensure you are improving specific Lactobacillus strains within the vaginal microbiome, look for products with Lactobacillus strains, particularly L. crispatus.

By understanding the delicate nature of your vaginal microbiome and implementing these simple changes, you can empower yourself to maintain a healthy and balanced ecosystem for optimal well-being, health and even fertility.