The vaginal microbiome may not be a term you are familiar with, but I am sure you have come across the gut microbiome. We have multiple places on our anatomy that have their own microbial communities. Each location has a different composition of microbes, and these microbes and their metabolites appear to impact our immunity, development, hormones, and metabolisms. We require them to function.
The reproductive microbiome includes the vaginal, cervical, endometrial, fallopian, seminal and placental microbiome – where the different microbial composition is found. Today, I want to talk about the vaginal microbiome. This is an incredibly interesting area of research and one that could potentially shed light on the high rates of unsuccessful IVF cycles, and on couples experiencing recurrent miscarriages and unexplained infertility.
So, let's look at the vaginal microbiome, the types of bacteria that should dominate, the implications on fertility when that microbial balance is compromised and how we can support it.
What Makes The Vaginal Microbiome Unique?
The vaginal microbiome (VMB) is unique because, unlike the gut microbiome, low diversity of species is associated with a healthy microbiome. The specific species that have been found to dominate the lower genital tract in healthy individuals is the Lactobacillus genus (with L. crispatus being the most dominant). High levels of Lactobacillus are associated with a low PH. The higher the pH, the more alkaline the environment becomes and this shift is associated with a more diverse community of bacteria and an increase in bacterial-related conditions such as Bacterial Vaginosis.
In addition, studies have shown that Lactobacillus species produce lactic acid and short-chain fatty acids, which can acidify the vaginal environment to a pH level of <4.5 and prevent the growth of other pathogenic bacteria. In other words, Lactobacillus has a protective role in maintaining a healthy environment, keeping the PH low, which is particularly important for fertility and pregnancy.
How Can The VMB Impact My Fertility?
Studies have shown that changes in vaginal microbiology, also known as dysbiosis, are associated with many pathological conditions, including infertility, miscarriage and premature birth.
A recent study looking at the vaginal microbiota of women undergoing IVF discovered that women with a low percentage of Lactobacillus in the vaginal microbiome had a lower rate of success in embryo implantation. This indicates that an abnormal vaginal microbiota may negatively affect the clinical pregnancy rate in IVF patients.
Earlier this year, a new study investigating the vaginal microbial composition and the local immune response in chromosomally normal and abnormal miscarriages, found that changes to a mother’s vaginal microbiome may be associated with pregnancy loss.
How Can I Support My Vaginal Microbiome?
There are many strategies to improve the health of the VBM; these include a healthy diet rich in fibre, prebiotic and probiotic-rich foods, adequate exercise and sleep, stress management, limiting drugs and alcohol and good hygiene practices.
I want to focus on good hygiene practices here because this is definitely a grey area with clients.
Frequent use of vaginal sprays and douches should be avoided to prevent irritation from the chemicals. Soaps should also be avoided as they can disrupt the PH of the vagina. A good alternative is castor oil soap.
For people with infections, avoid wearing G-strings or thongs on a daily basis. The anus and vagina are in close proximity and therefore the migration of bacteria from one area to another is aided when wearing these garments. Choose breathable natural fibres that promote airflow to the area.
When you go to the toilet, always wipe away from the vagina.
Change tampons and moon cups after a bowel movement and avoid wearing tampons when your period is light to avoid cotton wool being left behind.
Choose organic sanitary wear - Raphael, Yoni, Naturacare, and even Tampax offer an organic range.
Wash the vagina after sexual intercourse or exercise.
Avoid smoking as nicotine is directly secreted into the vagina and impacts the VMB.
Avoid lubricants or barrier methods that do not contain chemicals that can alter the PH of the vagina. YES BABY is a great brand offering natural solutions.
Another important part of maintaining a healthy vaginal microbiome is tuning in to different feelings down there, noticing (and not dismissing) aches and pains, abnormal coloured discharge and strange odours, as these symptoms could indicate a possible infection which will need to be addressed.
Testing can be highly beneficial. Companies such as Invivo Healthcare offer a wide range of diagnostic testing and therapeutics to support microbial imbalances, and I use them on nearly all of my clients, not just to support their fertility but to rule out complications in pregnancy and labour.
Who May Benefit From Testing?
- Women experiencing recurrent miscarriages
- Women who have previously had a recurrent UTIs or STDs
- Women who have experienced endometriosis or adenomyosis
- Women with "unexplained infertility"
If I am About to Start Trying for a Baby, Should I Be Thinking About Supporting My VMB?
100%! I cannot reiterate enough how important it is to rule out bacterial-related conditions before trying for a baby. Once fertilisation occurs, hormones such as estrogen increase, allowing estrogen-loving bacteria to flourish which may not only cause discomfort but could have negative outcomes for a pregnancy. I haven't come across a client so far, who hasn't had a history of UTIs, thrush or Bacterial Vaginosis associated symptoms or a squeaky clean report from a Vaginal swab. It is important to understand the microbial balance, the extent of the dysbiosis occurring and those species other than lactobacillus taking up a large percentage of the lower genital tract. When considering vaginal dysbiosis, it is also important to consider other reservoirs of cross-contamination, such as the gut and urinary microbiomes, and the oral/vaginal/penile microbiomes of sexual partners, which may warrant further investigations or hygiene practices to prevent re-infection.