Your Vaginal Microbiome: Why It Matters & What You Need To Know

You have most likely heard about the gut microbiome- especially if you follow me, as I talk about it’s importance often. The gut microbiome is the thriving colony of bacteria, viruses, fungi and even parasites that lives in your intestines and asserts its influence on everything from food choices to mental health. 

But did you know there’s also such a thing as a vaginal microbiome? 

What is the vaginal microbiome?

Your vaginal microbiome is not unlike your gut microbiome. It’s comprised of countless bacteria that live from the cervix to the external anatomy of the vulva. It is a complex little ecosystem made up of more than 200 bacterial species both pathogenic and nonpathogenic.

By “pathogenic” and “nonpathogenic” I mean “good” and “bad” bacteria that are present in our bodies. Most of the time, the “bad” bacteria aren’t actually harmful unless the microbiome gets out of balance.

Several species of bacteria, one of which is Lactobacillus (you probably heard about this one from seeing it on the back of your yogurt container), dominates the vagina and thrives in an acidic environment. This species of bacteria supports your ability to fight off infections and dysbiosis (microbiome imbalance), prevent sexually transmitted infections (STIs), maintain mucus production and help care for a healthy pregnancy and vaginal delivery

Lactobacilli contribute to the health of the vagina because they produce lactic acid, and it is lactic acid’s job to keep the pH of the vagina low. An acidic vagina is the first line of defense against infection. Ideally, you want a vaginal pH between 3.5 to 4.5.

How the vaginal microbiome becomes imbalanced

A variety of factors can knock the vaginal microbiome out of balance and increase vaginal pH, including simply getting older. For example, perimenopause which is characterized by shifts in estrogen, and less circulating estrogen in a woman’s body, can kick off a cascade of events that can disrupt the vaginal microbiome.

The lactobacilli in the vagina love glycogen, but the walls of the vagina are only rich in glycogen only when you have a good amount of estrogen in the body. When the glycogen depletes the pH goes up. Lower levels of estrogen can also contribute to vaginal dryness and a dry vagina is more easily invaded by bacteria.

But age isn’t the only factor. Certain types of birth-control medication- for example- can increase vaginal pH for some women. And douching, which can change the vaginal microbiome and leave women more susceptible to vaginal infections and sexually transmitted infections, is uniquely terrible for the vaginal microbiome.

Exposure to synthetic fragrances and chemicals, either through “feminine hygiene” products or harsh laundry detergents, can also irritate and disrupt vaginal tissue, as can a high-sugar diet, because yeast thrive and flourish on sugar. This can contribute to thrush, characterized by vaginal itching and a cottage cheese-like discharge.

Bacterial vaginosis (dysbiosis of the vaginal microbiome) can even happen simply from you having a new sexual partner. Sexual intercourse introduces new bacteria to the ecosystem and sometimes there’s an undesirable result. This could be vaginal itching, a foul-smelling “fishy” odor, or a burning during urination (easily mistaken for a urinary tract infection). Sometimes you can also be completely asymptomatic.

How you can support your vaginal microbiome

A lot of everyday interventions can help you support a balanced vaginal microbiome and keep a low vaginal pH. Some of my recommendations:

1. Avoid perfumes, dyes, and other synthetic chemicals. Scented hygiene products or other items, like underwear washed in laundry detergent with synthetic fragrance, will disrupt the vaginal microbiome. Same with any product that is marketed as a way to improve or eliminate vaginal odor. The vagina has a natural odor. If you notice a more pungent smell than usual, it can be a sign that the vaginal microbiome is imbalanced and it’s wise to consult a licensed healthcare practitioner.

2. Don’t douche. Douching disrupts the natural microbiome of the vagina, leaving it vulnerable to infection. The vagina is “self cleaning”, which means it will clean itself with natural secretions. Washing with soap and water in the shower is sufficient enough.

3. Wear cotton underwear (and make sure it’s not too tight). And when you can, ditch the undies altogether and give your vagina space to breathe which really helps. As my mother used to say when I was growing up 'get some air down there."

4. Watch the sugar. Dietary sugar feeds the yeast and other bad bacteria in the vagina. I say "watch the white, the wheat and the sweet". Opt for a diet high in healthy fats and low-glycemic, micronutrient-rich plant-based foods, like avocados, nuts, seeds, and plenty of low fructose fruits and colourful vegetables.

5. Give probiotics a try. The data is limited but some research does suggest that oral probiotics may help populate the vagina with healthy bacteria. It’s worth trying as it can help, and it probably won’t hurt.

6. If low estrogen or vaginal dryness is affecting vaginal pH, a topical estrogen cream may help. Topical estrogen creams are prescription-only, so talk with your healthcare provider if you suspect low estrogen (or erratic swings in estrogen) are contributing to imbalances in your vaginal microbiome. And be sure to TEST your estrogen first before just "assuming" that's the cause.

7. Try boric-acid capsules. If you’re prone to recurrent vaginitis, you can try boric acid as a prophylactic therapy. You can use boric-acid suppositories twice daily for two weeks, followed by once daily for two weeks. Not only is boric acid antiviral and antifungal, it also works to treat both Candida albicans and the more resistant Candida glabrata yeast strains. The two brands that come to mind are SEROflora and BoriCap.

The bottom line? Your vagina is a "self-cleaning oven" and it will usually take care of itself. But when it doesn’t, or if you suspect something is up, listen to your body and make sure you see your doctor or healthcare provider. Don’t rely on tips on the internet (even these!) because you might be dealing with more than you think you are.