What is the Vaginal Microbiome?

Aug 12, 2021

What is the vaginal microbiome?

The vagina is filled with good bacteria, or flora, that protects us from developing infection. All of the good bacteria that makes up the vagina is known as the vaginal microbiome or vaginal ecosystem. One of the most well-known bacteria in the vagina is the Lactobacillus species, often referred to as lactobacilli. These bacteria produce lactic acid, which keeps the vaginal pH at a normal, acidic level. (Normal vaginal pH is 3.5-4.5). It is more challenging for bacteria and viruses to thrive in an acidic state. The lactobacilli bacteria also make proteins that kill or prevent the growth of harmful bacteria. There are many factors that determine the bacteria that make up your vaginal microbiome, including genetics and environment. The vaginal microbiome is complicated and we are still learning about it.

What happens if my vaginal ecosystem is disrupted?

Our vaginal microbiome can be disrupted for a number of reasons. Any change that causes a decrease in good bacteria or alteration of the vaginal pH, can result in an overgrowth of bad bacteria. This imbalance most commonly causes bacterial vaginosis.

But what about yeast infections?

It is normal for yeast to be present in the vagina without causing symptoms. It is also normal for there to be no yeast in the vagina. We don’t understand why yeast causes problems in some women and not in others. It is possible that some people are more sensitive to yeast than others. It is also possible that certain yeast may cause more irritation than others. We only care about the presence of yeast in the vagina when it causes bothersome symptoms like discharge, itching, and irritation.

What’s the deal with antibiotics and yeast infections?

23% of women develop a symptomatic yeast infection after taking antibiotics. Antibiotics lead to yeast infections by killing the good bacteria in the vagina, as well as killing the harmful bacteria that we prescribed them for. Yeast is normally present in the vagina and generally doesn’t cause harm. However, a drop in good bacteria allows yeast to overgrow and cause bothersome symptoms.

Does menstruation affect my vaginal health?

During menstruation, it is normal for vaginal pH to increase, meaning the environment becomes less acidic. At the same time, red blood cells bind to our good bacteria, causing a significant decrease by the end of our menses. Some women are more sensitive to this change and may be at higher risk for developing bacterial vaginosis.

Does my diet affect my vaginal health?

No! There is an ongoing myth that diet has a direct impact on vaginal health. Unless you have diabetes, diet has not shown to cause or increase risk of yeast or other infection.

Are vaginal infections dangerous?

Disturbances in the vaginal ecosystem can increase your risk of developing HIV and other sexually transmitted diseases. If you have recurrent vaginal infections, you should talk to your healthcare provider about getting tested and establish a treatment plan.

How can I prevent recurrent vaginal infections?

Bacterial vaginosis is not considered a sexually transmitted disease in the same category as gonorrhea and chlamydia, however we do know that BV can be associated with intercourse. Using condoms is highly recommended to prevent infection, especially if you are prone to recurrent infection.

You should avoid douching, using petroleum jelly vaginally and spermicide/lubricant that may be damaging to lactic-acid producing bacteria.

If you smoke cigarettes, it is recommended that you quit. There is a significant correlation between smoking and developing bacterial vaginosis.

Vaginal probiotics may be beneficial in preventing infection (we just don’t know how beneficial). The most beneficial probiotic is likely one that contains lactobacillus, as we know this is a very important and prominent bacteria in the vaginal ecosystem. There is no harm in trying a probiotic.

There are some studies that show using an estrogen-containing birth control (like the pill, patch or ring) is protective against bacterial vaginosis. If you are using an alternative form of birth control and experience bacterial vaginosis multiple times per year, you may want to consider changing your method. 

We don’t know if there is any correlation between recurrent BV and having an IUD but if you get multiple infections per year, it is an important topic to discuss with your healthcare provider.

I have symptoms, should I try an at home test?

While at home tests are convenient and becoming more popular, they are not recommended. At home tests claim to evaluate for multiple microorganisms that may normally exist in your vagina and not be causing you any symptoms. When performing an at home test, it may lead to unnecessary antibiotics that will likely disrupt the vaginal ecosystem and then require additional treatment that may not have been needed in the first place. You should always consult your Obgyn for any bothersome symptoms.

Written by Emily O'Keeffe, NP:

Emily is a Colorado native and joined Red Rocks OB/GYN (a member of OB/GYN Affiliates) in July of 2020. She began her medical career as a CNA in 2010 and worked with post-operative spine patients. She earned her undergraduate degree from Denver College of Nursing in 2013 and transitioned into a nursing role in the Emergency Department at Swedish Medical Center, where she spent the majority of her nursing career. She then earned her Master's degree at Walden University and became a board-certified Family Nurse Practitioner. Emily is passionate about supporting women and enjoys being part of their preventive health and obstetrical care. She has participated in multiple medical mission trips to Haiti and Cambodia. Emily enjoys spending time with her husband and fur babies. She loves travel, champagne, plants, and live music.  Schedule an appointment with Emily by visiting http://www.redrocksobgyn.com/