Probiotics. Kombucha. Kefir. Dysbiosis. Symprove. By now, if you’ve ever googled the words “gut health”, you’ll be familiar with these terms. For the past few years, digestive wellbeing has been a major talking point in the wellness sector, with countless videos on TikTok touting the benefits of regularly popping probiotics and consuming the aforementioned paraphernalia. All help boost the illusive gut microbiome – aka the bacteria and other microbes that support digestion, immunity, heart health, and just about anything else.
Now though, the conversation has shifted, spotlighting a different, somewhat unsuspecting body part: the vagina. To some, this might sound bizarre. But there is such a thing as the vaginal microbiome, and it has become the subject du jour among the health-obsessed set. On TikTok, videos with thousands of views pontificate about the benefits of maintaining a healthy vaginal microbiome (a term that is used interchangeably with “vaginal microflora”), linking it to fertility, STIs, immunity, inflammation, and HPV. Online, you can buy all sorts of products claiming to support it, from shower gels to vaginal probiotics.
But what actually is the vaginal microbiome? And why should we be maintaining it? Like with gut microbiomes, the term simply refers to the group of microbes that are present in the area. Typically these comprise a mix of bacteria, viruses and fungi. “It’s a community of microorganisms that are usually found living together in a specific part or organ of the body,” explains Dr Shirin Lakhani, intimate health and hormone expert. “It’s a group of microorganisms specific to the vaginal ecosystem.”
The reason it’s so important to maintain a healthy vaginal microbiome is because any dysregulation can lead to a wide range of illnesses and health issues. “These include diseases such as bacterial vaginosis, yeast infections, an increased risk of infections, infertility, miscarriages, and pregnancy complications,” says Ina Schuppe Koistinen, a microbiome researcher at Karolinska Institutet in Stockholm. “The vagina and its microflora’s well-balanced ecosystem changes only due to external factors, such as hormone levels, medications, infections, the use of hygiene products, or penetrative sex.”
So, what does a healthy vaginal microbiome look like? Well, for starters, it has an abundance of Lactobacilli, which is the bacteria that prevents infections – it’s also the one found in kefir. “The Lactobacilli are seen as the ‘good’ bacteria and play a hugely important role in vaginal health as they release lactic acid and hydrogen peroxide which creates an acidic environment that helps to maintain a healthy pH balance within the vagina,” says Dr Lakhani. Typically, a healthy vaginal pH is low, usually between 3.8 and 4.5; maintaining this means that other harmful bacteria (like ones that cause thrush) are less likely to thrive there.
It’s normal for your vaginal pH to shift slightly throughout the month depending on where you are in your menstrual cycle. “Blood has a neutral pH of 7.4, so when menstruating, the presence of blood in the vagina will increase the vagina’s pH levels,” explains Dr Lakhani. Having unprotected sex can also increase the pH, subsequently making you more vulnerable to infection, given that semen typically has a pH of around 7.1 to 8. “Using condoms will prevent the semen from altering the vagina’s pH balance,” she adds. Of course, unprotected sex can also lead to a transference of bacteria, potentially exposing you to STIs that will disrupt the vaginal microbiome.
Completely avoid ‘feminine hygiene’ products. There is a big market but wipes, douches, or any deodorant-based product for your vagina usually have a high pH level which disrupts the vagina’s pH and causes irritation
Dr Shirin Lakhani
Smoking can increase the vaginal pH, too, with research finding that smokers are more likely to be at risk of bacterial vaginosis (BV), which is generally not serious but should be treated with antibiotics as it can heighten your risk of contracting an STI. Symptoms include unusual vaginal discharge, like a change in colour or smell.
Lactobacilli is partly maintained by oestrogen, which leads to the accumulation of glycogen – this is the main nutrient for the bacteria. This means that our vaginal microbiome changes with age. “After menopause, with reduced oestrogen production, the glycogen content in vaginal tissue decreases, resulting in a neutral pH,” explains Koistinen. “The number of Lactobacilli decreases, replaced by a vaginal flora similar to that before puberty. Women after menopause often lack Lactobacilli in the vagina, contributing to the high frequency of urinary tract infections. Oestrogen therapy can help restore a Lactobacilli-dominated vaginal microbiome.”
As for what women can do to maintain a balanced pH and vaginal microbiome, some companies would lead you to believe the key is to buy their products: vaginal drops and scented vaginal sprays and serums are just some of the options available online. Good marketing and branding might have you buying into the idea that these are essential items in order to help you maintain a healthy – and crucially, correctly scented – vagina. But in most cases, the opposite is probably true. Not only are these so-called “feminine hygiene” brands capitalising on a culture fostered by female shame, one that has tricked women into thinking their vagina needs to look or smell a certain way in order to be considered acceptable, but they are actually causing a devastating impact on our vaginal microbiome.
“Completely avoid ‘feminine hygiene’ products,” advises Dr Lakhani. “There is a big market but wipes, douches, or any deodorant-based product for your vagina usually have a high pH level which disrupts the vagina’s pH and causes irritation. The vagina is self-cleaning, so these products really aren’t necessary.”
Probiotics might help, depending on the content, although the benefits are disputed given the paucity of research in female sexual health more broadly. “There is no proven evidence that taking probiotics works for keeping a healthy microbiome in the vagina,” says Dr Lakhani. Koistinen has previously said that there are very few probiotics available that contain the specific Lactobacillus that has been found to promote the vaginal microbiome. “But probiotics that contain the right strains of Lactobacilli that are connected to good vaginal health can restore a dysbiotic vaginal microbiome,” she adds.
Of course, there are ways to ensure you’re getting the necessary nutrients through your diet. “Maximising prebiotic and probiotic rich fermented foods will promote Lactobacillus to grow and thrive,” says Hannah Alderson, hormone specialist and registered nutritionist. “Think kefir, kimchi and sauerkraut. Supplement-wise you could seek out a probiotic that contains specific vaginal strains, such as Lactobacillus Crispatus. The bacteria within an oral supplement or food will eventually make their way to your vagina.”
It might also be worth examining the menstrual products you use. “I always recommend opting for unscented, organic tampons and changing them regularly as this can help prevent bacterial overgrowth,” says Mo Carrier, sexual wellness expert and founder of MyBliss condoms. “Even better, try using a menstrual cup as this can minimise exposure to any nasty chemicals that can disrupt our pH.” What you wear can help, too. “Breathable cotton underwear and avoiding tight clothing – particularly during the warmer months – can also help maintain a healthy environment,” adds Carrier.
There is work being done to learn more about the vaginal microbiome. Research scientist Fatima Aysha Hussain, for instance, is leading a vaginal microbiome transplant study to see whether fluid from a healthy vaginal microbiome transferred to someone living with recurrent BV can prevent the infection from coming back. So far, initial results have proven promising. But more research is needed, particularly when you consider just how impactful the vaginal microbiome is on our overall health and wellbeing – because it’s not just about increasing the risk of STIs and BV.
“If there is an imbalance of the vaginal microflora, research suggests potential major roles with health outcomes like infertility, frequent miscarriage, endometriosis, polycystic ovaries, frequent urinary tract infections, and vagino-vulval itching,” adds Alderson. “Therefore your vaginal flora composition plays a huge role in vaginal, reproductive and overall health. As I see in my private clinic, sadly many women are not aware of these connections.”
Perhaps this is partly because all this is still fairly recent. “The concept that the vaginal tract has a microbiome was classified a little under a decade ago,” points out Alderson. “And although research is in its infancy, influencing and manipulating the vaginal microbiome to enhance gynaecologic and reproductive health holds vast potential. It’s incredibly exciting for women’s health.”
