Vaginal Flora

Our intimate area is like a garden, with a range of different plants and species aka ‘bacteria’. However, much like our hormones, we require a delicate balance of certain bacteria. Some bacteria aren’t as strong as others, while some are prone to growing rapidly and taking over. If left unchecked, this imbalance can go on to increase risk of more serious complications and diseases. Just as with a garden, we need to ensure we are providing the right environment to keep a harmonious balance.

The Main Players - what bacteria DO we want?

So we know that there lives a range of bacteria, but which is the good, the bad and the ugly? The vaginal area has relatively low bacterial diversity and is host to billions of different Lactobacilli which produce various antimicrobial compounds. This helps to ensure an acidic pH which prevents harmful germs and bacteria from multiplying. However, it is reported that women around the world have vastly different vaginal microbiomes depending on age, pregnancy, sexual activity, stress, etc. Often when we see an imbalance in the microbiome, there will be a decline in Lactobacilli and an increase other bacterial or fungi strains. Gardnerella Vagnalis is a bacteria that can rapidly replicate in the right environment and take over dominance of the vaginal microbiome, leading to the condition known as Bacterial Vaginosis (BV). Anther key player is the fungus Candida Albicans which is characterised in the condition known as Thrush. Alterations in the ideal pH can also increase risk of infections such as UTI.

Signs of Imbalance

Some women notice changes down there relatively quickly, however, other women may experience no symptoms at all. In the case of BV, the obvious changes include a distinct ‘fishy’ odour, thin or watery grey/brown discharge and itching. BV is characterised by a loss or sharp decline in the Lactobacillus and an increase in anaerobic microbes. It is a highly prevalent disorder among women of reproductive age and associated wth adverse gyneocologic and obstetric outcomes such as STIs, pelvic inflammatory disease and preterm birth.

A common fungal infection is Thrush, which is characterised by itching, burning sensation and a white/yellow crumbly discharge. Recurrent urinary tract infections (UTI) can also be caused by imbalances in bacteria which results in changes to the ideal pH. You may or may not notice all the symptoms and if you’ve noticed a change to normal it could be worth getting it checked out, especially if you are pregnant or trying to conceive.

Flora Disruptors

Hormonal changes

Oestrogen is a key hormone in the menstrual cycle and naturally fluctuates during the month. Higher levels of oestrogen promote lactobaccilus dominance by creating a suitable environment. For this reason, the presence of lactobaccili bacteria is lower during and after your period and in menopausal or post menopausal women. The oral contraceptive pill may also alter bacterial balance.

Antibiotics

Despite sometimes being necessary, antibiotics wipe both the good and bad bacteria. For this reason, I always encourage my clients to take probiotics after antibiotics to help reestablish positive bacteria in the gut and the vaginal flora.

Excessive personal hygiene

Many shower gels and soaps are not suitable for the vaginal area and can disrupt the pH, which promotes the growth of harmful bacterial species. Water or a suitable pH neutral intimate wash is advised.

Synthetic underwear

The balance of bacteria is highly depend on the environment in which it lives. Therefore, we want to create an environment that promotes a healthy flora. Avoid synthetic underwear that create warm and humid environment, and instead look for organic, cotton or bamboo.

Stress

it is well known that stress can affect our entire body, including our immune system and microbiome. Stress stimulates the hypothalamic-pituitary-adrenal (HPA) axis, which eventually leads to elevated levels of cortisol. This is an essential body process as it prepares our body in the case of danger, by increasing energy pathways and taking energy away from less essential systems. However, these changes create an environment that promotes the production of pathogenic bacteria and make it difficult for the positive lactobacillus bacteria to survive. To know about the impacts of stress on your hormones and cycle, read here.

Diet and lifestyle

Our vaginal flora is closely linked with our gut microbiome. So the food we eat on a daily basis will either support the growth of postitive, healthy bacteria, or support the growth of pathogenic bacteria. Dietary fibre is a carbohydrate found in plant foods that is not digested by our upper gastrointestinal tract, but rather fermented by bacteria in the large intestine. During this process, short chain fatty acids are released which help support our body in multiple ways. It is well known that a microbiome that is rich in diversity is associated with positive health outcomes. Including 30g of fibre a day from multiple sources of vegetables, fruit, wholegrains and legumes can help to support microbial diversity. Furthermore, a diet high in processed foods, sugar, alcohol and poor quality fats is associated with an increase in pathogenic bacteria.

When to seek help

If you have noticed changes in your discharge, cycle regularity or an increase in infections such as UTI’s, it might be time to talk to a professional. There are a range of dietary changes that can help to support a healthy vaginal flora. Supporting your hormones and regulating menstrual cycles can also help to balance vaginal flora. For more information or ideas to support the health of your microbiome, book a discovery call.

References

Amabebe E, Anumba DOC. Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health. Front Endocrinol (Lausanne). 2018 Sep 24;9:568. doi: 10.3389/fendo.2018.00568. PMID: 30319548; PMCID: PMC6165882.

Chen X, Lu Y, Chen T, Li R. The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front Cell Infect Microbiol. 2021 Apr 7;11:631972. doi: 10.3389/fcimb.2021.631972. PMID: 33898328; PMCID: PMC8058480.

Noormohammadi M, Eslamian G, Kazemi SN, Rashidkhani B. Association between dietary patterns and bacterial vaginosis: a case-control study. Sci Rep. 2022 Jul 16;12(1):12199. doi: 10.1038/s41598-022-16505-8. PMID: 35842517; PMCID: PMC9288476.

Severgnini, M., Morselli, S., Camboni, T., Ceccarani, C., Salvo, M., Zagonari, S., . . . Marangoni, A. (2022). Gardnerella vaginalis clades in pregnancy: New insights into the interactions with the vaginal microbiome. PLoS One, 17(6) doi:https://doi.org/10.1371/journal.pone.0269590