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Probiotics: Turns out, vaginas are complicated. And brilliant.

What you need to know about vaginal probiotics.

By Stephanie WilliamsPublished 3 years ago 5 min read
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"The vagina is a self-cleaning oven. Just leave it alone."

Sounds familiar, right?

I can still hear the words of my sweet-spoken professor, dropping this pearl on our women's health class, providing a valuable, yet simple, principle with which to guide our patient care. As NP students, we were taught to respect the body's ability to keep the vaginal peace. If a problem arose, we were trained to identify the condition, treat as necessary, and then advise the patient to resume leaving her vagina the heck alone. Don't flush it, scrub it, powder or perfume it. And the whole "yogurt-a-day-keeps-the-gyno-away" thing? Science wasn't supporting this, either. Gynecology professionals and governing health organizations had traditionally stood by the idea that there was no consistent evidence supporting oral probiotic efficacy for maintaining vaginal health and balance.

Let me just say this right now - probiotics have always bugged me. Not probiotics themselves, of course. I love myself a good, natural remedy in lieu of pharmaceutical treatment. What irked me was their cult following based on inconsistent data. I like evidence. Proof that what I'm suggesting to a patient does, in fact, have the potential to help them. What seemed to blow my mind, and prompt this blog post, was the wildly inconsistent opinions across health care professionals, research findings, and news articles regarding vaginal probiotic efficacy. I'm always left wondering if I'm missing something about what it is we know to be true about probiotics in gynecological health.

So, I made it my mission to find out: Do probiotics really help maintain vaginal health and balance?

After spending some time combing through the latest and most relevant research on probiotics in search of some solid, evidence-based data to finally put this debate to rest...the final answer was...maybe, sometimes. I know. Not the answer I was initially looking for either. However, enough information is available via some recent, promising studies to be able to make some more confident recommendations to patients regarding probiotic use moving forward, and I'm excited to share this information in hopes of helping more women keep the vaginal peace based on a realistic and data-driven understanding of probiotics.

So here's the scoop:

1. It's all about balance (a quick review on what's up down there). We need the good to keep the bad in check. Lactobacilli ("good" bacteria found inside the vagina) are known to provide protection against infection in several ways including: maintaining a low vaginal pH (<4.5), producing lactic acid (a known anti-viral and anti-bacterial agent), and by providing an actual physical barrier as it adheres to the vaginal wall and blocks access from infection-causing bacteria. From what we understand so far, without an adequate population of lactobacilli present inside the vagina to provide that protection, we are more vulnerable to the possibility of infection.

2. Not all Lactobacilli are created equal, and no two women are the same. Basically, there are a lot of moving parts in maintaining vaginal balance - factors like hormonal shifts, sexual intercourse, menstrual cycles, vaginal care, and bacterial exposure can all play a role in vaginal health. And similar to what we know to be true about breastmilk, each woman has her own special blend of vaginal microbes that protect her, and it still isn't completely understood by science exactly how they all protect and populate inside her, and whether or not the protection is lactobacilli species specific. Even though scientists have identified a handful of lactobacilli species as the most common species seen in women, it is nearly impossible to approach probiotic use as a one-size-fits-all treatment. Each woman has highly individualized sensitivities to external factors and her own unique microbiome. We can try and toss some helpers in the mix by way of probiotic use, but it isn't a guarantee that the treatment will positively affect her unique ecosystem.

3. Yeast infections can happen even when lactobacilli is still plentiful inside the vagina. Unlike BV (bacterial vaginosis), which is an infection that is almost always present in the absence of lactobacilli, a recent study published in August 2015 out of Canada has suggested that vaginal lactobacilli levels can still appear normal/unchanged during an active yeast infection. However, for reasons not entirely understood or explained, this same study did demonstrate that patients responded more favorably to treatment of a yeast infection when traditional anti-fungal treatment was combined with a probiotic treatment, indicating there is still potential benefits of probiotic use when treating yeast infections, but not necessarily avoiding the infections.

4. Probiotics may be able to help improve cure rates of bacterial and yeast infections when combined with antibiotic and anti-fungal treatments. Consider probiotics the Turbo Booster. Probiotics, when taken alone, are not likely to cure an active infection; however, based on a study done in 2006, rates of cure and post treatment levels of lactobacilli after 30 days of use were greater in women who combined traditional pharmaceutical treatment with probiotic use. Another study done in 2009 demonstrated similar results, looking specifically at BV cure rates when antibiotic treatment was received in conjunction with probiotics (87.5%) vs. antibiotic treatment alone (50%). However, the Center for Disease Control isn't yet buying it, and stated in the most recent, updated guidelines released in 2015 : "Overall, no studies support the addition of any available lactobacillus formulations or probiotic as an adjunctive or replacement therapy in women with BV. Further research efforts to determine the role of these regimens in BV treatment and prevention are ongoing."

5. Turns out, the stomach and vagina actually DO mix (to a certain degree). While it is clear that vaginal delivery of probiotics will provide a larger and more immediate dose of lactobacilli, it has now been shown that taking oral probiotics can also provide some protection by creating an abundant population of lactobacilli in and around the rectum. How is this helpful? Two reasons: first, it helps to minimize infection-causing ("bad") bacteria production by dominating the rectal balance and physically blocking the bad bacteria from traveling from the rectum to vagina and urinary tract (a common cause of infections); and second, the lactobacilli that populate the rectum can relocate and make the journey up to populate the vagina when in large enough numbers.

Bottom line: It's worth a shot.

Those who are likely to benefit the most from taking probiotics to maintain vaginal health:

1. Individuals experiencing frequent bacterial or yeast infections that return quickly after treatment is complete (taken daily to suppress infection).

2. Individuals who do not always respond to traditional pharmaceutical treatment alone (taken in adjunct with medication to treat infection, and continued for several weeks to months following resolution of symptoms).

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About the Creator

Stephanie Williams

Quiet dreamer. Mellow adventurer. I seize opportunities, find beauty, and keep asking questions.

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