Most of us know about the important role of the gut microbiome, but did you know that your vagina is also home to billions of bacteria that play a critical role in your intimate health?
This guide explains why they are so important, what happens when they’re out of kilter, and how you can look after them for your intimate health.
The link between vaginal health and the microbiome
Your vaginal microbiome is a delicate ecosystem of microorganisms (bacteria, yeast, and even viruses!) that call your vagina their home.[sup]1[/sup] In fact, there are thousands of different types of bacteria found in this community.
Its composition is complex and dynamic, and evolves throughout the various phases of your life such as puberty, pregnancy, childbirth, and menopause.[sup]1[/sup] But the superstar of vaginal health? Lactobacillus bacteria. They can make up over 90% of the bacteria in the vagina and are critical to maintaining balance in your vaginal microbiome.[sup]2[/sup]
Here’s how they work:
Lactobacillus bacteria naturally acidify the vaginal environment, creating a protective barrier against infections.[sup]2[/sup] If Lactobacillus levels drop, opportunistic bacteria—like Gardnerella vaginalis— or fungi – like Candida albicans - can overgrow and take over, leading to bacterial vaginosis (BV) or thrush.[sup]3[/sup]
What are bacterial vaginosis (BV) and thrush?
BV is caused by an overgrowth of Gardnerella vaginalis in the vagina and causes symptoms such as[sup]3[/sup] :
• A strong fishy odour
• Greyish or white discharge
• Mild soreness or itching
It’s the most common vaginal infection[sup]4[/sup] affecting 23-29% of women of childbearing age globally[sup]3[/sup] so if you’ve experienced it, you’re not alone! There are many things that can increase your risk of BV including vaginal deodorants, sexual activity, or even intrauterine device (IUD) use[sup]5[/sup]. The issue with BV is that it not only impacts your quality of life, but increases your need for antibiotics, and is associated with an increased risk of sexually transmitted infections (STIs), obstetric and gynaecological complications such as late miscarriage and premature labour.[sup]6[/sup]
Meanwhile, thrush develops typically when Candida Albicans, a yeast naturally found in your vaginal microbiome, is allowed to overgrow. Up to 75% of women will experience thrush at least once in their lives—and 40-45% more than once[sup]7[/sup]. Symptoms can include[sup]7[/sup]:
• Vaginal and vulvar itching or soreness
• A burning sensation during urination or sex
• A distinctive white discharge[sup]6[/sup]
Women at higher risk for thrush include:
• Pregnant women
• Those on oestrogen-based medications
• Individuals taking broad-spectrum antibiotics
• Immunosuppressed individuals or those with diabetes[sup]7[/sup]
Actively maintaining and supporting your vaginal microbiome is a proactive way to protect your overall health and wellbeing.
Here are some top tips to help reduce the risk and recurrence of BV or thrush :
● Avoid using perfumed soaps, bubble bath, shampoo or shower gel in the bath
● Use water instead of vaginal deodorants, washes or douches
● Avoid using antiseptic liquids in the bath – preferably take a shower
● Avoid using strong detergents to wash your underwear
● Avoid wearing tight-fitting or synthetic underwear (opt for cotton), as this can create a warm, moist environment that encourages overgrowth of microbes and may cause irritation to the area
Are there any benefits of taking live bacteria oral supplements for women?
Antibiotic and antifungal medication are typically used to treat BV and thrush, but relapse rates are high with many women experiencing recurrent symptoms within a year.[sup]7,9[/sup]. That's where live bacteria oral supplements may help support vaginal health by restoring Lactobacillus levels, and promoting a balanced vaginal microbiome essential for intimate health.
For example, strains like Lactobacillus acidophilus La-14® and Lactobacillus rhamnosus HN001™— combined with lactoferrin—are clinically proven to colonise the vagina within 7 days, increasing Lactobacillus and reducing Gardnerella vaginalis and Candida growth.[sup]10[/sup] This combination of strains has also been shown to reduce unpleasant symptoms like vaginal discharge and itching, and decrease the risk of recurrence of both BV and thrush.[sup]10[/sup]
If you choose to take a live bacterial supplement, remember that not all live bacterial supplements are created equal, and the latest science tells us it’s important to take the right strain, at the right time, in the right way. Every strain serves a specific purpose, so make sure to choose one supported by clinical evidence for your health concern. For the vaginal microbiome, Lactobacillus acidophilus La-14® and Lactobacillus rhamnosus HN001™ are your go-to strains.[sup]10[/sup] The right dose is also important, so match the dose that’s been proven effective in clinical trials. More doesn’t always equal better; it’s about finding the right fit for your needs.
Looking after your vaginal microbiome means taking care of your vaginal health. It’s all about the balance, and Lactobacillus bacteria orchestrate this balance to keep BV and Thrush at bay. If you look after them, they will look after you…
References:
1. Diop, K., Raoult, D. and Fournier, P.E. (2019) ‘Exhaustive repertoire of human vaginal microbiota’, Human Microbiome Journal, 11, p. 100051.
2. Miller, E.A., Livermore, J.A., Gilmore, M.E. et al. (2016) ‘Microbiota composition and its role in vaginal health’, Frontiers in Microbiology, 7, p. 1936.
3. NICE (2024) ‘Bacterial vaginosis: Complications’.
4. BUPA UK (n.d.) ‘Vaginal infections’.
5. NICE (2023) ‘Bacterial vaginosis: Definition’.
6. NICE (2023) ‘Candida (female genital)’.
7. NHS (2023) ‘Thrush in men and women’.
8. NICE (2023) ‘Candida (female genital)’.
9. Russo, R., et al. (2018) ‘Role of probiotics in fungal infections’, Mycoses, 62(4), pp. 328–335.
10. Russo, R., et al. (2018) ‘Probiotic therapy in gynecological health’, Archives of Gynecology and Obstetrics, 298(1), pp. 139–145.
Written by Corrine Toyn
Reviewed by Dr Emily Porter, Women's health and gut specialist dietitian