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The bacteria in the vagina or its microbiome has been linked to poor reproductive health such as infertility, poor IVF results, frequent miscarriage, pre-term birth and frequent infections, including bacterial vaginosis and thrush.  One remedy is oral or vaginal probiotics; more about this later. 

Do you know what is wrong?

First a proper diagnosis is needed.  Are we dealing with a bacterial imbalance or yeast overgrowth?  The key indicator of bacterial vaginosis which is an overgrowth of alkaline bacteria, is a fishy smell from the vagina.  Whereas thrush usually presents with a discharge, often lumpy and white and often accompanied with redness and itchy sensation.  There is another bacterial imbalance, where the acidic bacteria become too abundent, but in this case the symptoms are similar to thrush; this is called cytolitic vaginosis. A helpful sign to pinpoint the latter is that acidic bacteria naturally increases prior to the period, so symptoms worsen and then are soothed by the flow of the blood when the period begins.

If your symptoms aren’t giving you a clear diagnosis, you can get a test which identifies your unique vaginal microbiome, such as Vaginal EcologiX by INVIVO:

This might be critical. For example in vaginal vaginosus more acidic bacteria is required so supplementation with acidic probiotics (particular strains of lactobacillus) might be worth trying, but opposite is true for cytolitic vaginosis.  Giving acidic probiotic bacteria in the latter case, will make matters worse.

Oral and Vaginal Probiotics

A number of protective Lactobacillus species dominates the healthy vaginal microbiota in most women. Using probiotics whether oral or vaginal to encourage a healthy vaginal microbiome is controversial.  Vaginal microbiota is changed by the menopause, pregnancy, period flow, sexual activity, antibiotic therapy and the use of oral and vaginal contraceptives, vaginal douching, lactation, diabetes and stress.  Regularly using probiotics does seem to have a temporary beneficial effect though, but not for all women. Interestingly, 25% of women ostensibly maintain healthy vaginal microbiota without lactobacilli dominance.  So the question is:

Is the alteration of the vaginal microbiota caused by opportunistic infections or due to a systemic endocrine, immune or metabolic condition predisposing to good bacteria extinction?

Some consultants (Amabebe & Anumba) are now starting to consider how the immune system is reacting to vaginal bacteria.  Even when the ‘bad’ bacteria have been eradicated, inflammation caused by the immune system can continue in the absence of any infection and is believed to predispose the woman to further infections.

My reading of the evidence seems to suggest that giving antibiotics and using probiotics is temporary and there is a high relapse rate, so in such incidences we need to look more holistically. We need to get to root of the problem.  The gut is a good place to start, as much of the immune system is active around the gut, as our digestive system is a major source of pathogens. Ask yourself questions about your lifestyle – are you eating a wide variety of vegetables and enough protein, are you sleeping and exercising well?  Another key area to reflect on is stress which has profound impacts on our gut and immune systems particularly, and throughout the body.  This is where regular acupuncture can counteract the negative consequences of longterm stressors on the body.


This article is very detailed but offers the reader a good understanding of the vaginal microbiota.
Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Front Med (Lausanne). 2018;5:181. Published 2018 Jun 13. doi:10.3389/fmed.2018.00181
Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Womens Health. 2019;19(1):25. Published 2019 Jan 31. doi:10.1186/s12905-019-0723-4
Smith SB, Ravel J. The vaginal microbiota, host defence and reproductive physiology. J Physiol. (2017) 595:451–63. doi: 10.1113/JP271694
Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK, McCulle SL, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA. (2011) 108:4680–7. doi: 10.1073/pnas.1002611107