Your Vaginal Microbiome Matters More Than You Think (Here’s Why)

You may already know about the importance of the gut microbiome for overall health. But we have other microbiomes throughout the body, and today we’re going to talk about the often overlooked vaginal microbiome. 

The vaginal microbiome has a profound impact on hormonal, reproductive, and overall health, and imbalances in this ecosystem are responsible for the vast majority of vaginal health concerns like itching, odor, or infections. (1) 

Today, I’ll cover exactly what the vaginal microbiome is and why it matters, signs of dysbiosis, and a few tips for keeping things in balance. 

We’ll also look at how the vaginal microbiome is different from the gut microbiome (and how they’re connected). 

The Vaginal Microbiome: What It Is and Why It Matters 

Just like how your gut microbiome is a community of bacteria, fungi, and other microorganisms living in your gut, your vaginal microbiome is a microbial community that lives in the vaginal canal. 

If you have a vagina, the vaginal microbiome plays an essential role in supporting your reproductive system, immune system defenses, and hormonal balance. The balance of your vaginal community also affects your susceptibility to certain kinds of disease. 

Certain kinds of bacteria (mostly various species of Lactobacilli, we’ll get to specifics in a minute) work to protect against infections and disruptive microbes, and support the immune barrier of your reproductive tract. 

Disruptions in the balance of the vaginal microbiome can allow pathogens and infectious microbes in, trigger inflammation, and weaken immune system function. This can have a ripple effect throughout the reproductive system and beyond. 

Imbalances in the vaginal microbiome can lead to bacterial vaginosis (BV), yeast infections, and urinary tract infections, all of which may be recurrent. 

Vaginal dysbiosis can also lead to an increased risk of fertility issues, pelvic inflammatory disease (PID), STIs including chlamydia, and gynecological cancers. (2-5) 

What Makes Up a Healthy Vaginal Microbiome? 

One of the key components of a healthy gut microbiome is diversity—a wide range of different beneficial species and strains that work together in different ways. 

But the vaginal microbiome actually thrives on an abundance of a few particular species of bacteria, and not diversity. 

In a vaginal ecosystem, diversity can actually increase the risk of infection and inflammation. 

A healthy vaginal microbiome is typically dominated by one or two strains of Lactobacillus bacteria, particularly Lactobacillus crispatus. (6) 

In the vaginal microbiome, L. crispatus and other beneficial lactobacilli produce lactic acid and other natural antimicrobials to defend against infections, help regulate inflammation and protect the vaginal mucosa, and keep harmful bacteria like Gardnerella vaginalis, Prevotella, and Atopobium from taking over. 

They also work to keep vaginal pH low. A low (acidic) pH level, ideally between 3.8 and 4.5, makes it harder for pathogens to grow, and is a key sign of a healthy vaginal microbiome.  

Signs of Vaginal Dysbiosis 

When there’s an imbalance between protective lactobacilli and less protective types of bacteria, the vaginal microbiome enters a state of dysbiosis. This imbalance can lead to bacterial vaginosis (BV), yeast infections, urinary tract infections (UTIs), aerobic vaginitis (AV), cytolitic vaginosis (CV) and other problems. 

Here are a few possible signs of vaginal dysbiosis: 

• Frequent or recurrent infections including bacterial vaginosis, yeast infections, or UTIs 
• Vaginal itching, irritation, or a burning sensation
• Unusual vaginal discharge and/or odor 
• Pain during intercourse
• Vaginal dryness 

The most common type of vaginal dysbiosis is bacterial vaginosis, which is marked by a loss of Lactobacillus bacteria and an increase in anaerobic microbes. (7, 8) It’s thought to affect around a third of women at any given time. BV often gets missed, misdiagnosed, or returns after treatment with antibiotics. 

Most cases of BV are actually asymptomatic, which is part of why it’s so frequently missed by healthcare providers. But, even without symptoms, BV is linked to an increased risk of adverse gynecologic outcomes, pelvic inflammation, and future infections.

The Gut-Vagina Connection

The gut microbiome and the vaginal microbiome are closely connected. (9) 

You may have already seen this connection in action if you’ve ever taken antibiotics and then ended up with a yeast infection. This is a clear example of how dysbiosis in one system can trigger dysbiosis in the other: antibiotics disrupt gut flora, which can in turn affect vaginal flora. 

The gut also plays an important role in hormone metabolism. Imbalanced estrogen levels (from stress, poor detoxification, hormonal birth control, and/or other factors) can shift vaginal pH away from protective bacterial species. 

READ: How To Heal Your Gut: A Functional Medicine Guide To Restoring Microbiome Health 

What Causes the Vaginal Microbiome To Change? 

Again, like the gut microbiome, your vaginal microbiome is always changing and adapting based on environmental factors it encounters. 

These factors may include gut health, birth control, menstruation, menopause, stress, certain hygiene products, and dietary changes. 

One of the biggest factors is age. When females are younger, vaginal pH is more acidic and therefore more protective (an acidic vaginal environment helps to fight off pathogenic bacteria, yeast including candida, and viruses). 

But as women age, changes in hormones, including declining estrogen levels, start to shift the environment and vaginal pH becomes more alkaline. This decreases the natural defenses of the vaginal microbiome. (Hormonal birth control is another big factor that can cause vaginal pH to become more alkaline). 

This is why it’s important to keep an eye on your vaginal health especially once you reach your mid-30s, which is when these hormonal changes start to shift the vaginal environment. 

How to Support Your Vaginal Microbiome Health

If you know or suspect that you have vaginal dysbiosis, or if you want to be proactive in preventing it, there are several holistic strategies you can use to restore and support balance. 

• Test your vaginal pH. Knowledge is power! Look for simple at-home test strips to assess your current vaginal pH. You can do this regularly to see how your balance may be affected by hormonal or other changes. 
• Test your gut health. Gut microbiome testing doesn’t directly measure what’s going on in your vaginal microbiome, but chances are if you have gut dysbiosis, your vaginal environment will be affected. This is a good way to get a picture of what’s going on upstream. 
• Reacidify your vaginal environment. Topical DHEA (applied externally) may help to lower vaginal pH and improve the vaginal microbiome, especially around menopause. (10)
• Nourish the gut. Again, since the gut and vaginal microbiomes are connected, gut healing can make a huge difference for vaginal health. Start with an anti-inflammatory diet and probiotic & prebiotic support. 
• Avoid microbiome disruptors. Stress, processed foods, and scented hygiene products are a few common disruptors of microbial balance. (11) 
• Consider non-hormonal birth control. If you do take hormonal birth control, you might want to speak with your practitioner about other options. Of course this is an individual decision, but the birth control pill can disrupt your vaginal microbiome and your hormonal health. 
• Take probiotics. Taking a high quality, general probiotic supplement that contains Lactobacillus species would be my top choice, as you’re directly supporting gut health and indirectly supporting vaginal and overall health. However, there are also some newer formulations designed for vaginal health specifically, including some that can be inserted vaginally. 

There are several interesting research initiatives underway, with big advancements in vaginal modeling and testing as well as unique treatment options like vaginal microbiome transplants. (12, 13) I’m very happy to see more attention being paid to the vaginal microbiome—and, I would always suggest starting with simple diet and lifestyle practices like we’ve covered here first. 

Everything Is Connected

The vaginal microbiome is so important for women’s health, and it doesn’t exist in isolation. It’s in communication with your gut, immune system, and hormones, and can affect your overall wellbeing. I hope to continue to see increased awareness of vaginal microbiome health in the medical community moving forward. 

For those who are looking for more individualized support, our functional medicine telehealth clinic can help you look at the big picture through testing, gut repair, hormone support, and a root cause focus. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

• Sobel, J. D. (1990). Vaginal infections in adult women. Medical Clinics of North America, 74(6), 1573-1602.
• Van Oostrum, N., De Sutter, P., Meys, J., & Verstraelen, H. (2013). Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Human reproduction, 28(7), 1809-1815.
• Haggerty, C. L., Totten, P. A., Tang, G., Astete, S. G., Ferris, M. J., Norori, J., … & Ness, R. B. (2016). Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sexually transmitted infections, 92(6), 441-446.
• Brotman, R. M. (2011). Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective. The Journal of clinical investigation, 121(12), 4610-4617.
• Nené, N. R., Reisel, D., Leimbach, A., Franchi, D., Jones, A., Evans, I., … & Widschwendter, M. (2019). Association between the cervicovaginal microbiome, BRCA1 mutation status, and risk of ovarian cancer: a case-control study. The lancet oncology, 20(8), 1171-1182.
• Lewis, F. M., Bernstein, K. T., & Aral, S. O. (2017). Vaginal microbiome and its relationship to behavior, sexual health, and sexually transmitted diseases. Obstetrics & Gynecology, 129(4), 643-654.
• Koumans, E. H., Sternberg, M., Bruce, C., McQuillan, G., Kendrick, J., Sutton, M., & Markowitz, L. E. (2007). The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sexually transmitted diseases, 34(11), 864-869.
• Chen, X., Lu, Y., Chen, T., & Li, R. (2021). The female vaginal microbiome in health and bacterial vaginosis. Frontiers in cellular and infection microbiology, 11, 631972.
• Naji, A., Siskin, D., Woodworth, M. H., Lee, J. R., Kraft, C. S., & Mehta, N. (2024, September). The Role of the Gut, Urine, and Vaginal Microbiomes in the Pathogenesis of Urinary Tract Infection in Women and Consideration of Microbiome Therapeutics. In Open Forum Infectious Diseases (Vol. 11, No. 9, p. ofae471). US: Oxford University Press.
• Srinivasan, S., Hua, X., Wu, M. C., Proll, S., Valint, D. J., Reed, S. D., … & Mitchell, C. M. (2022). Impact of topical interventions on the vaginal microbiota and metabolome in postmenopausal women: a secondary analysis of a randomized clinical trial. JAMA Network Open, 5(3), e225032-e225032.
• Amabebe, E., & Anumba, D. O. (2018). Psychosocial stress, cortisol levels, and maintenance of vaginal health. Frontiers in endocrinology, 9, 568.
• Mahajan, G., Doherty, E., To, T., Sutherland, A., Grant, J., Junaid, A., … & Ingber, D. E. (2022). Vaginal microbiome-host interactions modeled in a human vagina-on-a-chip. Microbiome, 10(1), 201.
• France, M., Alizadeh, M., Brown, S., Ma, B., & Ravel, J. (2022). Towards a deeper understanding of the vaginal microbiota. Nature microbiology, 7(3), 367-378.