Can Probiotics Boost Vaginal Health?

Whether you go to drugstores or browse online, you can easily come across boric acid suppositories and supplements that claim to keep the vaginal microbiome balanced. But is there any scientific basis to these claims?

Before the advent of vaginal probiotics, a yogurt douche was used by many women with the belief that the live bacteria that balance the gut microbiome might do the same for the vagina. Women in the 1970s used soak a tampon in unsweetened yogurt and place it in the vagina as a home remedy for diseases such as yeast infections.

Although the yogurt douche lost its popularity with time, the idea behind it remained. Vaginal probiotic supplements claiming to “prevent intimate troubles”, “allow normal vaginal microflora to flourish”, and “restore feminine balance” by introducing healthy bacteria appeared online and in drugstores and are now advertised everywhere, from subway ads to Instagram.

Although the claims often tend to be vague, some manufacturers boldly advertise their products as prophylaxis against and cure for vaginal conditions such as BV supplements for bacterial vaginosis and yeast infections. Are these claims true? This is what we know.

How does the vaginal ecosystem lose its balance?

The vaginal microbiome can be compared to a rainforest – a diverse ecosystem composed of hordes of viruses, bacteria, and yeast. Although the composition of this microbiome varies from person to person, a particular group of bacteria called lactobacillus dominates in many premenopausal women. Members of this group can be found in fermented dairy products such as cheese and yogurt, as well as in the gut.

Vaginal lactobacilli are, however, special. Over centuries, these lactobacilli have evolved to digest the sugars secreted by vaginal cells and convert them into lactic acid, helping to maintain the slightly acidic pH of the vagina that prevents the entry of bacterial invaders. This natural barrier ensures that the bacteria that should not be present in the vagina indeed stay out of it and don’t cause infections.

The delicate balance of vaginal lactobacilli can be disrupted by, for example, menstruation, semen, antibiotics, douching, and sexually transmitted infections. A fall in the number of lactobacilli paves the way for non-resident yeast and bacteria to grow in the vagina, upsetting the normal balance.

Bacterial vaginosis is the most common state of imbalance in the vaginal microbiome caused by a shift of the ecosystem from lactobacillus to other anaerobic (surviving in environments with low oxygen concentrations) microbes. The classic symptoms of this condition include a “fishy” odor, thin greyish discharge, and itchiness in the vulva. This disease has been associated with pre-term labor and increases susceptibility to sexually transmitted infections such as HIV, gonorrhea, and chlamydia.

At present, symptomatic bacterial vaginosis is treated with antibiotics alone, but these drugs are not the best solution. Akin to forest fires, antibiotics wipe out the entire flora of the vagina, not only the invading bacteria. This further upsets the microbial balance and makes the vagina susceptible to infections. Manufacturers of vaginal probiotics claim that instead of wiping out the entire flora, adding healthy bacteria is a better solution for preventing an imbalance in the vaginal ecosystem.

Should you take vaginal probiotics for bacterial vaginosis and yeast infection?

The research on the effectiveness of vaginal probiotics in the treatment of bacterial vaginosis and yeast infections is limited but promising.  Data in favor of probiotics with Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1 has recently been appearing. This is because although lactobacilli are the dominant bacteria of the vaginal microbiota, their levels decrease during infections. Taking probiotics with these desired bacteria can help replenish the lactobacilli and restore the balance of the vaginal microbiome.  Make sure to do your research and talk with your healthcare provider if you have any questions regarding which supplements to take.