Vaginal Probiotics Overview

Many bacteria reside in the human body and provide benefits such as helping with digestion, preventing diseases, and promoting wound healing. Such “good” bacteria are also present in the vagina and are called the vaginal microbiome or vaginal flora. The body usually does a great job balancing the good and bad bacteria. Nevertheless, sometimes infections occur due to diseases, medications, and other disruptions to normal state of health.

The balance can be restored by using probiotics but understanding differences between probiotics is important. RC-14 and G4-1 combination probiotics are known for their beneficial effects in maintaining the flora of the urogenital tract. They allow healthy bacteria to grow in the vaginal and urinary tracts and thus prevent conditions such as urinary tract infections (UTIs), bacterial vaginosis (BV), and yeast infections (vaginal candidiasis).

The Use of Combination Probiotics

Pro-Fem contains two different Chr. Hansen strains, namely lactobacillus reuteri RC-14 (found in a healthy woman’s vagina) and lactobacillus rhamnosus GR-1 (found in a healthy woman’s urethra). The combination of probiotics found in the Pro-Fem blend is considered the best vaginal probiotics by many OB/GYNs. Since 2004, women’s nutritional supplements have contained a combination of these two strains.

Clinical Research on Combination Probiotics

The effects of a combination of the two aforementioned lactobacillus strains have been studied in no less than 25 clinical trials since 2001, with more than 60 publications (including randomized, placebo-controlled, double-blind trials, preclinical studies, and review articles) documenting the results. These effects have been explored in women of different ages (from teenage girls[1,2,3] to post-menopausal women[4,5]), pregnant women and HIV-positive women for as long as 12 months. In these studies, the strains were tested after oral intake, and no side effects were reported. [1, 2, 3, 4, 6, 8, 9, 10, 11, 12}

Clinical trials on the effectiveness of this probiotic blend have shown that a combination of RC-14 and GR-1 is beneficial for:

Promoting Urinary Tract Health

A probiotic blend containing lactobacillus reuteri RC-14 and lactobacillus rhamnosus GR-1 has been shown to reduce the risk of developing recurrent UTIs[11], vaginal discharge, and vaginal candidiasis. When this blend is used adjuvant to antifungal drugs, it decreases vaginal discharge and candida overgrowth more effectively than when antifungal drugs and a placebo are given together.[8]

Balancing Vaginal Bacteria

Studies show that taking combination probiotics with antibiotics is better for clearing bacterial infections than taking a placebo with antibiotics.[1,3,12] Moreover, even when taken without antibiotics, the Nugent score decreases much more when taking the combination probiotic than when taking a placebo.[3,5,10]

Supporting the Vaginal Microbiome

By recolonizing healthy lactobacilli, this combination probiotic balances the vaginal microbiome[9,12,14] and decreases infections by disease-causing yeast and pathogens in the test subjects.[9,13] It has been shown to eliminate Group B streptococci in pregnant women.[6]

Supplement Safety

Lactobacillus reuteri RC-14 and lactobacillus rhamnosus GR-1 have been declared safe for human consumption. The US Food and Drug Administration (FDA)[15] has accepted for filing a New Dietary Ingredient Notification which grants lactobacillus reuteri RC-14 and lactobacillus rhamnosus GR-1 ‘Qualified Presumption of Safety’ status by the EFSA.[16]

GR-1®, RC-14®are trademarks of Chr. Hansen A/S.

Reference list

  1. Anukam K, et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect. 2006;8(6):1450-4. (PubMed)
  2. Vujic G, et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2013;168(1):75-9. (PubMed)
  3. Martinez RC, et al. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can J Microbiol. 2009;55(2):133-8. (PubMed)
  4. Petricevic L, et al. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol.2008;141(1):54-7. (PubMed)
  5. Bisanz JE, et al. A Systems Biology Approach Investigating the Effect of Probiotics on the Vaginal Microbiome and Host Responses in a Double Blind, Placebo-Controlled Clinical Trial of Post-Menopausal Women. PLoS One. 2014;9(8):e104511. (PubMed)
  6. Ho M, et al. Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial. Taiwan J Obstet Gynecol. 2016;55(4):515-8. (PubMed)
  7. Hummelen R, et al. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV. Int J Gynaecol Obstet. 2010;111(3):245-8. (PubMed)
  8. Martinez RC, et al. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol.2009;48(3):269-74. (PubMed)
  9. Reid G, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 2003;35(2):131-4.(PubMed)
  10. Macklaim JM, et al. Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microb Ecol Health Dis. 2015;26:27799-. (PubMed)
  11. Beerepoot MA, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):704-12. (PubMed)
  12. Anukam KC, et al. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect. 2006;8(12-13):2772-6. (PubMed)
  13. Cianci A, et al. [Efficacy of Lactobacillus Rhamnosus GR-1 and of Lactobacillus Reuteri RC-14 in the treatment and prevention of vaginoses and bacterial vaginitis relapses]. Minerva Ginecol. 2008;60(5):369-76. (PubMed)
  14. Reid G, et al. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol. 2001;32(1):37-41. (PubMed)
  15. GR-1® and RC-14® were filed under NDIN 488 by the US FDA on March 3, 2008.
  16. EFSA Panel on Biological Hazards, et al. Update of the list of QPS-recommended biological agents intentionally added to food or feed as notified to EFSA 7: suitability of taxonomic units notified to EFSA until September 2017. EFSA Journal. 2018;16(1):e05131