Christina A Nowicki
Christina is currently a Ph.D. candidate at Rush University studying how the gut microbiome impacts hormone metabolism in postmenopausal women with breast cancer.

Christina A Nowicki
Christina is currently a Ph.D. candidate at Rush University studying how the gut microbiome impacts hormone metabolism in postmenopausal women with breast cancer.

Your body consists of trillions of microbes, many of which have made themselves at home in your vagina. Your vaginal microbiome can play a critical role in protecting you from disease and maintaining good vaginal health.

New products on the market have turned their attention to the vaginal microbiome. These include vaginal probiotics that claim to correct microbiome imbalances and at-home tests to diagnose the cause of recurrent infections. Unfortunately, not all products match up with the research, and some can even cause harm. So, how do you maintain a healthy vaginal microbiome?

First things first – what is your vaginal microbiome?

Your vaginal microbiome is a dynamic ecosystem that consists of all the microbes that reside in your vagina. This includes a variety of bacteria, fungi, and even viruses. However, what kinds of microbes and how many of them are there can change greatly over time. These changes can occur because of pregnancy, menstruation, personal hygiene, hormone levels, sexual intercourse, and more.

How does your vaginal microbiome keep your vagina healthy?

Many vaginal microbiomes are largely dominated by Lactobacillus species, which tend to be associated with good vaginal health. These bacteria are well-known for their ability to ferment sugars to produce lactic acid, therefore lowering the pH in your vagina and preventing infections. However, significant changes to the vaginal microbiome caused by frequent sexual intercourse, multiple sexual partners, and douching can negatively impact the pH and composition of your vaginal microbiome. 

Similarly, some people have vaginal communities that are associated with sexually transmitted infections (STIs) and poor reproductive outcomes. Normally, your vaginal microbiome helps to defend you against vaginal infections, either by directly killing the “harmful” microbes or by outcompeting them. This can also protect you from STIs. But when your vaginal microbiome is out of balance, sometimes it can’t do its job properly.

Probiotic bacteria Lactobacillus, 3D illustration. L. acidophilus, L. helveticus and other. Lactic acid bacterium
Lactobacillus bacteria can help lower the pH in your vagina and thus prevent infections.

Do vaginal healthcare products help?

Although statistics vary from study to study, about one in five women ages 15-49 in the United States clean or wash the inside of their vagina. Further, a survey of hygiene practices in Canadian women showed that 95% used at least one product in/around the vaginal area. However, research has shown that feminine hygiene products increase the risk of infections such as UTIs and bacterial vaginosis, a condition characterized by inflammation due to overgrowth of certain bacteria. 

Some feminine hygiene products also claim to be able to regulate the pH of your vagina. However, it’s actually the Lactobacillus community in your vaginal microbiome that helps to maintain your vaginal pH. It’s been shown that these products are not able to change your pH for more than a few hours. If anything, vaginal cleansing products can be harmful to Lactobacillus and other healthy bacteria. This can cause the pH of your vagina to increase, making it less acidic and making your vagina more prone to infection.

Woman Holding Vaginal Wash Against Gray Background
Vaginal cleansing products can harm healthy bacteria. This can raise the pH of your vagina, making it less acidic and increasing your risk of infection.

Currently, there are some products on the market that claim to help maintain a healthy vaginal microbiome. Some even include prebiotics and probiotics to promote the growth of “good” microbes. Prebiotics help to feed the good bacteria in your vaginal microbiome to increase their population, while probiotics directly repopulate your vaginal microbiome with good bacteria. Further, some of these products claim to help relieve bacterial vaginosis-related symptoms, such as itching, irritation, or discharge. 

But what does the research say about vaginal products for the vaginal microbiome?

Overall, studies have shown that most vaginal hygiene products end up harming your vaginal microbiome, instead of keeping it healthy. Intravaginal cleaning has been shown to have many negative effects, and has been linked to an increased risk of STIs, pelvic infection, premature delivery, and more. Further, conditions such as bacterial vaginosis can cause symptoms that many vaginal products claim to treat, such as itchiness and odor. In reality, feminine hygiene products can imbalance your vaginal microbiome, actually causing bacterial vaginosis instead of treating it.

Further, there are conflicting opinions amongst the medical and research community on whether probiotics can help maintain a healthy vaginal microbiome. What a “healthy” vaginal microbiome is can vary greatly. For example, some people that have an “imbalanced” microbiome may experience no symptoms. This makes it more difficult to conclude exactly how probiotics are impacting the vaginal microbiome from person to person. The variety of different species in probiotics, whether consumed orally or applied vaginally, also makes it difficult to distinguish the effects.

There are currently several clinical trials in progress to look at how probiotics affect the vaginal microbiome and associated health conditions, such as bacterial vaginosis, vaginal candidosis, fertility issues, and more. 

How about at-home vaginal microbiome tests?

There are currently kits on the market to test your vaginal microbiome, marketed mainly toward people experiencing chronic vaginal infections or fertility issues. Unfortunately, while some research has determined what changes in the vaginal microbiome could be leading to these issues, there are no definitive answers to these questions or targeted vaginal microbiome treatments available. While it could be interesting to see what your vaginal microbiome looks like, the bacterial community in your vagina is quick-changing and dynamic. This means that the test will only capture a snapshot in time, making it difficult to account for variations such as menses, diet, or changes in hygiene routine. 

So, how do you maintain a healthy vaginal microbiome?

The best thing that you can do to take care of your vaginal microbiome is to do nothing at all!

If you’re washing around your vaginal area, the best thing you can use is a mild, unscented soap. A healthy diet and a good hygiene routine can also help, but this doesn’t need to include vaginal hygiene products. It’s been shown in studies that orally consumed probiotics are unlikely to alter your vaginal microbiome. Vaginally-inserted probiotic products, while an interesting idea, have not yet shown promising results in clinical studies. If you’re experiencing issues down there, such as recurrent UTIs or bacterial vaginosis, your doctor will have the best recommendation. It can be tempting to reach for a product off the drug store shelves, but most are based on unproven claims and, in some cases, can make things worse. 

Overall, if you want to take care of yourself down there, don’t bother doing anything at all! Your vaginal microbiome is a complex and self-regulating community of microbes that quietly work together to protect you from disease. The best thing you can do to maintain your vaginal microbiome is to leave it alone, and let it do its magic.