Vaginal Microbiome: Everything YOU Need to Know

As women, no one needs to tell us that our bodies are dynamic. We are continually reminded of its complexity. One highly dynamic and vastly influential area that continual growing research is focusing on is the vaginal microbiome. This biome is a collection of microorganisms, their genes, genomes, and metabolites that reside in the vaginal area. Our vaginal microbiota continually influences our gynecologic health, reproductive health, and overall quality of life.

What is the Vaginal Microbiome?

The vaginal microbiome is a microbial community that protects the vagina, and really the entire body, from potential pathogens that can invade its host…which is you [1]!

Now, our vaginal microbiome communities can be a bit cliquey. While that can be traumatic in high school, it’s great for vaginal health. Our protective vaginal microbial communities produce an abundance of lactic acid [2].

Lactic acid, specifically D-lactate, makes the vaginal pH intolerable for potential predators to claim dominance over our microbiome. Sorry, this party is “invite-only”! Let’s discuss how your vaginal microbiota is beneficial for disease control and immunity.

What Does the Vaginal Microbiome Do?

Vaginal microbiota can provide protection against invaders that try to drive up infections. However, different species within our vaginal microbial communities can also become the pathogens that ignite inflammation.

Unlike the gut microbiome, the vaginal microbiome doesn’t like diversity. When other pathogens overtake the vaginal biome, or specific nonprotective species exert dominance, it can contribute to life-altering symptoms that are all too familiar to some.

A healthy vaginal microbiome has been shown to be helpful in the prevention of:

• Urinary Tract Infections (UTIs) [3]

• Yeast Infections [4]

• Bacterial Vaginosis

• Infertility [5]

• Miscarriages [5]

• Preterm Delivery [5]

• Pelvic Inflammatory Disease (PID) [6]

• Sexually-Transmitted Infections and Diseases (STIs, STDs), such as Chlamydia and Gonorrhea Risk [1]

• HIV Infection Risk [1]

When symptoms of these conditions rile up, there’s a good chance that you are suffering from vaginal microbiome imbalances and the attack of pathogens. That’s why your vaginal bacterial community composition is so important. Let’s discuss how your vaginal microbiome works to fight off fungi, viruses, and other potential threats to your body!

Hormones and the Vaginal Microbiome

Our protection against vaginal imbalances is dependent on the type of bacteria that reside within the vaginal biome. During the birthing process, depending on delivery mode, most females take on their mother’s vaginal bacteria. Bacteria in which we have relative abundances during pregnancy tend to be high in protective species. Hey, we’re warriors. It’s in our DNA!

As we age, the abundance of these protective bacteria declines due to the fluctuations of one essential molecule, estrogen.

Levels of these hormones tend to be high during:

• Pregnancy

• Second half of follicular Phase of Menstrual Cycle

• Mid-luteal Phase of Menstrual Cycle

Even when these events aren’t happening in the life of premenopausal women, our amount of hormones is up. We are fertile and in the prime of our lives, so our dynamic bodies get ready for anything…even when contraceptives are in use.

As premenopausal women, protective species of bacteria are generally high if within an optimal environment. That’s why it’s so important to know the bacteria that comprise your vaginal microbiota. According to the Centers for Disease Control (CDC) 84% of women show no signs of the most common bacterial infection, bacterial vaginosis [7]!

At Ombre, we will offer a Vaginal Health Test that uses microbial DNA sequencing to isolate 16s rRNA genes from your vaginal microbiome. This information will give us a snapshot of your vaginal bacterial community composition. With this info, we can determine your vaginal community state types (CSTs), so we can help you fight off infectious diseases and live your best life. We’ll discuss CSTs in a bit!

Now, knowing your vaginal microbiome isn’t just useful for menstruating women. Whenever estrogen levels drop, such as in postmenopausal women, protective species of bacteria tend to decline as well. Our innate instincts to protect potential life growing inside of us lessens. So, producing these hormones seems unnecessary to our system. Meanwhile, we’re left to deal with the uncomfortable side effects of this decline in estrogen.

Lower estrogen levels dictate a lot of things in a woman’s life. For one, it causes us to produce less calcium. That’s why postmenopausal women are prone to osteoporosis. Lastly, this shift in hormones also changes the influential bacteria found within our vaginal microbiome.

Which Bacteria Are Best for Vaginal Health?

Within a healthy vaginal microbiome, specific bacteria species will dominate the majority of the ecosystem and leave little room for additional microbes to grow. These bacteria are critical to gynecological and reproductive health. They protect us from pathogenic overgrowth and make the environment so inhospitable that even when we are exposed to pathogens, they tend not to stick around.

These protective vaginal superheroes fall within the Lactobacillus family [8]. In a perfect vaginal environment, the good bacteria Lactobacillus outnumber the bad anaerobic bacteria. Specific vaginal Lactobacilli species produce the lactic acid, hence the name! As I discussed earlier, lactic acid contributes to a low pH; that’s a good thing.

D-lactate helps inhibit the growth of potential pathogens and anaerobic bacteria, such as:

• Escherichia coli (E. coli)

• Gardnerella vaginalis

• Candida species

• Atopobium Vaginae

Vaginal Lactobacilli also contribute to vaginal lining integrity guarding against “leaky vagina [9].” Leaky vagina is the vaginal microbiome equivalent of Leaky Gut Syndrome. It’s an imbalance that drives up inflammation and has been suggested to contribute to endometriosis and reproductive organ disease damage.

A Lactobacillus-dominated vaginal microbiome can protect against UTIs, enhance fertility and delivery outcomes, and reduce the risk of sexually transmitted infections. A vaginal Lactobacilli dominance can also potentially be helpful in cervical cancer prevention [10].

Overall when thinking about vaginal health, think Lactobacillus, and think lots of it!

Vaginal Lactobacilli and Community State Types

Now, depending on which species of Lactobacillus, or lack thereof, that make up the abundance of your vaginal bacteria, you will fall under one of five general "community state types (CSTs)." These groupings have been created within the research to help us understand possible risks associated with the bacteria inhabiting our vagina.

According to the National Institute of Health, there are five CST categories [11]. CSTs I and II mean you have a healthy vaginal microbiome where Lactobacilli are exhibiting dominance.

CST III and CST V are indicators of a healthy vaginal microbiome but should be tested regularly to ensure there aren’t potential pathogens stirring since these are less protective community types. Of the two, CST V cases can be rare. CST III is the least protective Lactobacillus type, due to a lack of D-lactate-producing bacteria.

CST IV means a microbial imbalance. This category indicates that you need to make lifestyle changes that will limit the diversity in your vaginal microbiome. You must also introduce more vaginal Lactobacilli to help create a dominance of these bacterial species.

The relative abundances of bacteria in the following CSTs include:

• CST I: Lactobacilli Dominant, Namely L. crispatus

• CST II: Lactobacilli Dominant, Namely L. gasseri

• CST III: Lactobacilli Dominant, Namely L. iners and 

• CST IV: No Dominance, High diversity and High Proportions of Anaerobic Bacteria, Namely: Prevotella, Dialister, Atopobium Vaginae, Gardnerella, Megasphaera, Peptoniphilus, Sneathia, Eggerthella, Aerococcus, Finegoldia, and Mobiluncus.  In the case of CST IVs, this imbalance is due to a lack of dominant species. You want a Lactobacillus species to take over the area and regulate the area like a well-meaning helicopter mom.

• CST V: Lactobacilli Dominant, Namely L. jensenii

Much like our dynamic lifestyles, our CST can change, too.

We are all unique beings with our own set of genetics. There are also thousands of microorganisms in this world that science has discovered. Then, there are our lifestyle choices, exercise, and dietary preferences.

There are many factors that can cause a change in CST status, including:

• Estrogen Levels

• Ethnicity

• Hygiene Practices

• Specific Hormonal Contraceptives

• Sexual Intercourse

• Diet

• Weight

• Dysbiosis

• Leaky Vagina

These factors are as dynamic as our lifestyles. That’s why it might be a good idea to regularly test your vaginal microbiome health.

Vaginal Dysbiosis, Bacterial Vaginosis, and Pregnancy Issues

Imbalances within the vaginal microbiome, such as a wide variety of bacteria, pathogenic microbes, and elevated non-Lactobacillus bacteria, tend to contribute negatively to vaginal health. One term often used to describe vaginal imbalances is vaginal dysbiosis. This term is considered when there are imbalances within the microbial composition that disrupt homeostasis.

Symptoms associated with vaginal dysbiosis may include:

• Vaginal Discharge

• Fishy Odor

• Itching

• Pain During Intercourse

• Burning Sensation When Urinating

The most common vaginal bacteria imbalance that affects over 50% of women is bacterial vaginosis (BV).

BV is associated with a lack of protective Lactobacilli. The symptoms associated with bacterial vaginosis are the most common reasons women seek medical help addressing vaginal discomfort.

There are two basic types of bacterial vaginosis- symptomatic and asymptomatic. Both carry gynecological and obstetric risks. Even those with asymptomatic BV (no symptoms) are still at elevated risk for future vaginal infections or possible disease due to low protective bacteria levels.

Most treatment plans for BV are antibiotics; however, relapse is prevalent since there is a lack of protective bacteria to inhibit future pathogenic growth. This is where probiotics with specific strains for vaginal health and balance can be very helpful.

Vaginal imbalances can affect more than our day-to-day living; they can contribute to changes that affect our life. Specific diseases, such a pelvic inflammatory disease (PID), a painful condition that can result in infertility, have been associated with vaginal imbalances.

Preterm delivery and miscarriages have also been linked to specific microorganisms within the vaginal microbiome. Lastly, imbalances resulting from low protective bacteria levels can increase our risks of sexually-transmitted infections, HIV infection, and diseases.

Who Should Get Their Vaginal Microbiome Tested?

As I mentioned, our wellness journeys are as unique as a snowflake. We all have different environmental, physical, and emotional stressors that can comprise our health. Here are some instances where you might want to get your vaginal bacteria tested.

While antibiotics can help address some of the more common vaginal infections, antibiotics are a catch-22. They also negatively affect protective Lactobacillus levels. An unprotected vaginal microbiome can result in frequent recurrence within 3-4 weeks after treatment.

Knowing the bacteria that reside in your microbiota lets you know more about your own body. Understanding which bacteria help to contribute to vaginal and reproductive health is beneficial for creating a healthy environment for conception. Using 16s rRNA gene sequences, Thryve will also be able to rule out any pathogenic bacteria growth that might contribute to miscarriages, low birth weight, premature birth, infertility, and intra-amniotic fluid infections.

While we may not always know if we have been exposed to sexually transmitted pathogens, the vaginal bacteria that make up our vaginal microbiome know for sure. They help build up your immunity to diseases. Unfortunately, those who have BV are at an increased risk of contracting HIV [12].

Those who are HIV+ are also more likely to infect their partner if they have BV. Your vaginal Lactobacilli are the very first line of defense against sexually transmitted infections (STIs). So, getting a Vagina Health Test might be a good idea if you’re sexually active, especially if when you’re meeting new sexual partners.

Women can be asymptomatic and healthy but potentially have an increased risk for vaginal infections, STIs, or additional vaginal or reproductive imbalances. Understanding our level of protection and risk associated with the bacteria that make up our vaginal microbiome is a preventative health strategy similar to our yearly checkups.

We use to think that addressing common vaginal symptoms such as itching, discharge, malodor, painful urination, or intercourse, was to flush away all these bacteria. We now know that we need these bacteria. Our attempts to target the harmful bacteria with antibiotics and douches also negatively impacts our protective bacteria vital to our gynecological and reproductive health.

How to Improve Your Vaginal Microbiome

First, we gain insight into which bacteria are influencing our vaginal health and overall quality of life. Do we have a good abundance of protective bacteria? Are there pathogens driving up inflammation and resulting in recurrent infections? Do we have high amounts of non-protective bacteria that are opening the door for eventual pathogenic growth, infections, and even diseases?

Next, we remove the daily and lifestyle influencers and practices that may be negatively impacting our vaginal bacteria. When we completely alter the microbial environment through hygiene practices, diet, and lifestyle factors, we can open the door to recurrent imbalances, such as ongoing UTI’s, bacterial vaginosis, or vaginal infections.

Then we support the gut-vagina axis.

Gut-Vaginal Axis is a term used to describe the relationship between the gut and vaginal health. When the gut is inflamed (due to gut microbiome dysbiosis and or high inflammatory food choices), the immune system can ignite inflammation throughout your entire body. This immune response directly affects your vaginal microbiome. 

The increase in inflammation can suppress protective Lactobacillus growth. A lack of vaginal Lactobacilli encourages pathogenic bacteria that negatively affect vaginal health. Find out which foods may be contributing to your vaginal imbalances and which foods may encourage vaginal health.

Finally, we directly target the bacteria and pathogens within the vaginal microbiome.

Specific strains within probiotic bacteria have been supported in the research to reach the vaginal microbiome. These specific strains not only reach the vaginal environment, but they additionally have been shown to inhabit the microbiome. This integration positively addresses specific vaginal infections such as bacterial vaginosis, yeast infections, and UTI’s. 

Strain-specific bacteria, such as those found within Ombre's vaginal probiotics, optimizes the vaginal microbiome. This supplement encourages protective bacteria to grow. Their presence effectively corrects vaginal imbalances.

At times, antibiotics are needed to address elevated vaginal imbalances. Continually treating with topical antibiotics or oral antibiotics can further disrupt our protective bacteria in our gut and our vaginal microbiome. To guard against the common relapse vaginal infection seen with antibiotics, incorporate a research-supported strain-specific probiotic that will help guard your much needed protective bacteria.

How to Test Your Vaginal Microbiome

Ombre's Vaginal Health Test uses 16s rRNA sequencing to impart for you an easy-to-understand report on the bacteria that make up your vaginal microbiome.

With this information, we provide you the tools you need to best optimize your vaginal health by way of specific diet recommendations, suggestions of lifestyle factors that can contribute to your vaginal health as well as those that may be contributing to your vaginal imbalances, and recommended probiotic strains that have shown to reach the vaginal microbiome and address vaginal infections and imbalances.

Our bodies are dynamic, and so is our vaginal microbiome. Understanding how this influential environment contributes to our overall quality of life and protection is a valuable tool that we as women can now utilize to gain access to our optimal health.

Save 20% on a Vaginal Health Test. Use this code at checkout: WomensHealth20

Resources

[1] Lewis, F. M., Bernstein, K. T., & Aral, S. O. (2017). Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstetrics and gynecology, 129(4), 643–654. https://doi.org/10.1097/AOG.0000000000001932.

[2] FA. Guédou, L. Damme, et al. “Vaginal PH Measured in Vivo: Lactobacilli Determine PH and Lactic Acid Concentration.” BMC Microbiology, BioMed Central, 1 Jan. 1970, bmcmicrobiol.biomedcentral.com/articles/10.1186/s12866-019-1388-8.

[3] Stapleton A. E. (2016). The Vaginal Microbiota and Urinary Tract Infection. Microbiology spectrum, 4(6), 10.1128/microbiolspec.UTI-0025-2016. https://doi.org/10.1128/microbiolspec.UTI-0025-2016.

[4] Tortelli, B. A., Lewis, W. G., Allsworth, J. E., Member-Meneh, N., Foster, L. R., Reno, H. E., Peipert, J. F., Fay, J. C., & Lewis, A. L. (2020). Associations between the vaginal microbiome and Candida colonization in women of reproductive age. American journal of obstetrics and gynecology, 222(5), 471.e1–471.e9. https://doi.org/10.1016/j.ajog.2019.10.008.

[5] Zhao, Changying, et al. “Characterization of the Vaginal Microbiome in Women with Infertility and Its Potential Correlation with Hormone Stimulation during In Vitro Fertilization Surgery.” MSystems, American Society for Microbiology Journals, 25 Aug. 2020, msystems.asm.org/content/5/4/e00450-20.

[6] Sharma, H., Tal, R., Clark, N. A., & Segars, J. H. (2014). Microbiota and pelvic inflammatory disease. Seminars in reproductive medicine, 32(1), 43–49. https://doi.org/10.1055/s-0033-1361822.

[7] “CDC – Bacterial Vaginosis Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2020, www.cdc.gov/std/bv/stats.htm.

[8] Public Library of Science (PLOS). “Probiotics with Top-Performing Lactobacillus Strains May Improve Vaginal Health.” ScienceDaily, ScienceDaily, 4 June 2020, www.sciencedaily.com/releases/2020/06/200604152114.htm.

[9] Brusselaers, Nele, et al. “Vaginal Dysbiosis and the Risk of Human Papillomavirus and Cervical Cancer: Systematic Review and Meta-Analysis.” American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, 19 July 2019, pubmed.ncbi.nlm.nih.gov/30550767/.

[10] Yang, X., Da, M., Zhang, W., Qi, Q., Zhang, C., & Han, S. (2018). Role of Lactobacillus in cervical cancer. Cancer management and research, 10, 1219–1229. https://doi.org/10.2147/CMAR.S165228.

[11] Ma, Z. S., & Li, L. (2017). Quantifying the human vaginal community state types (CSTs) with the species specificity index. PeerJ, 5, e3366. https://doi.org/10.7717/peerj.3366.

[12] Alcaide, M. L., Chisembele, M., Malupande, E., Arheart, K., Fischl, M., & Jones, D. L. (2015). A cross-sectional study of bacterial vaginosis, intravaginal practices and HIV genital shedding; implications for HIV transmission and women’s health. BMJ open, 5(11), e009036. https://doi.org/10.1136/bmjopen-2015-009036.