Why vaginal microbiome is so critical for women’s health

Just like our gut microbiome, our vaginal microbiome is an intricate micro-ecosystem and keeping it in balance is crucial to good female health.

You had probably never even heard of the word microbiome until a few years ago.

The human microbiome is the entire collection of microbes that live on and inside our bodies, playing an essential part in our wellbeing.

Tiny and powerful, they also have an impact below the belt.

While the gut microbiome gets the lion’s share of attention, the vaginal microbiome is just as important, with science only now starting to truly understand its impact on our health.

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What is the vaginal microbiome?

The vaginal microbiome is made up of a community of microorganisms including bacteria, viruses and fungi.

“We all talk about gut microbes but many parts of our bodies have their own little intricate sets of bacteria that live together in harmony, or not,” sexual health physician Dr Terri Foran says.

If your vaginal microbiome is thrown off balance, a number of health issues can result – including the risk of preterm birth, miscarriage, STIs, UTIs and pelvic inflammatory disease.

How the vaginal microbiome differs to gut microbiota

In contrast to the highly diverse gut microbiota, a healthy vaginal microbiota is dominated by just a few lactobacillus species.

These defensive stalwarts help maintain the ideal environment to keep things healthy down below.

“When lactobacilli are dominant, the vagina can fight off infection, but if something alters that balance then it’s less able to defend itself, and this can lead to bacterial vaginosis (BV), a common infection that’s often mistaken for thrush,” Dr Foran, who is senior lecturer at the University of NSW School of Women’s and Children’s Health, says.

Bacterial vaginosis is the most common vaginal infection in women, with about a third of women likely to experience it at some point.

Microbiome composition varies from person to person and can be influenced by a range of factors such as age, hormonal changes, sexual activity, hygiene practices and antibiotics.

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What you need to know about bacterial vaginosis

Monash University sexual health physician Professor Catriona Bradshaw says despite being more common than thrush, less is known about BV.

“BV can cause vaginal symptoms such as watery, milky-white or greyish discharge and a strong fishy-like odour but some women do not notice any symptoms,” Prof Bradshaw says.

However, research shows women with BV are at a greater risk of sexually transmitted infections, HIV and pelvic inflammatory disease.

BV can also increase the risk of miscarriage, premature delivery and low birthweight babies.

“While GPs know about BV, it can be hard to diagnose BV well in general practice as private laboratories differ in the tests they use to diagnose BV, and with pressure on GPs women are not always examined,” Prof Bradshaw says.

The only recommended treatment is a course of oral or vaginal antibiotics prescribed by a doctor.

“And even if we treat it, if we get it right, it very often comes back,” Dr Foran says.

“I’ve had patients who have had three or four or five reoccurrences.”

What causes bacterial vaginosis?

While the exact cause of BV is unknown, researchers do have some insights.

“We know that women who are sexually active are far more likely to get BV than those who aren’t and in fact we do not find BV in women who have not been sexually active with others,” Prof Bradshaw says.

“You’re also more likely to experience the condition if you have sex with a new partner or sex without condoms.

Prof Bradshaw says recent studies shown the microbes responsible for BV can be carried by men, especially uncircumcised men and clinical trials are under way in Australia to examine whether treating men at the same time as their female partner improves the chance of curing BV.

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How to look after your vaginal microbiome

Safe sexual practices, a healthy diet and avoiding stress and smoking are all things you can do to support a healthy vaginal microbiome.

“The message is to know your own vagina,” Dr Foran says.

“Remember, it cleans itself as long as you leave it alone – don’t try and cleanse it as that can muck up the balance.

“If you think there’s been a change, discuss it with a health professional.”

Written by Liz McGrath.