Mind your microbiome: Ways to keep your vagina healthy

Just as everyone has a complex community of microbes living in their gut that play an integral role in maintaining our overall health, Corbett explains that women’s vaginas host microbes of their own. Microbes that are vital to protecting their reproductive health.

“The vaginal microbiome contains bacteria, viruses and fungi which work together to keep the vagina healthy,” she says.

Dr Laura Cullen, a Cork-based GP and the director of women’s health at the Irish College of GPs, elaborates further. “The predominant bacteria in healthy vaginas are Lactobacilli,” she says. “These beneficial bacteria produce lactic acid to keep the pH of the vagina slightly acidic, which prevents the growth of harmful microbes.”

 In a way, Lactobacilli can be compared to bouncers keeping uninvited guests out of a happening party. “Their job is to shut unfriendly bugs or pathogens off at the front door,” says Corbett. “They push them out of the vagina or, at the very least, they reduce their presence in the vagina to the extent that there aren’t enough of them to cause clinical symptoms.”

 However, problems occur when there's an imbalance.

“When levels of Lactobacillus go down, pathogens like Gardnerella have an opportunity to dominate,” says Corbett. “This can cause bacterial vaginosis (BV), a common condition in which the vagina becomes irritated and inflamed.” 

Symptoms of BV include a burning sensation, itching and a change in vaginal discharge. “Often, the discharge takes on a thin grey appearance and a stronger fishy odour,” says Cullen.

Treating BV means reinforcing the bouncers. This is usually done by taking an antibiotic that targets Gardnerella, which allows Lactobacillus to flourish once more.

BV is particularly problematic for pregnant women because it is associated with an increased risk of preterm birth. “A vaginal microbiome that is rich in Lactobacillus, especially Lactobacillus Crispatus, is the calmest for pregnancy,” says Corbett. “If BV is diagnosed in pregnancy, it has to be treated with an antibiotic.” 

Gardnerella isn’t the only pathogenic microbe that takes advantage of a drop in Lactobacillus levels. Thrush-causing Candida is another.

With thrush, there can also be burning or itching sensation and a vaginal discharge that Cullen describes as “like cottage cheese”.

Research shows that the composition of the vaginal microbiome also plays a role in women’s sexual health. For example, a 2019 Chinese study found that high levels of Lactobacillus lowered women’s risk of being infected with human papillomavirus and subsequent risk of developing cervical cancer. 

The vaginal microbiome is a living entity that is constantly in a state of flux. It varies according to the time of the month and where you are in your reproductive life.

“Oestrogen levels have a direct effect on the microbiome and on overall levels of Lactobacillus,” says Corbett. “Post-menopause, this means some women suffer with the likes of recurrent urinary tract infections or atrophic vaginitis, which happens when the vaginal lining becomes dry and thin, causing pain. There’s a lot of data to show that vaginal oestrogen can be safely used to replenish hormone levels in the vagina and increase Lactobacillus levels there.”

 Environmental factors also have a role to play, particularly in what we eat. Corbett’s research looks at the impact of a woman’s diet on her vaginal microbiome and, consequently, on her risk of preterm birth. “There is evidence to show that processed foods, added sugars and saturated fats affect the gut microbiome and that this has a knock-on effect on the vaginal microbiome,” she says. 

“Essentially, my advice to women who want to look after their vaginal microbiome is to eat well.” 

The experts caution us to stay away from the section of the pharmacy selling so-called vaginal hygiene products. “The vagina is a self-cleaning organ,” says Cullen. “It doesn’t need special soaps or douches. Cleaning with water is sufficient.” 

We certainly don’t need to sit over a bowl of freshly boiled water, no matter what wellness gurus advise.  “Deep cleansing in any way is not a good thing,” says Corbett. “You’ll only end up flushing out all your good bacteria.” 

In the absence of symptoms such as pain, irritation or an unusual discharge, the prevailing advice is to leave our vaginas alone.

“Your discharge should have a mild slightly musky or yeasty odour,” says Cullen. “It will change throughout the menstrual cycle, varying from a white or yellow colour to a think clear mucus around the time of ovulation and a darker brown colour prior to and at the end of menstruation. If you notice any changes, make an appointment with your GP to check for potential problems.” 

If you have no cause for concern, you can maintain a healthy balance in your vaginal microbiome with the following simple steps recommended by Corbett:

• Stay healthy by eating and sleeping well and exercising regularly.
• Stick to warm water when washing. It’s fine to use unscented soap externally but don’t use anything internally. 
• Only ever wipe from front to back. 
• Wear cotton underwear and don’t wear anything too tight.

“Basically, don’t interfere too much,” says Corbett. “Leave your vaginal microbiome alone and it will get on with doing its job.”