Even with the best personal hygiene, dysbiosis (an imbalance or reduction in the diversity of bacteria present in a person’s natural microflora) is not a good thing for women, as it can result in uncomfortable ailments in the vagina and surrounding organs. That’s why many women are searching for more holistic cures for their gynecological distress.
Enter vaginal probiotics, which may have the potential to help with everything from UTIs to bacterial vaginosis. But how could probiotics—most commonly used for alleviating digestion and stomach disorders—affect vaginal health? Below, a deep dive into all things vaginal probiotics.
The vagina’s ecosystem requires a delicate balance
Gut bacteria have been featured in the press a lot as of late. Experts believe they play a critical role in your health, and dysbiosis can result in inflammatory bowel disease, obesity, and other health conditions.
However, the gut isn’t the only body part relying on a host of bacteria to function at peak capacity. The vagina has its own easily disrupted ecosystem that hosts billions of microbes, dominated by Lactobacillus, the ‘good bacteria’ of the vagina, says Dr. Jill Krapf, M.D. M.Ed., board-certified OB/GYN and vulvar pain specialist at the Center for Vulvovaginal Disorders in Washington, D.C. and Clinical Associate Professor in the Department of Obstetrics and Gynecology at George Washington University.
A significant drop in Lactobacilli and an overgrowth of other bacteria can result in one of the most common vaginal maladies, bacterial vaginosis (or BV). Doctors usually treat this unpleasant condition with antibiotics, but a study published in the Journal of Lower Genital Tract Disease suggests that such traditional methods could result in “suboptimal cure levels and high recurrence rates.” For starters, it is challenging for antibiotics to penetrate the bacterial vaginosis biofilms and fully eradicate them. Furthermore, continued use of antibiotics to treat recurrent BV raises the risk for adverse effects and potential drug resistance. Hence, the interest in developing alternate treatments, like probiotics, lactic acid, prebiotics, and antiseptics.
The theory behind vaginal probiotics
“Probiotics are used for vaginal health with the hope of recolonizing the vagina with Lactobacilli, increasing production of lactic acid to lower the vaginal pH, and controlling the local immune response in vaginal tissue,” explains Dr. Krapf. Vaginal probiotic companies claim their products can help restore an optimal balance of bacteria. This may minimize the potential for unpleasant vaginal ailments to develop and potentially improve traditional treatment outcomes.
Katherine Livingston, WHNP-BC (Women’s Health Nurse Practitioner-Board Certified), at the Virginia Women’s Center of Richmond, elaborates further: “A good probiotic for the vaginal microbiome could potentially correct chronic yeast infections and bacterial vaginosis.” There could also be an improvement for UTIs and painful intercourse related to vaginal dryness, she says.
What vaginal probiotics might be the most effective?
Though more research is necessary, a particular strain of microbes hold potential for women seeking relief. “A relatively new strain of Lactobacillus, L. crispatus, has been found to be most associated with a healthy vaginal microbiome,” says Dr. Krapf. “Most of the past studies did not evaluate this promising strain of Lactobacillus,” she continues, adding that ongoing studies are evaluating vaginal capsules of L. crispatus for recurrent bacterial vaginosis and recurrent urinary tract infections.
One such study, published in the New England Journal of Medicine, focused on the impact of the microbiome-based biologic drug, Lactin-V (L. crispatus CTV-05), on the recurrence of BV. For the investigation, some participants completed a course of vaginal metronidazole gel, while others were in a placebo group. Women in the group who used Lactin-V experienced a significantly lower incidence of recurrence of BV after 12 weeks.
Furthermore, a study published in Clinical Infectious Diseases suggested that premenopausal women using a Lactobacillus crispatus intravaginal suppository probiotic (Lactin-V) to prevent ongoing urinary tract infections could see a lower recurrence rate.
A note about These Studies
The FDA has not yet endorsed the use of vagina probiotics for conditions like BV, vaginal dryness, yeast infections, or UTIs. Why is this?
“Probiotics are generally considered safe,” says Dr. Krapf. “[Nevertheless,] it has been difficult to determine if probiotics truly provide the benefits claimed by manufacturers. This is because the studies on probiotics for vaginal conditions have small sample sizes and have many variations, including different Lactobacillus types, dosages, length of treatment, antibiotic co-treatments, and outcome measures.”
Still, when the Royal College of Obstetricians and Gynecologists compared 34 eligible studies on the impact of vaginal probiotics for treating BV and vulvovaginal candidiasis (vaginal yeast infections), they found that probiotics may be helpful for treating and preventing BV and possibly vaginal yeast infections.
Who might be a good candidate for vaginal probiotics?
Many women could find value in vaginal probiotics, according to Livingston. “[Women who suffer] from recurrent yeast or bacterial vaginosis would benefit greatly from probiotics to help their vaginal flora to maintain a healthy balance,” she says. “Many of these women struggle from month to month with vaginal imbalances or infections. Others have such issues after having sex; therefore, they mentally start to shut down their intimate life because the rebounding infections are that disruptive.”
Can probiotics intended for digestive issues help other parts of your body?
What if you’re already taking a general probiotic for gut health—might it help more than just your digestive tract? Unlikely, according to Dr. Krapf. “Probiotics have demonstrated efficacy in certain gastrointestinal conditions, including inflammatory bowel disease, irritable bowel syndrome, and different types of diarrhea. It is possible that probiotics taken for gut health could benefit the vagina, but it is more likely that there are specific bacterial strains [that benefit the vagina more than the gut] and vice versa.” Also, worth noting, most probiotics for gut health are taken orally, whereas probiotics that have shown the most promise are vaginal capsules.
Research on vaginal probiotics is still developing
To women suffering from recurrent vaginal conditions like BV and yeast infections, vaginal probiotics may seem like a lifeline. However, according to Dr. Krapf, “Prolonged antibiotic treatments are more effective in reducing recurrence of bacterial vaginosis than probiotics.”
That said, she confirms that promising research has shown vaginal probiotics—especially those including L. crispatus—may be useful in treating people with recurrent bacterial vaginosis, aerobic vaginitis, or urinary tract infections.
Women looking to supplement traditional Western medicine methods for treating vaginal bacterial imbalances with a vaginal probiotic may want to try one that contains the L. crispatus microbe. While vaginal suppositories have shown the most promise, several oral vaginal probiotics also contain this helpful bacteria.
Ongoing research could uncover additional uses for probiotics. There may be hope yet for women eager to avoid taking antibiotics and antifungals when encountering a vaginal bacteria imbalance.