Did you know that about 1 billion women around the world suffer from urogenital (urinary & vaginal) infections each year? The microbiota in the vaginal canal is just as important as the microbiota in the gut. Today we will focus on the importance of having a well-balanced vaginal microbiota for optimizing health. 

The bacteria that live in the vaginal canal play an important role in the maintenance and prevention of urogenital infections. These infections can be bacterial in nature (Urinary Tract Infections, Bacterial Vaginosis) or fungal (Yeast Vaginitis). The vaginal canal is home to about 50 different microbial species. Now, compare this to 800 different species that live in the GUT – the diversity of microbes present in the vaginal canal is much lower than in the gut! The vaginal canal in healthy women is dominated by the Lactobacillus species: L.iners, L. crispatus, L. acidophilus, L. reuteri, L. rhamnosus. Depletion in these healthy organisms can leave women prone to vaginal and urinary infections.

What factors deplete the ‘good bacteria’ in the vaginal microbiota?

• Acidity – The vaginal environment is known to be acidic in nature with a pH around 4.0. This helps to prevent the 'unfriendly' bacteria from overpopulating and helps to maintain levels of the ‘friendly’ bacteria, Lactobacilli. Menstrual flow, antibiotic use, and IUD's can raise pH levels. This causes a decrease in the ‘friendly’ bacteria and an increase in the ‘unfriendly’ bacteria.  
• Hormone levels  – Decrease in estrogen levels, as experienced in menopause can decrease the number of the Lactobacilli present in the vaginal canal. So, vaginal microbiota varies between premenopausal women and menopausal women.
• Sexual behaviours - Exposure to spermicidal agents can decrease lactobacilli in the vaginal microbiota and increase pH.
• Diet  - Diets high in refined sugars can make a woman more likely to urinary infections.

Treatment of these infections traditionally involves the use of antimicrobials. However, they are not always effective and often many women can experience recurring infections, so alternative treatments are being considered. Re-populating the vaginal microbiota with Lactobacilli species mentioned above can help to prevent and treat these infections. 

What is the best route of delivery? Now you know probiotic supplementation, specifically the Lactobacillus species can be useful to promote a well-balanced vaginal microbiota to prevent various urogenital infections. The next question is how to best take probiotics that are meant to target the vaginal canal? Both oral and vaginal probiotics can be effective.  Oral Lactobacilli are able to pass through the intestines and reach the vagina. However, this method may take longer to populate the vaginal microbiome as opposed to a probiotic suppository. I often recommend a probiotic suppository if trying to prevent recurring infections and an oral probiotic with emphasis on the Lactobacilli species for regular maintenance of the vaginal microbiome.

Dosage? 200 million – 5 billion CFU for vaginal suppositories and an oral probiotic with 10-20 billion CFU can be useful to maintain the vaginal microbiota.

Probiotic combinations of the Lactobacilli species is a safe and effective way for women of all ages to maintain a healthy vaginal microbiota to reduce the chance of urogenital infections! Probiotics can also help to re-populate the vaginal microbiota with ‘friendly’ bacteria after a course of antimicrobial treatment. It is always best to speak to your healthcare practitioner prior to starting anything new. 

**Disclaimer

The advice in this article is for informational purposes only. It does not replace the care of a Naturopathic physician. 

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