How to Nurture a Healthy Vaginal Microbiome

Oct. 29, 2021

The vaginal microbiome is often mentioned in passing - sort of as an afterthought - usually when we’re really talking about the gut microbiome. We’ve decided to give the vaginal microbiome centre stage today, and with good reason - it’s a huge factor when it comes to the quality of a woman’s life and health, and has implications for fertility, pregnancy and childbirth, and risks associated with sexually transmitted infections.

On this podcast, NBT Scientific Director and Coach Megan Hall and I are discussing the vaginal microbiome: what it is, how to assess for problems, and how to maintain a state of good health. Megan talks about the effects of vaginal dysbiosis on pregnancy and fertility, and how to create the best possible outcome for childbirth. She explains what causes disruption to the vaginal microbiome in the first place, and how ancestral health principles can keep you on track. She also outlines how to rebalance the vaginal microbiome when there’s dysbiosis, along with practical steps to take before resorting to antibiotics and antifungals.

Here’s the outline of this interview with Megan Hall:

[00:02:30] Why care about the vaginal microbiota?

[00:03:55] Megan's outline for this podcast.

[00:04:50] What is the vaginal microbiome (VM)?

[00:05:52] 5 core vaginal microbiome community state types (CSTs).

[00:07:40] Why lactobacilli are beneficial.

[00:10:52] Lucy Mailing, PhD; Podcasts: 1, 2, 3.

[00:12:06] Diagnoses associated with vaginal dysbiosis.

[00:13:47] Direct to consumer VM testing.

[00:15:48] Changes throughout a woman's lifespan.

[00:18:02] Podcast: You Are Not Broken: A Modern Approach to Women’s Sexual Health and Desire, with Kelly Casperson, MD.

[00:18:38] Common vaginal microbiome dysbiosis pathologies: Bacterial Vaginosis (BV), Vulvovaginal Candidiasis (VVC), and Group B Strep (GBS).

[00:26:16] Pregnancy: protection from preterm labor, preeclampsia, and infertility.

[00:29:44] Studies on the effects of the microbiota and success with infertility treatment: 1. Moreno, Inmaculada, et al. "Evidence that the endometrial microbiota has an effect on implantation success or failure." American journal of obstetrics and gynecology 215.6 (2016): 684-703. and 2. Moore, Donald E., et al. "Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization." Fertility and sterility 74.6 (2000): 1118-1124.

[00:31:06] NBT Podcasts with Dr. Malcolm Kendrick: 1, 2.

[00:32:15] Causes of disruption to the vaginal microbiome: menses, gut dysbiosis, diet, smoking, contraceptives, antibiotics, general hygiene, stress, tampons, lubricants, hygiene products.

[00:35:49] Women who eat a vegetarian diet have higher vaginal microbial diversity (which is unfavorable); Study: Song, Stephanie D., et al. "Daily vaginal microbiota fluctuations associated with natural hormonal cycle, contraceptives, diet, and exercise." Msphere 5.4 (2020): e00593-20.

[00:37:05] Compounds from cigarette smoke can be found in cervical mucus; Study: Prokopczyk, Bogdan, et al. "Identification of tobacco-specific carcinogen in the cervical mucus of smokers and nonsmokers." Journal of the National Cancer Institute 89.12 (1997): 868-873.

[00:37:24] Microbial composition of man's penis can predict BV incidence in female sex partner: Study: Mehta, Supriya D., et al. "The Microbiome Composition of a Man's Penis Predicts Incident Bacterial Vaginosis in His Female Sex Partner With High Accuracy." Frontiers in cellular and infection microbiology 10 (2020): 433.

[00:38:53] Maternal stress alters proteins related to vaginal immunity and abundance of lactobacilli; Study: Jašarević, Eldin, et al. "Alterations in the vaginal microbiome by maternal stress are associated with metabolic reprogramming of the offspring gut and brain." Endocrinology 156.9 (2015): 3265-3276.

[00:39:34] Maternal vaginal microbiome mediates responses to prenatal stress; Study: Jašarević, Eldin, et al. "The maternal vaginal microbiome partially mediates the effects of prenatal stress on offspring gut and hypothalamus." Nature neuroscience 21.8 (2018): 1061-1071.

[00:42:44] Summarizing lifestyle practices that most affect the vaginal microbiome.

[00:43:07] The BBC More or Less Podcast: Has the number of periods a woman has in her lifetime quadrupled?

[00:43:49] Best options for contraceptives; Fertility Awareness Method. Podcast: The Truth About Fertility and the Fertility Awareness Method, with Torea Rodriguez.

[00:45:08] Personal hygiene products - be wary.

[00:46:49] Podcast: How to Manage Stress, with Simon Marshall, PhD.

[00:47:22] How to rebalance the vaginal ecosystem (before resorting to antibiotics and antifungals).

[00:48:19] Vaginal pH test strips.

[00:48:33] Probiotics: Jarrow Fem-Dophilus has two good strains.

[00:52:34] Intervaginal vitamin C can help treat BV; Study: Petersen, E. Eiko, and Paola Magnani. "Efficacy and safety of Vitamin C vaginal tablets in the treatment of non-specific vaginitis: A randomised, double blind, placebo-controlled study." European Journal of Obstetrics & Gynecology and Reproductive Biology 117.1 (2004): 70-75.

[00:52:46] Medical grade honey, thyme and garlic.

[00:55:13] The next frontier in VM study.

[00:57:02] Seeding with fecal microbiota transplantation in C-section infants; Study: Korpela, Katri, et al. "Maternal fecal microbiota transplantation in cesarean-born infants rapidly restores normal gut microbial development: a proof-of-concept study." Cell 183.2 (2020): 324-334.

[00:58:30] Microbiome-based biologic drug being studied (L crispatus probiotic); Study: Lagenaur, Laurel A., et al. "Connecting the dots: Translating the vaginal microbiome into a drug." The Journal of Infectious Diseases 223.Supplement_3 (2021): S296-S306.

[01:00:09] 4-quadrant model.