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The Vaginal Microbiome

We have microbiomes all over our bodies. Millions of microbes in communities - for example, the ear, the sinuses, the skin, the gut, and on and on. Women also have a vaginal microbiome. When the microbiome of the vagina gets disrupted, health effects such as bacterial vaginosis (BV) can occur.

The Scientist recently published a good article on the vaginal microbiome, as well as the microbes in the vagina associated with health and those associated with health problems. [Note: All these microbes live together in a healthy vaginal microbiome - it's just that sometimes the balance gets disrupted.] Much has been learned since they first wrote about the microbiome of the healthy vagina in 2014 - but much is still unknown.

Some good news is that the beneficial bacteria Lactobacillus crispatus, which is very important for a healthy vagina, is now easily available as a probiotic supplement (to be taken when needed) in the US. Back in 2016 it was only available in Europe for BV and urinary tract infections (UTIs). This bacteria has been referred to as the "golden child of all the lactobacilli" in the vaginal microbiome.

Excerpts from The Scientist: The Vaginal Microbiome is Finally Getting Recognized

Vaginal dysbiosis has long been a taboo subject, but studying and optimizing the vaginal microbiome could be a game changer for women's health.

By comparison, the vaginal microbiome has received very little attention, despite the prevalence of bacterial vaginosis (BV), which occurs when the vaginal microbiome shifts into a dysbiotic, or unhealthy, state. BV plagues approximately 30 percent of reproductive-age women in the United States; in some countries, more than 50 percent of women may be affected.1,2 

While many people consider the pain, burning, itching, and strong odor characteristic of BV to be merely a nuisance, this condition can have enormous effects on patients’ lives. “People will tell you that BV has destroyed their sense of intimacy with their partner and that it makes them feel ashamed. It has really destroyed their sense of well being,” said Caroline Mitchell, a reproductive biologist at Massachusetts General Hospital.

However, the impacts of vaginal dysbiosis extend even further, with important health consequences not just for women, but for humanity as a whole. That’s because research indicates that the vaginal microbiome could influence the propagation of sexually transmitted infections (STIs), including chlamydia, gonorrhea, and human immunodeficiency virus (HIV).3 BV has also been linked to infertility and risk of preterm birth, which is itself associated with an increased risk of lifelong cardiovascular, respiratory, and neurodevelopmental conditions in the child. 4–7

“The vaginal microbiome, one could say, is probably the most important microbiome because none of us would be here without pregnancy and birth,” said Craig Cohen, a reproductive health researcher at the University of California, San Francisco.

A healthy gut microbiome contains a diverse array of microbes that can vary dramatically between individuals.9 The healthy vaginal microbiome, in contrast, is often dominated by one of four Lactobacillus species: L. crispatus, L. iners, L. paragasseri, and L. mulieris.10 Of these types, L. crispatus seems to be associated with optimal health. “Crispatus is the golden child of all the lactobaccilli,” said Melissa Herbst-Kralovetz, a vaginal microbiome researcher at the University of Arizona. A microbiota dominated by L. iners, on the other hand, has been linked to a greater risk for developing BV.11

When the lactobaccilli lose dominance, a diverse array of anaerobic bacteria, including Gardnerella vaginalis, Fannyhessea vaginae, and Prevotella bivia, may begin to flourish and cause dysbiosis.12 However, no single microbe seems sufficient to cause BV, and many BV-associated bacteria are also found in healthy women.13

“It’s really this polymicrobial consortium of bacteria,” said Herbst-Kralovetz. “There’s not just one agent, and it doesn't always look the same in every woman.” This makes the condition difficult to study, let alone prevent or treat.

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