Vaginal Microbiome Basics + Healing

The vaginal microbiome is one of the roots of vibrant womb, sexual and pelvic health. This post is a deep dive into what this ecosystem is, what influences it and how to support its thriving.  

Let’s get started...

The microbiome consists of all the microbes (bacteria, fungi, viruses to name a few) that inhabit a host (you, human) and how they function within the system and express genetically. Each human microbiome consists of approximately 100 trillion microbes (mostly helpful bacteria). When robust, the microbiome supports thriving life in a dynamic symbiosis.

While the gut microbiome is most often discussed and studied in the past 20 years, researchers are now discovering that many areas of the body have unique and bio-individual microbiomes. Within the larger reproductive microbiome, different strains of beneficial bacteria have been found within the endometrium (innermost uterine lining), ovarian follicular fluid, uterine tubes, vagina, cervix, breast tissue and even the placenta!

Here the focus is on the vaginal microbiome for a few reasons:

• It is the portal into the rest of the reproductive microbiome.
• It profoundly affects resistance to infections, vulva health and fertility.
• It’s well studied because it’s less invasive than more inner reproductive parts!

What influences your vaginal microbiome? 

Your overall microbiome is influenced by many factors. Here are some of the major influencers:

• Genetics and ethnicity.
• Early exposure through your own birth and childhood experience.
• Diet! What you eat feeds what’s inside, for better or worse.
• Environmental exposure, which can be positive like dirt or negative like toxic chemicals in the air or in countless other products.
• Psycho emotional stress or trauma, especially if prolonged (negatively influences microbiome resilience).

The good news is there is no one “healthy” microbiome and many of these you have agency to change to your benefit! The vaginal microbiome is primarily (90-95%) lactobacilli strains of bacteria. However, the research around microbiome diversity remains clear: while yes, there are generally some specific bacteria strains that are beneficial, there is a wide variety of normal, healthy functionality. Humans are truly complex, bio-individual ecosystems! And your pussy is too.

Your vaginal microbiome is influenced by all of the above and the following specifics: 

Period care. Any products with toxic chemicals can be a negative influence. Your best bet is a menstrual cup, reusable cotton pads, period underwear or organic cotton pads / tampons.

STI status (or other infections). Any infection needs to be treated and then you can recover a healthy vaginal microbiome. Treatment occasionally does require antibiotics but often there are herbal options as well.

Hormones. Hormonal imbalance can alter vaginal pH and shift your vaginal microbiome to be less resilient and more prone to bacterial vaginosis or yeast.

Cycle phase (without hormonal contraceptive use). Your vaginal microbiome tends to be at its lowest point of resilience right before and during bleeding when estradiol is also lowest.

Sexuality. Unclean toys, hands etc can be an assault on even the most robust ecosystem. Same goes for chemicals in lube or condoms. Sexual shame or boundary violations can also be a largely undiscussed reason for vaginal microbiome issues.

Pregnancy, birth and breastfeeding history. Pregnancy alters the vaginal microbiome in a very unique way and the changes from that initiation last! More on this below!  

Self-assessment

So, now you have some basics, but what does a robust vaginal microbiome look and feel like?  

When it comes to vaginal health you usually don’t think much about it until something goes wrong. If you’re cruising along, without any of the following symptoms then it’s likely that your microbiome is working for you!

Here’s what to look out for that are red flags that your pussy ecosystem may need some support: 

• Frequent infections - yeast, BV, UTIs, recurring herpes outbreaks.
• General discomfort and inflammation - itching, pain, redness around the vaginal opening.
• HPV diagnosis and / or cervical dysplasia, especially if recurring or chronic.
• Painful penetrative sex - while there can be many causes for this, lack of tissue resilience related to VMB dysbiosis can contribute. Vaginal irritation after sex is also relevant here.
• Infertility, recurrent miscarriages or preterm birth - especially when infertility is “unexplained” (again here there can be many causes).

You may be wondering, what about occasional changes in vaginal discharge or smell? While that might tip you off to be aware of a potential infection (especially if there are other symptoms), it could also be normal changes with your hormonal cycle. It’s important to get to know what’s normal for you in terms of odor, cervical fluid patterns and all forms of vaginal secretions.

If you’re not sure, ask! We’re living in a time where our personal ecosystems are under the attack of modern life, including everything from depleted soil growing food to synthetic, toxic chemicals in tampons, pads, lubricants, condoms, underwear etc.

It can indeed feel overwhelming but with knowledge and some inner resolve to do better for your body, you can create resilience for this root of your pelvic and sexual health.

Supporting your vaginal microbiome

There are many angles to approach microbiome support but here are my top recommendations for getting started:

Cut back on sugar! Yes, even fruit for a short period of time. Increase veggie diversity and consumption. And pair any carb consumption with fat and protein! Diet can make all the difference in which microbes thrive and which don’t.

Use toxin free period care, sex toys, lube and condoms. Avoid BPAs, non-organic cotton, parabens, synthetic flavors, pesticides and chlorine bleaching. 

Consider ditching hormonal contraceptives or even an IUD. Research is mixed on this one but some studies indicate that hormonal contraceptives do negatively impact vaginal ecology. The copper IUD has been shown to increase risk of bacterial vaginosis. 

Get proper identification and treatment of infections! Don’t let an issue linger. Either get tested or if you know it’s yeast or recurring bacterial vaginosis then get support or take action. Using some treatment (herbal usually preferred, antibiotic occasionally helpful), the first step to recovery is getting rid of the infection itself.

Consider taking probiotics orally and inserting vaginally to colonize more beneficial bacteria. Strains to look for include: lactobacillus - crispatus, gasseri, jensenii, rhamnosus, reuteri. The last two are most commonly found. These strains decrease vaginal pH through lactic acid production and inhibit growth of bad bacteria. Check out Integrative Therapeutics Pro-flora for a product I like.  

Find embodied healing. If you are reading this you were born into a culture that inherently perpetuates sexual shame. This is even more complex based on personal experiences, family dynamics and so much more. Reclaiming your wholeness through the lens of sex and discovering what healthy sexuality means for you can radically shift your vaginal health.

If you can implement one thing from this list, you’ll be tending to the root of your pelvic, womb and sexual health. Other ways to support your vaginal microbiome or heal vaginal health issues include: herbal medicine, vaginal steaming, gut healing and acupuncture. 

Be sure to check out the Vaginal Microbiome Rehab + Cervical Health Workshop for more! 

Pregnancy, Birth and your vaginal microbiome

So what is unique about the vaginal microbiome and how it’s affected by pregnancy, birth and breastfeeding?

First up, pregnancy shifts the vaginal microbiome to be less diverse in strains with an overall increase in lactobacillus strains. This protects against ascending infections and associated preterm birth. This shift is the result of increased estrogen helping “feed” the good bacteria.

Preterm birth and recurrent miscarriages can be associated with bacterial vaginosis, which includes a shift in lactobacilli away from protective strains and an increase in lactobacillus iners. This can be asymptomatic, unfortunately, but there are non-pharmaceutical interventions and a quality probiotic during pregnancy can be beneficial.

Progesterone increases bifidobacterium both in the gut and the vagina in the 3rd trimester as the body prepares to seed the microbiome of the baby! Biology is truly amazing.

After birth, there is a period when the vaginal microbiome shifts and is less resilient overall. This is in response to the uterine, amniotic and placental microbes passing through the vagina (even with cesarean births due to lochia), as well as progesterone and estrogen dropping drastically. You may be more likely to get infections at this time so it’s good to take precautions around diet and lifestyle and consider taking a probiotic for additional support.

Pregnancy alters the vaginal microbiome long term, even if it isn’t carried to full term. This is a normal physiological process; however, if you experience symptoms or challenges through the sex, birth, motherhood continuum please get the support you need to thrive.

Takeaways…

Microbiome resilience and health is shaped largely by our environment, lifestyle and stress exposure. It’s an ecosystem that reflects what’s happening on the macro level as well. There are no quick solutions, just diligent steps forward and discernment around what’s needed to support  your vaginal ecology.

If you are looking for a place to start reclaiming your microbiome resilience, check out this workshop.

Sources: 

PMID: 28860491

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PMID: 29505773

This content was originally posted on Instagram but edited for this post.