The vaginal microbiome: 4 predominant species to prevent dysbiosis

 

You’ve addressed biofilms, cleared your thrush and or bacterial vaginosis — now what? Prevention is everything. Once the infection is removed or reduced, the next step is to recolonise with protective species and maintain an environment that keeps those opportunists in check. Here’s how to do that, and what the science says.


Recolonise: The Core Lactobacillus Species

A healthy vaginal microbiota is typically dominated by several Lactobacillus species. When these are present and active, they help maintain a low-pH environment, produce lactic acid, and crowd out pathogens (yeasts, anaerobes, proteobacteria, etc.).

Here are five key species to aim for, and what evidence supports them:

  1. Lactobacillus crispatus

    • Strongly associated with vaginal health; depleted in dysbiosis such as bacterial vaginosis (BV).

    • Several studies using L. crispatus (e.g. the strain CTV-05 / LACTIN-V) showed that after antibiotic treatment of BV, applying this strain, (as a vaginal tablet and orally) reduces recurrence dramatically and helps reestablish a Lactobacillus-dominated community.

  2. Other species that are also important but in smaller amounts are Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii.

    • These species work together in a healthy vaginal microbiomes to maintain homeostasis and prevent overgrowth of pathogens. A good vaginal probiotic may contain 2-3 strains of crispatus and any of the lactobacillus above.

    • Lactobacillus species produce lactic acid which maintains the vaginal Ph. When Lactobacillus are compromised your pH will rise allowing opportunist yeast and bacteria to take hold and grow.

Maintain that PH

Recolonisation is helped by creating an acidic environment that favors lactobacilli and disfavors yeasts and unwanted bacteria. The aim is for it to be anywhere between 2.5-4.0 with some variation either side. When your vaginal biome has been compromised the pH will rise. This allows for the bacteria and yeasts that thrive in that environment to grow. We may be more prone to pH changes when we go through hormonal transitions, are on our period, under stress, increased sexual activity and poor diets. Below are a couple of tips to prevent future overgrowths.

  • Vitamin C vaginal tablets/suppositories:
    Studies have shown that using ascorbic acid vaginal tablets (e.g. 250 mg once daily for several days) can help treat bacterial vaginosis by lowering vaginal pH, restoring healthier flora, and reducing symptoms. There's also evidence that monthly use of such acidifying treatments can help prevent recurrence of BV. One study showed that using 250 mg ascorbic acid vaginal tablets on the 6 days following your menses per month for 6 months after successful treatment of bacterial vaginosis halves the risk of recurrence from 32.4% to 16.2%.

Vaginal pH tracking: It’s helpful to use pH strips occasionally, especially after menstruation, antibiotic use, or other events that may disturb flora. This helps you keep track and know when your more suspectable to infections.

Be cautious: some treatments (e.g., boric acid suppositories) have pH around ~5.1, which may help with biofilms or certain infections, but may not be acidic enough for all pathogens, and not appropriate for all uses. There is less evidence about their ability to fully restore a low-pH, Lactobacillus-dominated microbiome. (Also, boric acid should never be taken orally.)

Probiotic Administration (Oral + Vaginal)

Suppository / vaginal administration: Using a vaginal probiotic (especially strains of L. crispatus) as a suppository can help seed the flora locally. Studies show that vaginal application of L. crispatus CTV-05 after antibiotic treatment of BV reduced recurrence rates.

Oral administration: For those prone to thrush, UTIs, or BV recurrences, regular (e.g. daily or every other day) use of a well-designed probiotic (with strong strains such as L. crispatus, L. gasseri, L. jensenii) can help maintain resilience. The evidence particularly for L. crispatus formulations suggests improved time to recurrence, and fewer episodes.

Conclusion

As you continue your vaginal microbiome restoration journey remember the key points below:

  • A healthy vaginal biome is dominated by L. crispatus, L. gasseri, L. jensenii, and to a lesser extent L. iners.

  • Recolonisation using vaginal probiotics (especially L. crispatus) may help prevent recurrent BV and UTIs. More on UTIs to come in future articles.

  • Keeping the environment acidic via vitamin C (vaginal acidification) 6 days after your menses may be an effective method in prevention.

  • Ongoing maintenance through oral probiotics, pH monitoring, and biofilm disruptors can help reduce recurrence.

For guidance and an individualised treatment plan please book an initial consulation. Book an initial consultation to get started on healing your vaginal microbiome.

 

References

  1. Chee, W. J. Y., Chew, S. Y., & Than, L. T. L. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microbial cell factories, 19(1), 203. https://doi.org/10.1186/s12934-020-01464-4

  2. Lagenaur, L. A., Hemmerling, A., Chiu, C., Miller, S., Lee, P. P., Cohen, C. R., & Parks, T. P. (2021). Connecting the Dots: Translating the Vaginal Microbiome Into a Drug. The Journal of infectious diseases, 223(12 Suppl 2), S296–S306. https://doi.org/10.1093/infdis/jiaa676

  3. Bohbot, J. M., Daraï, E., Bretelle, F., Brami, G., Daniel, C., & Cardot, J. M. (2018). Efficacy and safety of vaginally administered lyophilized Lactobacillus crispatus IP 174178 in the prevention of bacterial vaginosis recurrence. Journal of gynecology obstetrics and human reproduction, 47(2), 81–86. https://doi.org/10.1016/j.jogoh.2017.11.005

  4. Petersen, E. E., Genet, M., Caserini, M., & Palmieri, R. (2011). Efficacy of vitamin C vaginal tablets in the treatment of bacterial vaginosis: a randomised, double blind, placebo controlled clinical trial. Arzneimittel-Forschung, 61(4), 260–265. https://doi.org/10.1055/s-0031-1296197

  5. Czaja, C. A., Stapleton, A. E., Yarova-Yarovaya, Y., & Stamm, W. E. (2007). Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women. Infectious diseases in obstetrics and gynecology, 2007, 35387. https://doi.org/10.1155/2007/35387

  6. Nunes, T. S. B. S., Rosa, L. M., Vega-Chacón, Y., & Mima, E. G. O. (2020). Fungistatic Action of N-Acetylcysteine on Candida albicans Biofilms and Its Interaction with Antifungal Agents. Microorganisms, 8(7), 980. https://doi.org/10.3390/microorganisms8070980

  7. Mändar, R., Sõerunurk, G., Štšepetova, J., Smidt, I., Rööp, T., Kõljalg, S., Saare, M., Ausmees, K., Le, D. D., Jaagura, M., Piiskop, S., Tamm, H., & Salumets, A. (2023). Impact of Lactobacillus crispatus-containing oral and vaginal probiotics on vaginal health: a randomised double-blind placebo controlled clinical trial. Beneficial microbes, 14(2), 143–152. https://doi.org/10.3920/BM2022.0091

  8. Krasnopolsky, V. N., Prilepskaya, V. N., Polatti, F., Zarochentseva, N. V., Bayramova, G. R., Caserini, M., & Palmieri, R. (2013). Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. Journal of clinical medicine research, 5(4), 309–315. https://doi.org/10.4021/jocmr1489w

 
 
Female Health, Gut Health, Hormonal balance, microbiome, Womens Health, Vaginal Microbiome, Recurrent ThrushKatherine MatthewsBiofilm, Thrush, BV, Bacterial vaginosis, Yeast InfectionComment