Vaginal Microbiome and Fertility

By now most people know that there are good bacteria and bad bacteria, yeast, parasites, and viruses that inhabit our digestive tract. In fact, there is a quadrillion of them. This is termed our “microbiome”. But, you may not be aware that there is also a vaginal microbiome. The vaginal microbiome consists of good bacteria, bad bacteria, yeast, protozoa, and viruses, just like your gut does. Having the right mix of these keeps your vagina healthy. The wrong mix leads to infections from yeast, Gardnerella vaginalis overgrowth (BV) and even fertility problems.

Here’s all you need to know about your vaginal microbiome and how to fix it if it’s not right.

The Good Bacteria

First, let’s look at which bacteria should be there. One of the key good bacteria in your digestive tract is called Lactobacillus acidophilus. Different strains of this same bacteria also inhabit your vagina. Lactobacillus strains make up 90-95% of the reproductive microbiome. The most frequently isolated strains are Lactobacillus crispatus, Lactobacillus iners, Lactobacillus jensenii, and Lactobacillus gasseri in White and Asian women. Interestingly, Black and Hispanic women have less dominance by Lactobacillus species. Their vaginal flora more often included Gardnerella, Pretovella, Corynebacterium, Atopobium, Megasphaera, and Sneathia. These are generalizations. Research shows that not only is the diversity of the vaginal flora unique to each individual woman, but each woman’s microbiome composition fluctuates throughout her reproductive lifespan.

Because these bacteria help to maintain an acidic environment in the vagina, they prevent other “unfriendly” microorganisms from growing there. They create an acidic pH by breaking down glycogen, a form of stored sugar, into lactic acid. The release of glycogen from the vaginal walls is regulated by estrogen. By breaking down glycogen Lactobacillus maintains a normal and healthy vaginal pH of 3.8-4.4.

The Bad Bacteria and Yeast

When conditions aren’t right for the growth of Lactobacillus species (hormone imbalance, high carb/sugar diet, antibiotic use) their population decreases. This results in reduced lactic acid production, and the pH in your vagina increases. There is also decreased amounts of hydrogen peroxide and an anti-bacterial substance called lactocin. This allows for overgrowth of the bad bugs: Gardnerella vaginalis, Candida albicans, Atopobium sp., and Prevotella sp. leading to the signs and symptoms of bacterial vaginosis and/or yeast infections.

How to Know if Your Vaginal Microbiome is Healthy

The main way to know if you have the right balance of good bacteria in your vagina is the lack of any vaginal symptoms.

Signs and symptoms of unhealthy vaginal flora include:

• abnormal vaginal discharge (white chunky, fishy-smelling, greenish, bloody)
• friable cervix
• cervical dysplasia
• Candida infections
• bacterial vaginosis (BV)
• irritation
• pain with intercourse
• bleeding after intercourse
• itching
• burning or
• fertility problems. Tiny bacteria known as mycoplasma and ureaplasma are particularly associated with infertility or recurrent miscarriage. They cause endometritis or inflammation of the lining of the uterus. They are picked up on a high cervical swab. This is a special type of swab. It is not the one routinely done by your medical doctor.

The first thing to do is to see your medical doctor for some diagnostic testing. You may need a PAP smear, ultrasound, and/or vaginal swab. If swabs indicate an infection (Candida, Gardnerella, Prevotella, Atopobium), especially if it’s a recurring problem, or there is no other obvious explanation for your symptoms, then it may be a microbiome issue.

What Affects Your Vaginal Microbiome

Much like your gut bacteria, there are factors that influence how healthy your vaginal bacteria are. The following are some of the factors that alter your vaginal flora:

• Stress
• Sleep, or lack thereof
• High sugar or high carb diet
• Antibiotics
• Hormone levels or hormone imbalance
• Puberty
• Your menstrual cycle
• Menopause
• Intercourse
• Semen
• Exercise
• Pregnancy
• Smoking

Implications for Fertility and Infant Development

The vaginal microbiome of the mother plays a vital role in populating the microbiome of newborn babies. This then has an impact on the baby’s gut health, immune system, and neurological development.

5 Steps to Fix Vaginal Infection or Dysbiosis

Here are 5 steps to fix vaginal problems:

1. Address any of the predisposing factors I mentioned above that you can. Fix your sleep, reduce your stress, cut back on the carbs and sugar, quit smoking and exercise regularly.
2. If you have to take antibiotics, always take a good quality probiotic along with them.
3. Balance hormones. Many of the above measures help hormone balance. In addition, there are vitamins, minerals, and herbs that help. These are not something that I can recommend without seeing you.
4. At periods of hormonal transition such as menopause, perimenopause, puberty, pregnancy, ovulation, and menstruation, maintaining healthy hormone balance eases any symptoms, including disruption of the vaginal flora.
5. Restore healthy vaginal flora. Once the predisposing factors have been fixed, then you can restore healthy vaginal bacteria by taking a good quality probiotic orally or using vaginal suppositories of good bacteria. Without addressing the above, probiotic bacteria can’t survive long-term and vaginal infections will be a recurring problem.

By Dr. Pamela Frank, Naturopathic Doctor

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.

Vaginal Health and Fertility Research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137456/

https://www.sciencedirect.com/science/article/pii/S1472648317301876

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780402/

https://www.news-medical.net/health/Vaginal-Microbiome-Variation-and-Bacterial-Vaginosis.aspx