Vaginal Probiotics: What Does The Science Say?

It’s Q&A Day at 10almonds!

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In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝Is there any merit to vaginal probiotics?❞

What a fun question! First let’s break it down, as this could mean two different things:

1. Probiotics, which you consume, using your mouth, which are marketed as benefiting vaginal health
2. Probiotics taken as a vaginal pessary/suppository, to act directly there

The former has limited evidence for it, but generally speaking, improving one’s gut health improves all other areas of health, so it’s not surprising if it helps this too.

See for example:

Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis

Some notes:

• candidal vaginitis means a yeast infection causing vaginal inflammation
• bacterial vaginosis means a vaginal bacterial imbalance (generally also featuring vaginal inflammation, though it can be asymptomatic)

In the latter case, the “imbalance” in question is usually a shortage of Lactobacillus sp. (that is to say, the diverse species of the Lactobacillus genus) resulting in an overgrowth of other kinds of bacteria, which in turn results in changing the vaginal microbiome to make it warmer and more acidic than it should be.

While a healthy vagina shouldn’t smell of roses, it shouldn’t smell fishy either; if it does, that’s a sign of bacterial vaginosis.

What it’s supposed to be like: slightly bitter (acidic) yet at the same time slightly salty, distinctly umami, along with a cocktail of personal pheromones (and if menstruating or otherwise* vaginally bleeding, then of course add: iron/”metallic”). The pheromones will also reflect any hormonal changes, but should never make anything smell bad, just different.

*e.g. due to PCOS, fibroids, etc. Note that in the case of PCOS, it may also smell a little different (if it does, then usually: a little more musky, and in extreme cases it may also be approaching sweet-and-salty rather than bitter-and-salty), due to often different hormone levels. Again: it still shouldn’t smell bad, though, just different.

In the above-linked study, taking more live Lactobacillus acidophilus (in yogurt, eating it, with their mouths) improved levels of L. acidophilus in the vagina. While the study authors concluded “this ingestion of yogurt may have reduced episodes of bacterial vaginosis”, which is rather a weak claim, it can be argued that it merely improving the levels of L. acidophilus in the vagina was already a win.

That was a small (n=42, and only 7 followed through to completion) and old (1996) study, and it bears mentioning that most of the studies into this seem to be small and old, but conclude similarly with weakly positive statements.

However, it does make a difference what kind of Lactobacillus is used, for example in this next study…

• L. fermentum RC-14 worked well (90% success rate)
• L. rhamnosus GR-1 worked somewhat (40% success rate)
• L. rhamnosus GG did not work (0% success rate)

So, diversity is key, and getting a wide range of Lactobacillus sp. seems to be a safe bet.

Short version: enjoying probiotics as part of your diet probably improves vaginal health, just like it improves pretty much everything else.

See also: Make Friends With Your Gut (You Can Thank Us Later)

You would think that this would mean that taking probiotics as a vaginal pessary/suppository would be even better, but the results are weaker, as in this study, which produced temporary improvements in about half the study group, with only 3 out of 28 being free of bacterial vaginosis the next month:

Treatment of bacterial vaginosis with lactobacilli

This study got better results, with a 61% success rate:

Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis

Important note

Do note that this last category, involving topical treatments (i.e., manually introducing Lactobacillus sp. to the vagina) were all in cases of pre-existing bacterial vaginosis, not as a prophylactic and/or general health-improving thing.

If your vagina seems happy right now, then do not mess with its happy bacterial balance!

And at all times (regardless of whether it seems happy right now or not): do not douche (it does not need it and will not benefit from it; the vagina is self-cleaning*) as this will wash out many of your Lactobacilli and will do absolutely nothing against any Candida there (C. albicans being a rooted fungus, whereas Lactobacillus is a sausage-shaped bacterium with many tiny appendages but no actual ability to stay put), so Candida will flourish in the Lactobacillus’s absence.

*by the vagina, we are referring to the vaginal canal. The vulva—the outside part consisting of the two pairs of labia, the glans clitoris, and clitoral hood—are not self-cleaning, and should just be washed gently per your normal bath/shower routine; that’s perfectly fine and good.

And definitely don’t put any “cleansing” toiletries inside the vagina (or any toiletries at all, for that matter), even if they are sold and marketed for that purpose; they will not help and they will harm.

Also, due to their neighborliness, messing up the microbiome inside the vagina is a common way to also get Candida inside the urethra:

How To Avoid Urinary Tract Infections (UTIs)

One other option

Finally, unless you have a “very good friend” you have a pressing urge to swap germs with, you might want to leave this one to the scientists, but we share this paper just for interest:

The effectiveness of vaginal microbiota transplantation for vaginal dysbiosis and bacterial vaginosis: a scoping review

Lastly…

Going back to oral supplementation, if you’d like to try that then check out this for further notes on what, why, how, etc:

How Much Difference Do Probiotic Supplements Make To Health?

Take care!