What is the comparative efficacy of vaginal probiotics versus oral probiotics for vaginal health?

From the Guidelines

Vaginal probiotics are the preferred choice for maintaining vaginal health due to their direct application and immediate local effects, as evidenced by a study using L. crispatus which showed promising results 1. When considering the use of probiotics for vaginal health, it's essential to understand the differences between vaginal and oral probiotics. Vaginal probiotics, such as those containing Lactobacillus, are administered directly to the vagina, providing immediate local effects. In contrast, oral probiotics are taken by mouth and work systemically, supporting vaginal health from within. Some key points to consider when choosing between vaginal and oral probiotics include:

• The direct application of vaginal probiotics provides faster relief for acute vaginal issues like bacterial vaginosis or yeast infections
• Oral probiotics offer convenience and broader health benefits, making them suitable for long-term vaginal health maintenance
• The most effective approach often combines both vaginal and oral probiotics, with vaginal probiotics providing immediate relief and oral probiotics supporting ongoing maintenance
• Both types of probiotics work by maintaining a healthy vaginal pH and promoting Lactobacillus dominance, creating an environment inhospitable to harmful microorganisms 1. It's also important to note that while there is some evidence supporting the use of orally administered lactobacillus containing products to prevent recurrent urinary tract infections 1, the quality of these studies is often poor, and more research is needed to fully understand the benefits of oral probiotics for vaginal health.

From the Research

Vaginal Probiotics vs Oral Probiotics for Vagina

• The study 2 found that vaginal probiotics, specifically Lactobacillus rhamnosus BMX 54, were effective in restoring and maintaining vaginal microflora and pH, and reducing the recurrence of bacterial vaginosis.
• In contrast, the study 3 found that oral probiotics, specifically a combination of Lactobacillus acidophilus, Lactobacillus rhamnosus, and Lactobacillus reuteri, improved vaginal dysbiosis in asymptomatic women.
• Another study 4 found that Lactobacillus rhamnosus and Lactobacillus acidophilus had antimicrobial activities against pathogens responsible for bacterial vaginosis and aerobic vaginitis.
• The study 5 found that oral probiotics, specifically Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, had no significant effect on the vaginal microbiota, cytokines, and chemokines in pregnant women.
• A review article 6 discussed the use of probiotics in vaginal health, highlighting the potential of Lactobacillus species to decrease the pH of the vagina and prevent the growth of other microorganisms.

Comparison of Vaginal and Oral Probiotics

• The studies suggest that both vaginal and oral probiotics can be effective in improving vaginal health, but the route of administration may affect the outcome.
• Vaginal probiotics may be more effective in restoring and maintaining vaginal microflora and pH, as seen in the study 2.
• Oral probiotics, on the other hand, may have a more systemic effect, as seen in the study 3, which found that oral probiotics improved vaginal dysbiosis in asymptomatic women.

Mechanisms of Action

• The studies suggest that Lactobacillus species can produce lactic acid and hydrogen peroxide, which can help to decrease the pH of the vagina and prevent the growth of other microorganisms 4, 6.
• The probiotics may also have antimicrobial activities against pathogens responsible for bacterial vaginosis and aerobic vaginitis 4.