From the Guidelines
To restore the vaginal microbiome, I recommend using probiotic supplements containing Lactobacillus species, particularly L. crispatus, L. gasseri, L. jensenii, and L. rhamnosus, taken orally at doses of 1-10 billion CFU daily for at least 1-2 months. Vaginal probiotic suppositories containing these same bacteria can also be used, typically inserted once daily for 5-7 days, then 2-3 times weekly for maintenance. Boric acid suppositories (600mg inserted vaginally at bedtime for 7-14 days) can help restore proper vaginal pH if dealing with recurrent infections. Lifestyle measures are equally important:
- avoid douching
- use unscented soaps
- wear cotton underwear
- limit tight-fitting synthetic clothing. Dietary changes that support microbiome health include consuming prebiotic foods (garlic, onions, bananas) and fermented foods (yogurt with live cultures, kefir, sauerkraut) 1. These approaches work by reintroducing beneficial bacteria that produce lactic acid, maintaining the vaginal pH between 3.8-4.5, which creates an environment where harmful bacteria and fungi cannot thrive. The vaginal microbiome is dynamic and can be disrupted by antibiotics, hormonal changes, sexual activity, and hygiene practices, so consistent maintenance may be necessary for long-term balance. In the context of bacterial vaginosis, treatment with oral metronidazole, clindamycin cream, or metronidazole gel can help relieve vaginal symptoms, but reported cure rates for all regimens fall short of cure rates for most other reproductive tract infections 1. Studies are now under way to evaluate the efficacy of vaginal lactobacilli suppositories, in addition to oral metronidazole, for initial treatment and prevention of recurrent infection. However, the use of probiotics and lifestyle modifications can help support the growth of beneficial bacteria and maintain a healthy vaginal microbiome.
From the Research
Restoring Vaginal Microbiome
- The vaginal microbiome is a complex and dynamic microecosystem that plays a crucial role in women's health 2, 3.
- Bacterial vaginosis (BV) is a highly prevalent disorder of the vaginal microbiota, characterized by the loss or sharp decline in the total number of Lactobacillus and a corresponding marked increase in the concentration of anaerobic microbes 4, 2.
- Treatment with antibiotics, such as metronidazole, can reduce the taxa diversity and eradicate most of the BV-associated phylotypes, but may not restore the vaginal microbiota to its healthy state 5, 6.
- Probiotics, particularly Lactobacillus rhamnosus BMX 54, have been shown to be effective in restoring and maintaining the vaginal microflora and pH, and may be considered a new prophylactic treatment for preventing recurrence of BV 4, 5.
Factors Affecting Vaginal Microbiome
- Age, sexual behavior, ethnicity, and hygiene are some of the factors that can alter normal vaginal microbiota homeostasis 3.
- The use of metagenomics and bioinformatics tools has improved our understanding of the vaginal microbiome and its role in women's health 3.
Treatment and Restoration of Vaginal Microbiome
- Probiotic supplementation with vaginal Lactobacillus rhamnosus BMX54 has been shown to be useful in hindering bacteria growth, especially after antibiotic therapy, and may be considered a new prophylactic treatment for preventing recurrence of BV 4.
- Treatment with probiotics can maintain normal vaginal microbiota longer due to effective and steady vaginal microbiota restoration, providing new insights into BV treatment 5.
- The role of Lactobacillus iners in vaginal health and dysbiosis requires further investigations 6.