How can I introduce Lactobacillus (lactic acid bacteria) vaginally to maintain vaginal health?

From the Guidelines

Lactobacillus can be introduced vaginally through over-the-counter probiotic suppositories or vaginal probiotic capsules specifically designed for vaginal use, such as RepHresh Pro-B, VH Essentials Probiotics with Prebiotics, or Fem-Dophilus, which typically contain Lactobacillus species like L. rhamnosus, L. reuteri, or L. crispatus. These products are designed to colonize the vagina with beneficial bacteria that produce lactic acid, maintaining a healthy acidic pH (3.8-4.5) that inhibits the growth of harmful microorganisms, thus helping to prevent bacterial vaginosis, yeast infections, and other vaginal imbalances 1. Some key points to consider when using these products include:

• Insert one suppository or capsule deep into the vagina daily for 5-7 days, then maintain with 1-2 applications weekly as needed.
• Always wash your hands before insertion.
• Consider consulting a healthcare provider before starting any vaginal probiotic regimen, especially if you're pregnant or have recurring infections. It's also worth noting that some women prefer using plain, unsweetened yogurt containing live Lactobacillus cultures applied with an applicator, though commercial products are more standardized 1.

From the Research

Introduction to Lactobacillus and Vaginal Health

• Lactobacillus is the most frequently isolated microorganism from the healthy human vagina, including species such as Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii 2.
• These vaginal lactobacilli play a crucial role in preventing the invasion of pathogens by keeping their population in check, thus maintaining vaginal health.

Methods of Introducing Lactobacillus Vaginally

• Oral intake of lactobacilli/lactoferrin mixture has been shown to lead to significant vaginal colonization by Lactobacillus acidophilus and Lactobacillus rhamnosus, resulting in the restoration of normal vaginal microbiota 3.
• Vaginal probiotics containing Lactobacillus crispatus strains have been found to reduce the signs and symptoms of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) in patients 4.
• Probiotic lactobacilli have been widely used as an alternative or adjunct to traditional antibiotic therapy for the treatment of vaginal infections and restoration of the vaginal microbiome 5.

Benefits of Lactobacillus for Vaginal Health

• Lactobacillus derivatives have been found to have anti-biofilm, antioxidant, pathogen-inhibition, and immunomodulation activities, making them beneficial for developing remedies for vaginal infections 2.
• The use of probiotic lactobacilli has been shown to prevent vaginal infections, including BV and VVC, and restore the vaginal ecosystem 3, 6.
• Lactobacillus crispatus-containing oral and vaginal probiotics have been found to improve vaginal health by reducing the signs and symptoms of BV and VVC 4.

Key Findings and Implications

• The composition of vaginal microbiota plays an important role in determining vagina health, and the use of lactobacilli derivatives can help maintain a healthy vaginal microbiota 2.
• Oral and vaginal probiotics containing Lactobacillus strains have been found to be effective in reducing the signs and symptoms of vaginal infections and improving vaginal health 3, 4.
• The use of probiotic lactobacilli has been shown to be a safe and effective alternative or adjunct to traditional antibiotic therapy for the treatment of vaginal infections 5.