The vaginal microbiome is the community of microorganisms, including bacteria and yeast, that live in the vagina. A healthy microbiome is predominantly made up of beneficial bacteria called Lactobacilli. These bacteria produce lactic acid, which keeps the vagina slightly acidic, protecting it from infections and maintaining overall health.
Why does it matter?
A balanced vaginal microbiome is your body’s natural defense system. It helps to:
- Prevent infections like Bacterial Vaginosis (BV) and thrush.
- Protect against Sexually Transmitted Infections (STIs).
- Maintain a healthy pH balance.
- Prevent unpleasant odour and discomfort.
What are the signs of an unbalanced microbiome (Dysbiosis)
An imbalance, where harmful bacteria outnumber the good Lactobacilli, can lead to:
- Unusual discharge (thin, grey, white, or green).
- A strong, “fishy” odour.
- Itching, burning, or irritation around the vagina.
- Pain during sex or urination.
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What causes an Imbalance?
- Antibiotics: If taken for any other reason can kill both good and bad bacteria in the vaginal flora.
- Hormonal changes: Fluctuations in hormonal levels during periods, pregnancy, and menopause.
- Spermicides and harsh soaps: Can indiscriminately destroy vaginal epithelial cells and beneficial bacteria
- Unprotected sex: Semen is alkaline, which can alter vaginal pH and disrupt the vaginal flora
- Douching: Disrupts the natural bacterial balance, by washing away beneficial Lactobacillus and mucous layer.
- Stress and poor diet: Stress can cause hormonal changes leading to disruption of vaginal microbiome, while foods high in sugar and refined carbohydrates feeds harmful bacteria.
‘Testing beyond basic swabs and smears’
Traditional tests often only look for a few specific pathogens. Next-Generation Sequencing (NGS) technology is a revolutionary way to test your vaginal health.
- What is NGS? It’s an advanced DNA testing method that identifies all the bacteria and fungi present in your sample—not just the usual suspects. It provides a complete map of your vaginal microbiome.
- How it works: A simple, painless vaginal swab (often you can do it yourself) is sent to a laboratory where NGS technology is used to analyse the entire microbial community, showing the percentages of beneficial bacteria, harmful bacteria, and everything in between.
- Why it’s better: It offers a much more detailed and accurate picture than standard tests, allowing for highly personalised treatment plans, which may not be possible with traditional tests.
The conventional microbiological culture and quantitative PCR is suitable for confirmation of specific infections but unable to screen for the entire bacterial and yeast composition of the microbiome. This sometimes results in women continuing to experience recurrent infections with little or no answers. A single swab test checking thousands of microbes through NGS technology with 99.99% accuracy should be now the gold standard test for vaginal ecosystem.
Management & Treatment
- Probiotics: Specific strains of probiotics such as Lactobacilli can help replenish good bacteria including L. crispatus, L. rhamnosus and L. reuteri, which play a crucial role in maintaining vaginal health and overall vaginal wellness.
- Prebiotics: These are “foods” like onions, garlic, whole grains, fruits and vegetables help maintain an acidic vaginal environment, which inhibit harmful bacteria and yeast.
- Personalised Care: Based on an NGS test result, your gynaecologist can recommend targeted treatments (like specific antibiotics if needed) or probiotic strains, rather than a one-size-fits-all approach.
- Avoid Irritants: Skip douches, scented sprays, and harsh soaps to protect vaginal epithelial cells and beneficial bacteria.
Frequently Asked Questions
Q: I don’t have symptoms. Should I get tested?
A: Yes! A “silent” imbalance can still increase your risk of STIs or other complications. Testing of vaginal microbiome provides a baseline of your vaginal health.
Q: How is this different from a test at my GP or hospital?
A: A standard test looks for common infections like thrush or BV. An NGS test for microbiome gives a complete, detailed census of every microbe present, offering a deeper level of insight of vaginal health
Q: Can my partner affect my microbiome?
A: Yes. Semen, saliva, and the transfer of bacteria during sex can alter your vaginal pH and bacterial balance. Using condoms can help maintain stability.
Q: Does vaginal microbiome affect the health of my baby during pregnancy?
A: Yes! Newborn’s gut microbiome is most similar to the vaginal microbiome of woman giving birth and plays key role in the establishment of baby’s immunity and risk of disease for the newborn in the future.
Q: Can I test my microbiome without seeing a doctor?
A: Yes. Many services often allow you to order a test kit directly online without a prescription, however, your gynaecologist can help you choose the right one for you and help formulate management plan for healthy vaginal flora.
eGynaecologist Advice
- Your vaginal microbiome is a key indicator of your gynaecological health. It deserves as much attention as your gut health.
- Sometimes, dysbiosis can be “silent” with no noticeable symptoms but still pose risks. Advanced testing like NGS can reveal hidden imbalances that traditional tests might miss.
- If you suffer from recurrent infections (thrush, BV), dryness, or irritation, ask your gynaecologist about comprehensive microbiome testing.
- You should discuss your vaginal microbiome with your gynaecologist when planning a pregnancy, as it can impact fertility and pregnancy outcomes.
