What does a healthy vaginal microbiome look like?

A healthy microbiome can take many shapes and forms. There is a lot of variation of what is ‘healthy’ for each person when it comes to which bacteria and yeasts live in the vagina.

What is the vaginal microbiome?

The vaginal microbiome is a community of microbes – bacteria and yeasts/fungi – that live complex, interconnected lives inside the vagina. It’s also called vaginal flora or vaginal microbiota. The vaginal microbiome plays a major role in reproductive and vaginal health.

One of the main reasons women hunt down health advice is due to uncomfortable vaginal symptoms^​1​. Over 90 per cent of these visits are due to an imbalanced vaginal microbiome^​2​. These imbalances may include conditions such as bacterial vaginosis (BV), aerobic vaginitis (AV), yeast infections, cytolytic vaginosis (CV) and others.

The vaginal microbiome impacts more than just the vagina – imbalances are associated with complications during pregnancy, infertility, sexually transmitted infections (STIs) and sometimes even cancer^​3​.

So why do we still know so little about the vaginal microbiome if it’s so important? Microbiology and study into the human microbiome is a quickly developing field, with most of the study so far being on the gut and skin.

The gender healthcare gap means women and people with vaginas have been left out of research for the most part (but we’re helping fix that!).

Meet the players in the vaginal microbiome

The vaginal microbial community is made up of a multitude of bacteria, fungi, and even viruses and sometimes other organisms. The main standout player in most healthy vaginas is Lactobacillus species, our ‘friendly’ or ‘good’ bacteria.

Enter stage left, lactobacilli

Lactobacilli are pretty handy to have around, because they produce lactic acid to keep the vaginal pH between 3.8 and 4.5. Lactic acid is harmful to most other bacteria, so they stay away.

Lactobacilli use up vaginal real estate, living on vaginal cells, keeping the cell protected from other bacteria moving in. Lactobacilli also produce bacteriocins – a natural antibiotic – to keep harmful bacteria populations down.

Lactobacilli also keep inflammation down.

Three of our favourite lactobacilli species are Lactobacillus crispatus, L. jensenii and L. gasseri.

Meet the creeps – disruptive vaginal microbes

If your lactobacilli friends are in short supply, other bacteria that are not so helpful will take their place. These potentially disruptive microbes include Gardnerella, Ureaplasma, yeast like Candida, or even E. coli and other bacteria that belong in the digestive system.

When there are too many unfriendly bacteria in the vagina, we call this vaginal dysbiosis^​4​. Put simply, it just means ‘bacteria out of balance’ or ‘too many of the wrong bugs in the wrong place’, which is different to, say, a vaginal infection. Vaginal dysbiosis and vaginal infections are not the same thing.

Bacterial vaginosis (BV) is the most common form of vaginal dysbiosis. Each year, a third of women will develop BV^​5​. Some groups of women are affected more than others^​6​. Other forms of vaginal dysbiosis include yeast infections (thrush), urinary tract infections (UTIs) and aerobic vaginitis (AV), and can cause itching, burning, unpleasant odours and irritation.

But, not everyone gets symptoms, and not everyone needs treatment. A healthy vaginal microbiome is one that doesn’t cause problems for you or your sexual partners.

Unfortunately, misdiagnosis rates are high, as are recurrence rates after conventional treatments – over 50% of cases of BV recur after antibiotic treatment.

Here at My Vagina, we are diving into the how and why of these recurrences, working on treatments that address the underlying drivers of vaginal dysbiosis, not just the microbiome disturbances. We are doing unique research into the driving factors that influence the vaginal microbiome.

Understanding the driving forces behind vaginal microbiome issues means treating the cause, not just the microbes or symptoms. As anyone with recurring vaginal symptoms will know, antibiotics and probiotics can only take you so far.

What a protective vaginal microbiome looks like

Your test doesn’t have to come back ‘perfect’ to be great! It’s a good sign to have a small range of bacteria present, with majority protective species.

Below is a good-looking vaginal microbiome tested using Juno, from the vagina of someone not experiencing vaginal symptoms.

Testing your vaginal microbiome at home

If you don’t have symptoms, your vaginal microbiome may be just fine for you. If you have symptoms, getting a comprehensive vaginal microbiome test is a great idea, no doctor required. Order online anywhere in the world.

How vaginal flora impacts the rest of your body

When the vaginal flora is disrupted, it allows disruptive bacteria and fungi to move in, which can result in inflammation of the vaginal cells. Many pathogens can interfere with vaginal cells’ ability to defend themselves, blocking the immune response.

With a strong colony of lactobacilli in the vagina, disruptors are kept at bay, keeping vaginal immunity intact and defences strong.

Some broader impacts of vaginal microbiome disturbances include being at greater risk of catching an STI^​7​, pelvic inflammatory disease (PID)^​8​, infertility^​9​ or failures of IVF treatments^​10​, miscarriage^​11​, premature babies^​12​, preeclampsia^​13​ and problems in newborn babies^​14​. Other serious health problems include certain gynaecological cancers (ovarian^​15​, cervical^​16​, endometrial^​17​).

Vaginal flora changes with your body

The microbes in your vagina change all the time depending on the menstrual cycle (or lack of), sex, changing hormones (pregnancy, birth control, post-partum, menopause^​18​), and behaviours like smoking^​19​, stress^​20​, douching and certain medications.

Understanding Community State Types (CSTs)

You might see on some vaginal microbiome reports a Community State Type listed. This is a broad classification of which lactobacilli species dominates the vagina, or in the case of CST Type 4, not dominated by lactobacilli.

• Type 1: ‍Lactobacillus crispatus 
• Type 2: ‍Lactobacillus gasseri 
• Type 3: ‍Lactobacillus iners 
• Type 4: Non-lactobacilli species dominant, five subgroups
• ‍Type 5: Lactobacillus jensenii 

Generally speaking, CSTs 1, 2 and 5 are considered more favourable, but take this information as a broad sweeping generalisation only.

References

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