Vaginal Microbiota: What It Is and How to Keep It Healthy

Published: 17 October, 2024 | 12'

In our bodies, there exist bacterial communities known as microbiotas, which are essential for the well-being and health of different areas of the body such as the skin, the intestine, or the oral cavity. Each of these is composed of a vast population of microorganisms that inhabit a specific area of our body, such as the vagina, which has its own microbiota.

We explain what the vaginal microbiota is and the importance of maintaining it in good condition with the help of Dr. Joan Matas Dalmases, integrative gynaecologist. 

What is the vaginal microbiota and why is it important for your intimate health? 

The vulva is responsible for protecting the genital tract from potential infections and, from its external opening to the cervix, the vagina is characterised by having high moisture and mucosity. As such, “this area has specific characteristics with its own microbiota, a set of bacteria that play roles in the development of the immune response”, informs the doctor.

The composition of the vaginal microbiota: A delicate balance of beneficial bacteria

The normal vaginal microbiota is predominantly composed of lactobacilli along with other organisms present in smaller numbers (including Staphylococcus epidermidis, Corynebacterium spp, Ureaplasma spp, Streptococcus/Enterococcus spp, Gardnerella vaginalis, Candida spp). Throughout the different stages of a woman's life, the composition of her vaginal microbiota will vary. Thus, the vaginal mucosa of women during their reproductive years contains more than ten different species of Lactobacillus, with L. crispatus, L. gasseri, L. jensenii, and L. iners being predominant. 

The presence of vaginal lactobacilli is directly related to hormonal levels, resulting in a normal pH level of 3.8 - 4.4. 

These hormonal levels and age are also key factors in the state of the microbiota. “For example, in childhood, there is a minimal vaginal microbiota, as its composition and abundance develop with growth and are influenced by the hormonal presence of oestrogens and progesterone”, explains Matas. Also, during the menopause, the vaginal microbiota undergoes notable changes due to the reduction in oestrogen levels, resulting in an increase of gut bacteria and those originating from the skin. These changes can lead to an increase in gynaecological infections during this age. Furthermore, the presence of factors mediating inflammation in this area, among which are cytokines, can help regulate inflammation depending on their quantity and the balance of the immune system.

Key functions of the vaginal microbiota: Barrier, balance, and well-being 

The microbiota in this area, also known as the vaginal bacterial flora, is mainly composed of Lactobacillus, as we have mentioned. These produce lactic acid which creates an acidic environment forming a biofilm on the surface of the vaginal mucosa. Moreover, lactobacilli produce antimicrobial substances (such as bacteriocins) and hydrogen peroxide (H2O2), which inhibit the adherence of pathogens.

These Lactobacillus that are part of the usual flora of the vagina are commonly called “good bacteria” due to their positive effects on the well-being of the microbiota, such as immunomodulation and the restoration of the characteristic microflora of both the vagina and the intestine, where they are also present.

Warning signs: How to know if your vaginal microbiota has become imbalanced? 

When the presence of lactobacilli decreases, other microorganisms can grow excessively in the area, causing the pH to rise above 4.5, thereby creating a floral imbalance that leads to the occurrence of urogenital infections, called bacterial vaginosis. Dr. Matas confirms that “pH alterations are very common during a woman’s fertile phase, as well as changes in oestrogen levels in later ages”. These changes can cause discomfort in the vaginal area and can serve as warning signs that help detect this imbalance. Furthermore, they are much more common in summer due to swimming in pools or the sea and due to the effects of sweat increasing humidity in the genital area.

Another very common vaginal imbalance is a fungal infection, usually caused by a yeast of the genus Candida spp, primarily the species known as Candida albicans, commonly referred to as candidiasis. Normally, this species is a component of the normal vaginal microbiota, and its presence is kept under control thanks to lactobacilli, but when an imbalance occurs and the concentration of lactobacilli falls below a critical level, this situation can be exploited by these fungi, leading to an excessive growth in the area.

Common discomforts of an imbalanced vaginal microbiota

According to Dr. Matas, “an imbalance in the microbiota due to oestrogen deficiency can cause vaginal atrophy and other symptoms such as vaginal dryness, itching, discomfort, changes in discharge or pain during sexual intercourse”.

pH alterations cause similar symptoms such as irritation, dryness, and changes in discharge, but can also result in burning, strong odour, pain during urination, and even anal discomfort.

Tests and diagnostics to evaluate the health of your vaginal microbiota

It is ideal to have regular gynaecological check-ups if there are no pre-existing conditions to ensure everything is in order with a physical examination or, if necessary, to conduct other tests such as cytology or cultures to determine the presence of other lesions, vaginal infections due to the presence of fungi or other parasites, or sexually transmitted infections (STIs), among other conditions.

In the event of any visible alterations or discomfort as described above, it is most advisable to consult a healthcare professional who can determine the cause and the appropriate treatment and to avoid self-medication.

What factors are associated with the imbalance of the vaginal microbiota?

The imbalances occurring in the vaginal flora can be due to both internal and external factors. Firstly, there are inevitable factors that are part of the woman's life cycle that affect this microbiota, including:

• Age, as mentioned earlier, since as we age, variations in the composition of the flora appear, decreasing the number of lactobacilli that are part of the usual flora.
• The phase of the menstrual cycle. For instance, menstrual fluid can cause variations in the pH values of the vaginal area, leading to differences at various stages of the menstrual cycle.

Other factors depend on lifestyle, daily habits, or specific situations that can alter it, let’s review some of them.

Daily habits associated with the imbalance of your vaginal microbiota

There are daily habits that can alter the levels of the bacteria that usually inhabit the vagina or those that can help the proliferation of microorganisms causing discomfort, such as:

• A very frequent sexual activity or multiple partners.
• Inadequate intimate hygiene using aggressive products such as soaps with a pH different from that of the flora, deodorants, or vaginal douches.
• The use of tampons, especially during infections or other alterations, as they can worsen the state.
• Clothing can also have an impact with the use of very tight garments or underwear made from non-breathable fabrics, as the most suitable is cotton.
• Diet also influences, as excessive sugars or carbohydrates favour the presence of pathogenic bacteria.

The effect of medication on vaginal balance

The use of certain medications can also affect the levels of characteristic bacteria in the microbiota, both intestinal and vaginal. This occurs with antibiotics, which can disrupt the normal balance of the microbiota while fulfilling their function. Hence, antibiotics can lead to variations in the composition of the vaginal microbiota.

On the other hand, “the use of oral contraceptives or other types of hormonal therapies affects the balance of the vaginal flora as it influences hormone levels, as oestrogens are elevated”, informs the doctor. Additionally, oral contraceptives disrupt intestinal microbiota and all microbiotas are interconnected, which can negatively impact the vaginal microbiota.

Conditions and situations related to the microbiota

Some stages of hormonal changes such as puberty or pregnancy affect the levels of lactobacilli and other microorganisms in the vaginal flora, thereby causing changes in discharge or other symptoms as described above.

There are also some intrinsic conditions such as uncontrolled diabetes, or a weakened immune system due to certain treatments, stress, or other causes that affect other processes in the body. 

Sexually transmitted diseases and infections (STIs) can also affect the vagina and cause symptoms such as changes in discharge or other variations in the microbiota. To prevent this, the doctor explains that “it is important to maintain proper hygiene and intimate habits, as well as barrier contraceptives to avoid these modifications, which can become chronic”.

Restore balance: How to maintain vaginal microbiota

Maintaining an adequate balance of the vaginal area is directly related to proper hygiene along with a healthy diet. While there are numerous conditions that can affect its balance due to various causes, there are some guidelines that can be followed to promote its good condition, such as:

• Keep the genital area clean and dry.
• Wear cotton underwear and avoid tight clothing that may cause irritation due to continuous friction and hinder perspiration.
• During the menstrual cycle, regularly change pads, tampons, or menstrual cups according to the recommendations for each intimate hygiene product. Panty liners should also be changed according to individual recommendations and needs.
• Visit the gynaecologist regularly, especially if you have conditions in the vaginal area or experience any unusual discomfort or symptoms.

Dietary tips to nourish your vaginal microbiota

In addition to the previous hygiene tips, following an appropriate diet will also support the good state of the vaginal microbiota.

1. Hydrate properly (six to eight glasses of water a day), as this will help you urinate regularly and promote the expulsion of potential bacteria from the urinary tract.
2. Moderate carbohydrate intake, as these can promote the growth of bacteria in the intestinal and urinary tracts. Instead, opt for whole grains and fibres to avoid refined flours.
3. Avoid saturated fats and refined sugars.
4. Consume nutrients such as vitamin C or B vitamins and other minerals like zinc, which assist the stages of the immune response.
5. Foods rich in probiotics and prebiotics.

Probiotics and prebiotics: The allies of your vaginal flora

Probiotics are live microorganisms found in some foods that are beneficial to our microbiota, mainly in the intestinal and vaginal areas. Lactobacilli are an example of probiotics; in addition to being regularly found in our vaginal flora, they are also found in some dairy products such as yoghurt and kefir, dark chocolate, and plant-derived foods such as sauerkraut and pickles.

In adequate and regular amounts, the intake of lactobacilli has beneficial effects for the maintenance of the vaginal microbiota, as well as for its recovery after an imbalance and to prevent recurrence.

On the other hand, prebiotics are a specific type of dietary fibre that stimulate the growth of probiotics in our body, as they serve as food for them. For this reason, it is advisable to ingest a good amount of plant fibre in our daily diet.

“In this way, a diet high in probiotic and prebiotic foods will be beneficial for our vaginal and intestinal microbiota,” the doctor assures.

Dr. Joan Matas Dalmases: Expert in integrative gynaecology

As a gynaecologist, Dr. Joan Matas highlights the importance of following correct habits as previously detailed, but also, as an integrative expert, he indicates the importance of “paying attention to our overall health, since a vulvar imbalance or issue may stem from another condition”.

The expert's view on the importance of vaginal microbiota

The vaginal microbiota is unique and specific to each woman, also having characteristics different from the rest of the body. Its importance lies in “the capacity for maintaining vaginal health and its own barrier system, as it can regulate and modulate the presence of bacteria and other microorganisms in order to preserve its integrity and help control the adhesion of pathogenic bacteria”, which is why the doctor emphasises following specific care and guidelines to preserve its good condition.

Dr. Matas's recommendations for maintaining a healthy vaginal microbiota

As already mentioned, “the environment of the genital area is characterized by high humidity, mucousness, and its own pH, which can be altered by various factors. Therefore, firstly, the most advisable approach is to start with a proper intimate hygiene routine as follows”:

1. Wash the external vulvar area once a day with a gentle hypoallergenic soap.
2. Avoid using regular shower gels, bubble baths, exfoliants, wipes, or any other product with fragrances.
3. Do not use sponges or towels; wash the area with your hand.
4. Gently and thoroughly dry after a shower with a towel. Change underwear or gently wash after excessive sweating and after swimming at the beach or pool, changing a wet swimsuit for a dry one.
5. Avoid vaginal douching, as this directly disrupts the bacteria that protect the vagina.
6. Pay attention to hygiene before and after sexual intercourse, and use protection during it. Additionally, it is advisable to urinate afterwards to facilitate the expulsion of potential bacteria.

There are many other factors that can alter the composition of the microbiota. Therefore, “it is vital to follow a healthy and active lifestyle with a balanced diet, regular exercise, as well as adequate rest and stress avoidance, which complements these hygiene guidelines to maintain a healthy microbiota”.

Integrative approach to imbalances in the vaginal microbiota

“Integrative medicine is based on understanding the human body as an interconnected whole”, explains the expert. “Thus, from integrative gynaecology, we seek the origin of an imbalance in our microbiota, or another condition that may arise, since this does not always originate from the vulvar area”.

An imbalance in our microbiota can be due to other factors such as a weakened immune system due to stress or the intake of certain compounds, for example. It can also be caused by a chronic digestive imbalance, either due to viral or bacterial processes. Therefore, “it is important to address each patient’s issue from an integrated perspective, taking into account any internal or external factors”.

The foundation of integrative medicine is also the practice of combining conventional medical treatments with natural or complementary alternative therapies in order to provide the best possible care.

Frequently asked questions about vaginal microbiota

If you experience any discomfort in the vaginal area, it is advisable to consult a specialist to determine the cause of the discomfort as soon as possible and to prevent it from developing into a more significant issue.

How long does it take for the vaginal microbiota to recover?

The normal state of the vaginal microbiota usually recovers within a few days after an imbalance caused by common factors such as a yeast infection or bacterial vaginosis, by following appropriate hygiene and dietary guidelines, as well as the treatment advised by the gynaecologist.

What can I do to maintain my vaginal microbiota balanced in the long term?

The most suitable way to maintain a balanced microbiota is to follow proper intimate hygiene and a healthy lifestyle as we have detailed in the previous instructions. All this, coupled with regular check-ups with the specialist and acting promptly in the face of any discomfort or alteration.

Is it normal to have vaginal discharge? When should I be concerned?

It is common for all women to experience changes in their vaginal discharge, especially due to the menstrual cycle influenced by different hormone levels. For example, discharge tends to be more abundant during ovulation and less so after bleeding.

The most significant changes that may indicate an imbalance in the microbiota are:

• Change in consistency to more lumpy or pasty.
• Yellow, whitish, greyish or greenish colour.
• Strong smell or unpleasant odour.
• More quantity than usual.

If you notice any of these changes, it is most common to consult a specialist to determine the cause and appropriate treatment.

If you want to know more about the microbiota…

• Intestinal microbiota. Functions and its importance for health
• Microbiota. Do you know what it is and where it is found in the body?
• Probiotics and prebiotics: What is the difference?