Research shows that 138 million women suffer from vaginal infections each year [1], yet when vaginal discomfort appears, women are often slow to ask for help and by the time they reach out, in many cases they have tried many over the counter remedies. Even then, they are often not correctly diagnosed, leading to years of recurring symptoms.
What is causing my vaginal issues?
Research shows that 138 million women suffer from vaginal infections each year [1], yet when vaginal discomfort appears, women are often slow to ask for help and by the time they reach out, in many cases they have tried many over the counter remedies. Even then, they are often not correctly diagnosed, leading to years of recurring symptoms.
I often hear women tell me that they have recurring thrush and that treatments only work for a short period of time before they get a recurrence. However, there are several different organisms that can create vaginal discomfort and correctly identifying the problematic microbes is the key to successful and lasting results. On the other hand, incorrect treatment can cause an exacerbation of symptoms. For instance, antimicrobials for bacterial vaginosis can cause recurring thrush. Likewise, treating thrush when it is a bacterial organism can enable troublesome microbes to flourish.
Statistics show that more than 75% of women will develop dysbiosis at some point in their lives, and more than 10% live with chronic or recurring symptoms. Given the scale of the problem, it is unthinkable that despite an explosion of studies into the gut microbiome in the last decade, the vaginal microbiome remains somewhat neglected. It was not until 2016 that the female vaginal microbiome was fully sequenced. Finally, the momentum is increasing on understanding this especially important area.
One cannot ignore the psychological impact on women. Women often report feeling ashamed or embarrassed and worry about others detecting a smell or abnormal discharge. In some instances, women avoid sexual activity or oral sex as they are too conscious of their symptoms to engage in these activities.
What do we know about the vaginal microbiome?
One of the most important indicators of a healthy gut microbiome is diversity. The vaginal microbiome, in contrast, is the healthiest when it lacks diversity. So, diagnosis and correct treatment of this area is much simpler, if you do thorough testing. There should really only be acid loving lactobacillus thriving in the female genital area. When the pH changes, however, lactobacillus cannot thrive and other problematic microbes take hold. They then in turn alter the pH even more, creating a vicious cycle of dysbiosis.
What are the signs that something isn’t right with the vaginal microbiome?
· Itching, burning, pain, discharge, smelly discharge, vaginal dryness
But why is it important to test?
Vaginal issues are not just a bit of a nuisance, they have been shown to have a much larger impact on health. For women who are thinking about conceiving, ensuring a healthy vaginal microbiome is exceptionally important because:
1. Bacterial Vaginosis is linked to miscarriage, preterm labour and early membrane rupture[2]
2. Bacterial vaginosis is more prevalent in women with tubal infertility[3]
3. Embryo transfer in IFV shows greater success if the right microbes colonise the cervix[4]
4. Women with higher lactobacillus had a higher live birth rate than mothers with streptococcus found present at the time of embryo transfer[5]
5. The presence of Lactobacillus iners hasbeen associated with preterm birth, whereas Lactobacillus crispatus is predictive of a full-term birth[6]
For those not trying to conceive, the discomfort is not the only consideration. Left untreated,dysbiosis can lead to immune responses creating chronic inflammatory conditions and are associated with recurrent UTIs, painful sex, pelvic floor issues, vulvodynia, endometritis, pelvic inflammatory disease to name just a few.
What to do if you have vaginal discomfort:
1. Speak to a health professional, but insist on thorough testing. Do not use treatments if you have not had microbiology tests done. Find someone who has a sensitive and compassionate approach.
2. Although medications such as metronidazole will treat Bacterial vaginosis in the short-term, we know that the recurrence rate is more than 80%, so consider looking at not only treating the immediate infection, but re-establishing the right bacterial growth by providing the right conditions within the body.
3. If your problem is chronic, consider getting PCR testing done to look at the vaginal ecology so that you can get extremely specific about how you treat.
4. Treat underlying conditions such as metabolic conditions, heavy metal burdens, hormonal issues and conditions that trigger inflammation.
How do we treat vaginal issues from a Functional Medicinepoint of view?
We take a very careful history, looking at when in your cycle symptoms are worse, what the triggers are (sex, food intolerances etc). We always prefer testing because with testing, you can be extremely specific about the treatments that you select. In addition to treating the problematic microbes, we would recommend localised treatment with natural agents to help support the correct pH, use scientifically validated probiotics and natural acidifiers such as vitamin C. In addition, we also look at hormone levels and inflammation that may be translocating from the gut to the vagina. Treating metabolic issues that put you at higher risk is also very beneficial. If your symptoms are persistent get in contact with a Functional Medicine practitioner, but do ask about their experience in treating the female ecological system, as this is a rare speciality that few clinicians have had any training in.
We use Invivo Clinical’s Vaginal health and microbiome profile in our clinic. The test uses quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) to provide an accurate, reliable and quantifiable measurement of microbiota abundance and host inflammatory markers.
The profile detects:
– Inflammation
– Abundance of four key Lactobacillus species associated with eubiosis
– Abundance of strictly anaerobic bacteria associated with dysbiosis
– Abundance of enteric bacteria associated with aerobic vaginitis
– Abundance of bacterial vaginosis associated bacteria
For more information, please get in contact with charmaine@edinburghhealth.co.uk.
[1]Ratho, Buffler, 2014
[2] Brownetal 2018
[3]van Oostrum, N., De Sutter, P., Meys, J., & Verstraelen, H.(2013). Risks associated with bacterial vaginosis in infertility patients: a systematicreview and meta-analysis. Human reproduction, 28(7), 1809-1815.
[4] Salimetal 2002
[5] Mooreetal 2000
[6]Kindinger, L. M., Bennett, P. R., Lee, Y. S., Marchesi, J. R., Smith, A.,Cacciatore, S., MacIntyre, D. A. (2017). The interaction between vaginal microbiota,cervical length, and vaginal progesterone treatment for preterm birth risk.Microbiome, 5(1).indinger etal, 2017