---
title: "Supporting the Vaginal Microbiome: The Why and How"
description: Certain Lactobacillus strains may support vaginal microbial balance and reduce bacterial vaginosis, according to several clinical studies.
image: https://www.casi.org/hubfs/casi/featured/8-15-vaginal-microbiome.jpeg
---

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# Supporting the Vaginal Microbiome: The Why and How

CA Cory Ambrose, ND, MAT Aug 15, 2023

![Supporting the Vaginal Microbiome: The Why and How](https://www.casi.org/hs-fs/hubfs/casi/featured/8-15-vaginal-microbiome.jpeg?width=960)

Evidence indicates that the most common causes of vaginal itching, abnormal discharge, irritation, and odor are due to an [imbalance or overgrowth of unwanted bacteria and yeast](https://www.dynamed.com/approach-to/vulvovaginitis-approach-to-the-patient) in the vagina. Occurrences of bacterial imbalances in the vaginal tract are [common among women](https://pubmed.ncbi.nlm.nih.gov/31901667/), have high recurrence rates, and may increase the risk of other gynecologic conditions. Similar to the gastrointestinal (GI) microbiome, [evidence suggests](https://pubmed.ncbi.nlm.nih.gov/37111086/) that the vaginal microbiome may benefit from targeted support to help promote healthy microbial diversity and balance.

Research indicates that a [healthy vaginal microbiome](https://pubmed.ncbi.nlm.nih.gov/37111086/) contains *Lactobacillus crispatus, L. rhamnosus, L. gasseri,* and *L. jensenii.* Certain *Lactobacillus* strains may produce lactic acid and hydrogen peroxide; this may help maintain the vaginal microenvironment by [supporting a normal pH](https://pubmed.ncbi.nlm.nih.gov/31901667/). They may also [produce chemicals](https://pubmed.ncbi.nlm.nih.gov/31901667/) that may target unwanted bacteria. Certain *Lactobacillus* strains may also help support normal systemic and local acute [inflammatory responses](https://pubmed.ncbi.nlm.nih.gov/31901667/) and help inhibit the expression of certain pro-inflammatory cytokines including interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α). They may also help support epithelial cell tight junctions and the production of endothelial growth factor to help promote [tissue healing](https://pubmed.ncbi.nlm.nih.gov/31901667/). Certain species in the [*Bifidobacterium* genus](https://pubmed.ncbi.nlm.nih.gov/36293436/) have also been shown to help produce hydrogen peroxide and help maintain homeostasis in the vaginal microflora.

Evidence suggests that a [risk factor](https://www.dynamed.com/condition/bacterial-vaginosis-bv) for common pathologies related to vaginal dysbiosis may include reductions in populations of hydrogen peroxide-producing *Lactobacillus* species in the vaginal microbiome. [Decreased populations](https://pubmed.ncbi.nlm.nih.gov/34414130/) of *L. crispatus, L. gasseri, L. jensenii, L. reuteri,* and certain species in the *Bifidobacterium* genus have been observed in individuals with certain gynecological conditions. In one [population study](https://pubmed.ncbi.nlm.nih.gov/14586379/) of pregnant individuals with and without bacterial vaginosis (BV), hydrogen peroxide-producing *Lactobacilli* were found in only 5% of pregnant women with BV, as compared to 61% with normal flora.

[Evidence suggests](https://pubmed.ncbi.nlm.nih.gov/14586379/) that vaginal colonization by *L. crispatus* and *L. jensenii* has been associated with a lower incidence of BV. In addition, the oral administration of *Lactobacillus*-containing probiotics, including *L. rhamnosus*, has been shown to help support [healthy microbial populations](https://pubmed.ncbi.nlm.nih.gov/14586379/) in healthy women.

In animal studies, *L. gasseri* was reported to help downregulate the [expression](https://pubmed.ncbi.nlm.nih.gov/31901667/) of TNF-α and IL-1β. Preliminary laboratory studies in certain cell lines indicate that some *Lactobacillus* strains may also help support the body’s response to certain [viral loads](https://pubmed.ncbi.nlm.nih.gov/31901667/).

A [double-blind, randomized, controlled pilot study](https://pubmed.ncbi.nlm.nih.gov/29065710/) investigated the potential efficacy of a yogurt drink containing 1 billion CFU each of *Lactobacillus crispatus, L. rhamnosus, L. gasseri, and L. jensenii* on 36 women with a stable menstrual cycle or menopause diagnosed with BV. All participants received a medical intervention to the standard of care. In addition, the treatment group received the yogurt drink twice daily for 4 weeks. At the [study terminus](https://pubmed.ncbi.nlm.nih.gov/29065710/), 100% of individuals in the treatment group were free from BV, as opposed to 65% in the placebo group. 

Another [clinical trial](https://pubmed.ncbi.nlm.nih.gov/37111086/) assessed the efficacy of a *Lactobacillus*-containing probiotic in asymptomatic women classified into two categories based on Nugent scores (NS): Low-NS (n=26) and High-NS (n=10). A Nugent score is one of the determining factors in the status of BV in an individual; a low NS indicates negative status and a high NS is suggestive of the presence of BV. The study consisted of six weeks of daily administration of a probiotic containing *L. acidophilus and L. rhamnosus*. At the study's conclusion, [vaginal dysbiosis](https://pubmed.ncbi.nlm.nih.gov/37111086/) improved most in asymptomatic individuals with high NS scores. 

Similar to the GI microbiome, certain probiotics may help support the vaginal microbiome. They may help create [unfavorable conditions for undesired bacteria](https://pubmed.ncbi.nlm.nih.gov/31901667/), help promote a healthy repopulation of intestinal flora, and support the intestinal barrier, the inflammatory response, and a healthy mood. 

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### Cory Ambrose, ND, MAT

Clinical Application

## Clinical Considerations in Practice

 In clinical practice, practitioners considering the topics discussed above may also weigh nutrient form, delivery and formulation, alongside individual patient variability.

### Practitioner Formulation Example

![ProbioMed™ V-Balance](https://cdn.sanity.io/images/lemtscrs/production-www/f7d50d747b189b5f9d71bc9abc9bed2c09e18430-2000x2000.png?w=128&h=128&fit=max&auto=format)

ProbioMed™ V-Balance

Lactobacillus rhamnosus vaginal probiotic · Capsules

[Explore Formulations →](https://www.designsforhealth.com/products/probiomed-v-balance)

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