Taking Care of Your Vaginal Health: Optimising the Vaginal Microbiome
Vaginal dysbiosis, or an imbalance in the vaginal microbiome, can lead to a variety of uncomfortable symptoms and health issues for women. Fortunately, there are several effective strategies for managing vaginal dysbiosis and promoting optimal vaginal health.
Screening and Diagnosis
It is important for healthcare providers to screen for vaginal dysbiosis in women who are symptomatic or at high risk, such as those who are pregnant or have a history of sexually transmitted infections. Diagnosis is typically made through clinical evaluation and laboratory testing, such as vaginal pH and microscopic examination of vaginal fluid.
Treatment Options
Treatment for vaginal dysbiosis depends on the specific condition present. For bacterial vaginosis, the most common vaginal infection, antibiotics such as metronidazole may be prescribed. For vulvovaginal candidiasis, antifungal medication such as fluconazole or topical agents may be recommended. However, it is important to note that antibiotic and antifungal medications can disrupt the vaginal microbiome and may not be effective for all women.
There are several non-pharmacologic treatment options that may be appropriate be used alone or in conjunction with medications. These include:
Probiotics - Probiotics are beneficial bacteria that can help to restore the vaginal microbiome. Specifically, lactobacillus strains such as Lactobacillus crispatus and Lactobacillus jensenii have been shown to be particularly effective. Probiotics can be taken orally or used topically in the form of suppositories or vaginal capsules. Of course, probiotic foods are also important - we'll discuss this further below.
Prebiotics - Prebiotics are non-digestible food ingredients that promote the growth of beneficial bacteria in the gut and vagina. Examples include inulin, fructo-oligosaccharides (FOS), and galacto-oligosaccharides (GOS). If you feel worse for including prebiotics, you may have FODMAP intolerance or SIBO. This can make prebiotic prescription tricky as they may trigger painful symptoms. In this case, consider a fibre supplement such as PHGG which is typically well tolerated in sensitive individuals.
Lifestyle modifications - Certain lifestyle factors can improve vaginal health. These include maintaining good hygiene practices, avoiding douching, using non-irritating hygiene products, wearing breathable underwear and avoiding tight-fitting clothing, and engaging in safe sex practices.
A nutritionist perspective
While a nutritionist may not be the primary healthcare provider for treating dysbiosis of the vaginal microbiome, they can provide recommendations for a healthy diet that can support the growth of beneficial bacteria in the vagina. Some dietary factors that may impact the vaginal microbiome include:
Probiotic-rich foods - Consuming foods that are rich in probiotics can help improve the balance of bacteria in the vagina. Examples of probiotic-rich foods include long-fermented sourdough bread, brine cured olives, yoghurt, kefir, pickles, kimchi, sauerkraut, tempeh, natto and miso.
Fibre-rich foods - A diet high in fibre can help promote the growth of beneficial bacteria in the gut, which in turn may positively impact the vaginal microbiome. Examples of fibre-rich foods include whole grains, fruits, vegetables, nuts, seeds and legumes. If you find you respond negatively to high fibre foods, this may indicate a gut microbiome imbalance such as bifidobacterium deficiency - in this case, you may wnat to try supplementing with a broad spectrum probiotic and a digestive enzyme containing cellulase for 2 weeks - then reintroduce high fibre foods. You may also wish to consider testing your gut microbiome.
Avoiding processed foods - Processed foods, which are often high in sugar and refined carbohydrates, can disrupt the balance of bacteria in the gut and potentially impact the vaginal microbiome. For example: Candida, a yeast present in the vaginal canal, thrives on a high carb/sugar diet. Candida causes minimal issues when in lower numbers, however when overgrown, candida may cause vaginal thrush, jock itch and may heighten sensitivity to creams, soaps, perfumes and synthetic fibres.
Adequate hydration - Drinking plenty of water and other hydrating fluids can help flush out harmful bacteria and promote the growth of beneficial bacteria in the vagina. This also helps to promote healthy bladder function and help prevent cystitis. Don't forget your hydrating foods also such as cucumber, watermelon, celery, apples, iceberg lettuce - whilst these are your super-hydrators, all fruits and veggies improve hydration unless they have been roasted or dehydrated (which removes the water from them).
It is important to note that while dietary changes can have a positive impact on the vaginal microbiome, they should not replace medical treatment.
Conclusion
Vaginal dysbiosis can cause significant discomfort and can increase the risk of other health issues for women. However, with proper screening, diagnosis, and management, most women can achieve optimal vaginal health. By incorporating both pharmacologic and natural treatment options, healthcare providers can offer women a comprehensive approach to managing vaginal dysbiosis. Remember, it is important to consult with a healthcare provider before starting any treatment regimen.
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