Normal Vaginal Flora: Why the Vaginal Microbiome Matters
Wondering what normal vaginal flora is and why the vaginal microbiome matters? We’re asked this question frequently inside our pelvic health physical therapy sessions.
In this blog post, we’ll go over the normal vaginal flora, vaginal hormones, symptoms and diagnoses, and treatment for vaginal flora concerns.
What is the vaginal microbiome?
The vaginal microbiome refers to the diverse community of microorganisms, including bacteria, fungi, and viruses, that inhabit the vaginal environment.
This microbiome plays a crucial role in maintaining vaginal health and preventing infections. The most common bacteria in a healthy vagina are lactobacilli, which help to maintain a low pH and create an acidic environment that inhibits the growth of harmful pathogens.
Why is the pH of the vaginal tissue important?
The normal pH of the vagina typically ranges from about 3.8 to 4.5.
This acidic environment helps maintain a healthy balance of bacteria, particularly lactobacilli, which produce lactic acid and contribute to the vaginal acidity.
A balanced pH is crucial for preventing infections and maintaining overall vaginal health. Changes in pH can occur due to factors like menstrual cycle fluctuations, sexual activity, infections, or hormonal changes.
We know that hormonal changes, whether it's menopause, birth control, or lactation, can really alter the microbiome and make women more susceptible to infections.
So, what happens when the vaginal pH gets more basic (higher)?
A few things occur when the vaginal pH gets more basic.
Increased Risk of Infections: A higher pH can allow harmful bacteria and pathogens to thrive, leading to infections such as bacterial vaginosis (BV) or yeast infections.
Bacterial Vaginosis (BV): BV is characterized by an overgrowth of certain bacteria, leading to symptoms like abnormal discharge, odor, and irritation. It’s often associated with an elevated vaginal pH.
Yeast Infections: While yeast (like Candida) can thrive in both acidic and alkaline environments, a disruption in the microbiome can lead to overgrowth, resulting in yeast infections.
Irritation and Discomfort: Changes in pH can lead to irritation, itching, and discomfort in the vaginal area.
Complications in Reproductive Health: An imbalanced pH can affect fertility and may be linked to complications during pregnancy, such as preterm labor.
What are the key differences in severity and symptoms between a UTI and bacterial vaginosis?
A UTI is generally considered more serious than bacterial vaginosis.
While bacterial vaginosis may lead to mild symptoms like odor, UTIs typically present with severe symptoms that can escalate rapidly and become quite distressing for many women.
That's why it is crucial to prevent UTIs, as many women die from urinary tract infections each year. Vaginal hormones are highly effective and beneficial for supporting a healthy microbiome!
When these hormones are optimized but infections still occur, it's crucial to understand the microbiome better. Many people may not be using vaginal hormones in the most effective way.
What is the role of vaginal hormones for the lifespan of any woman?
Women are often prescribed birth control pills, which can negatively impact the microbiome of the bladder.
There is likely a role for using vaginal hormones in women on birth control, but more research is needed. Vaginal hormones do not alter systemic blood levels of estrogen, making them suitable for various populations, including lactating and pre-menopausal women.
However, this approach is not studied or promoted sufficiently.
How can vaginal estrogen specifically aid in the balance of the vaginal microbiome?
The decline in estrogen levels in postmenopausal women has been linked to an increase in pelvic floor symptoms and disorders, such as urinary tract infections (UTIs) and overactive bladder (OAB).
These symptoms often go hand in hand with changes in the vaginal microbiome.
In premenopausal women, there is typically lower microbial diversity, with a dominance of Lactobacillus, compared to postmenopausal women. Hormone replacement therapy (HRT) can help restore this balance.
In postmenopausal women, vaginal estrogen has been shown to alleviate OAB symptoms, which include urinary urgency, frequent urination, and nocturia, with or without urgency urinary incontinence, in the absence of infection or other underlying conditions.
While the exact mechanism behind this relief is not fully understood, vaginal estrogen is known to enhance vaginal blood flow and reduce the density of autonomic and sensory nerves in the vaginal area.
The natural decline in estrogen during menopause leads to structural and chemical changes in the urogenital tract, such as a reduction in urothelial thickness and proteins that mediate cell health.
This deterioration may compromise the urothelial barrier, making it easier for pathogens to colonize and cause infections.
How can I best balance my hormones well before I hit premenopausal age?
Everyone benefits from vaginal hormones. For those currently on birth control pills, it is recommended to explore alternatives like IUDs.
The goal is to help people move away from birth control and optimize their hormone levels.
Vaginal hormones are known to promote beneficial lactobacilli and help lower and maintain pH levels.
Another important aspect to understand is the role Dehydroepiandrosterone (DHEA) plays in the body.
DHEA is a hormone that your body naturally produces in the adrenal gland. DHEA helps produce other hormones, including testosterone and estrogen. Natural DHEA levels peak in early adulthood and then slowly fall as you age.
DHEA should be accessible to everyone since it contains androgens, which are just as essential for tissue health as estrogen. It is the foundation.
While additional supplements like D-Mannose, cranberry, and probiotics can be valuable, it is important to prioritize ensuring that people have the essential hormone support they need.
Even young people can gain from learning how to balance their hormones in their 20s. DHEA and its analogs are safe to use. There are various reasons why women in their 20s might require extra hormones, such as excessive exercise, disordered eating, fluctuating hormones due to PCOS, or the use of birth control pills.
The idea that premenopausal or reproductive women don’t face hormonal imbalances is simply incorrect.
If you are local to the Jacksonville area and are experiencing pelvic discomfort, frequent urination, leaking with exercise/exertion, or are looking for pelvic floor support during your menopausal years, we’d love to help you here at Samson Strength and Performance Physical Therapy. We offer pelvic health physical therapy services inside our Jacksonville Beach clinic and you can request a call to get started. We’d love to help you.
