The often ignored power of the vaginal microbiome in a woman’s life.

Take a peek at the party downstairs

Things are very lively down-under, and that is nothing but great! When you hear the word microbiome, you probably think mainly of the community of microorganisms in our gut. However, there are many more such local microbiomes, be it the aforementioned gut microbiome, dermal, oral, or vaginal. Every one of them is distinctive in terms of composition, proportions, and representation of individual species of microorganisms (for simplification, I will hereafter only name bacteria) and has different needs for its life, depending on the different conditions of the inhabited space. Even your left and right hand microbiome differ (for example, if you are left-handed, you perform certain activities with your left hand and leave other, easier activities to your right hand), and it is as unique as the iris or fingerprint. The individual bacterial communities are not hermetically separated from one another, however, they affect each other and communicate. And it makes sense - after all, they all live on the same planet - your body!

The life of a vaginal microbial town is not easy because the vaginal environment changes dynamically based on cyclicity, hormonal changes, or the woman’s stage of life (1). And what if the woman’s cycle is irregular, and so the vaginal microbiome faces sudden changes or its “militia” is weakened for some reason? Although it is not easy to thrive in such uncertainty and throw a quality party, your bacteria do their very best. A partial indicator of such a good and healthy party is the bacterial guestlist, but it is not the only or sufficient indicator. We can tell a lot from the overall health, immunity, and emotional state of the woman, her individual physiology and metabolism, the state of the gut microbiome, hormonal (im)balance, lifestyle, ethnicity, and genetic predisposition. It would definitely be a lot less fun if we knew the guestlist and the exact development of the party, anyway. There are still plenty of confusing aspects, and the research of the vaginal microbiome is still in its infancy (and in our knickers, right?).

Whose presence is a must and what about catering?

As I hinted before, studying the vaginal guestlist is not a piece of cake, partly because it is impossible to cultivate these bacterial strains in Petri dishes or other laboratory equipment (it is such a different environment for vaginal bacteria that they are unable to grow there) and also - as biological research keeps teaching us, gently but adamantly - nothing is quite as simple and clear as we would like (2). And now to the point - what about those guests?

Less is more and strength lies primarily in balance; nobody should gain the upper hand too much. Although there is no such thing as a perfect list of bacterial strains that would distinguish a healthy woman from a woman suffering from an imbalance, it has been shown that a healthy vaginal microbiome is usually characterised by fewer strains in mutual balance than in the very complex gut microbiome. This is mainly due to the richness of nutrients that we send to the gut, while the vaginal microbiome is more monotonous in terms of nutrition and not every bacterial strain can thrive there. On the contrary, an increase in diversity may indicate a vaginal dysbiosis (3). So invite only the most esteemed micro-guests to your vaginal party and pamper them.

We count the Lactobacillus strains among the most common inhabitants of our vaginal microbiome. These probably originally came from the gut microbiome (perhaps it was too crowded for them there, but honestly, this migration did not help a lot…), like the Candida yeast, for example (we will definitely speak more of it in future articles). Studies done on Afroamerican and Hispanic women showed that a healthy vaginal microbiome does not have to consist mainly of Lactobacillus (4). It was also shown, however, that such a non-lactobacillary composition of vaginal microbiome is more susceptible to sexually transmitted diseases and infections; I will only mention one study, but if you want more evidence, do not hesitate to get in touch (5). So you can find different types of viruses, bacteria, and yeast in this magical environment (many microorganisms probably still remain to be discovered), and it does not necessarily indicate a dysbiosis or disease. Future research based on extensive databases could reveal, among other things, more differences between the microbiome of fertile and infertile women, women suffering from frequent vaginal infections and those who don’t, or women who use and don’t use hormonal contraception.

And what do I mean by “monotonous catering”? The bacteria in our womb can feast on the main course of the vaginal menu, which is primarily glycogen (not the only source of nutrients, though), a glucose polymer whose main chef is - hold on to your chef’s hats - oestrogen! It is therefore clear who plays the role of the true “periodic” supervisor of our vaginal party.

Lactobacilli, as well as many other microorganisms, ferment glycogen to lactose and lactate (basically lactic acid) which - together with the epithelial production - creates a specific acidic environment.

Don’t look so sour, where it’s sour, it’s not dour

Really. Acidic pH is beneficial in the context of the vaginal environment as it makes survival more difficult for pathogens that you did not invite to your party, but that would very much like to infiltrate and infect you (3). However, it is also true here that a different composition of bacterial strains leads to different levels of acidity, and that is why African American and Hispanic women have a higher pH than white and Asian women (6).

Two forms of lactic acid are produced during bacterial feasts, and their healthy ratio ensures a stronger immunity of the invited guests (7). Thanks to lactic acid, it is precisely Lactobacillus in the form of probiotics that can protect your party castle from marauders. Since the composition of every vaginal microbiome is unique, however, all we can do is support it, rather than miraculously replace and fix it (such a drastic action would probably have the opposite effect). Lactic acid plays the role of a bouncer at your party - it actively protects you from STDs, such as Chlamydia trachomatis, Trichomonas vaginalis, HIV, herpes simplex virus, or papillomavirus (8), but its other roles remain to be understood. The same as with Lactobacillus, an acidic environment in itself does not guarantee a healthy vaginal microbiome and absence of disease, but it is one of the many indicators that we can take into account and support them.

There is both strength and risk in contact

Not even your private party is a completely isolated world. Guests come and go, their numbers change, as well as their moods, they are affected by the outer world and communicate with it. Most of your worldly activities also influence the fun at the party. As you can certainly imagine, sexual activity has a fundamental effect on your womb (9). I shall describe its action in one of my next articles. Excessive and inconsiderate intimate hygiene is like the irritable gentleman in the apartment above the dancefloor, who does not hesitate to call the police and ruin all the fun. Another long-term saboteur is of course an unhealthy lifestyle based on an unbalanced diet, drinking, or smoking (9, 10). Hormonal contraception is also a huge topic. I feel obliged to write a separate article dedicated entirely to this problem because the consequences of its use can be truly far-reaching and every woman should be aware of it. The overuse of topical vaginal antibiotics, or their use without well-established and proven reasons is an equally problematic (if not even more dangerous) disruptor (11). Other factors that play an important role are your psyche, immunity, hormonal changes and the state of your gut and oral microbiome. In the end, these microbial communities are not far from each other and they share many things (12, 13). 

The list of factors that contribute to your vaginal health and disease is staggeringly long, so I take it upon myself to at least mention all of them. Not because I want to scare you, but to give you a clue - that even apparently unrelated activities and physiological processes can directly or indirectly affect the course of the party downstairs, and so it is a good idea to be conscious of your actions. Just as we are starting to realise many things that relate to the gut microbiome, so should the awareness of the vaginal microbiome increase as well. Nobody wants any unnecessary trouble at a party.

When love and truth prevail and come to light

What do I mean by this “Summer Meditations” headline? Childbirth! This is the reason why the vaginal microbiome should be of interest not only to women, but also to our partners and men in general. Not only does the health of your partner’s womb affect the whole sexual relationship and the man’s health, vaginal microbiome also marks the very begging of our arrival into this world, no matter our gender. In natural birth, the body and mouth of the baby are populated with the mother’s vaginal, dermal, oral, and gut microbiome - the baby receives great equipment for life. Babies delivered by C-section, by contrast, are populated mainly with skin microbiome and their equipment is therefore significantly poorer. This is why something called vaginal seeding is performed in many parts of the world. It is a practice in which a newborn baby is swabbed with its mother’s vaginal fluids (14). Here, too, caution and more studies are advisable. Our feminine intuition tells us that we have been adapted to natural childbirth over the millennia, and so the baby benefits more from the riches of its mum’s vaginal microbiome. I need to emphasise, however, that many caesarean sections are inevitable and have saved countless lives. The question is the context we provide during childbirth - not only microbial contact, but also the relative physical and mental wellbeing of the mother. Everything is alright, as long as we respect life and health.

In my next articles, I will explore the dynamic changes in the vaginal microbiome within the menstrual and life cycles, the possible imbalances and their solutions, and the overall prevention and support of the vaginal environment.

Send some loving attention to the party and read the continuation of this MicroWorld story just as carefully. Read you soon, Sys.

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Bibliography:

(1) Gajer P, Brotman RM, Bai G, et al. Temporal dynamics of the human vaginal microbiota. Sci Transl Med. 2012;4(132):132ra52. doi:10.1126/scitranslmed.3003605 

(2) Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486(7402):207-214. Published 2012 Jun 13. doi:10.1038/nature11234

(3) Vaginal microbiome. V. Buchta. Ústav klinické mikrobiologie FN a LF UK, Hradec Králové, přednostka doc. MUDr. H. Žemličková, Ph. D. Ceska Gynekol. 2018; 83(5): 371-379

(4) Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011;108 Suppl 1(Suppl 1):4680-4687. doi:10.1073/pnas.1002611107

(5) Brotman RM, Bradford LL, Conrad M, et al. Association between Trichomonas vaginalis and vaginal bacterial community composition among reproductive-age women. Sex Transm Dis. 2012;39(10):807-812. doi:10.1097/OLQ.0b013e3182631c79 

(6) Huang B, Fettweis JM, Brooks JP, Jefferson KK, Buck GA. The changing landscape of the vaginal microbiome. Clin Lab Med. 2014;34(4):747-761. doi:10.1016/j.cll.2014.08.006

(7) O'Hanlon DE, Moench TR, Cone RA. Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS One. 2013;8(11):e80074. Published 2013 Nov 6. doi:10.1371/journal.pone.0080074

(8) Aldunate M, Srbinovski D, Hearps AC, et al. Antimicrobial and immune modulatory effects of lactic acid and short chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis. Front Physiol. 2015;6:164. Published 2015 Jun 2. doi:10.3389/fphys.2015.00164

(9) Beigi RH, Wiesenfeld HC, Hillier SL, Straw T, Krohn MA. Factors associated with absence of H2O2-producing Lactobacillus among women with bacterial vaginosis. J Infect Dis. 2005 Mar 15;191(6):924-9. doi: 10.1086/428288. Epub 2005 Feb 8. Erratum in: J Infect Dis. 2005 May 15;191(10):1785. PMID: 15717268

(10) Brotman RM, He X, Gajer P, et al. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infect Dis. 2014;14:471. Published 2014 Aug 28. doi:10.1186/1471-2334-14-471 

(11) Vallor AC, Antonio MA, Hawes SE, Hillier SL. Factors associated with acquisition of, or persistent colonization by, vaginal lactobacilli: role of hydrogen peroxide production. J Infect Dis. 2001 Dec 1;184(11):1431-6. doi: 10.1086/324445. Epub 2001 Oct 30. PMID: 11709785

 (12) Petricevic L, Domig KJ, Nierscher FJ, Krondorfer I, Janitschek C, Kneifel W, Kiss H. Characterisation of the oral, vaginal and rectal Lactobacillus flora in healthy pregnant and postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 2012 Jan;160(1):93-9. doi: 10.1016/j.ejogrb.2011.10.002. Epub 2011 Nov 15. PMID: 22088236

(13) El Aila NA, Tency I, Claeys G, et al. Identification and genotyping of bacteria from paired vaginal and rectal samples from pregnant women indicates similarity between vaginal and rectal microflora. BMC Infect Dis. 2009;9:167. Published 2009 Oct 14. doi:10.1186/1471-2334-9-167

(14) Clemente JC, Dominguez-Bello MG. Safety of vaginal microbial transfer in infants delivered by caesarean, and expected health outcomes. BMJ. 2016 Mar 31;352:i1707. doi: 10.1136/bmj.i1707. PMID: 27033374