Many women write vaginal dryness off as normal or impossible to treat, leaving them to face symptoms in silence.¹ That needs to change. Let’s explore what vaginal dryness is, trace its hormonal and microbial causes, and pick up an integrative gynecologist’s tips for finding lasting relief. 

What Is Vaginal Dryness?

Vaginal dryness occurs when the vaginal tissue becomes thin and dry (often as a result of low circulating estrogen), which can lead to itching, burning, soreness, and in some cases, recurrent vaginal infection.

Vaginal discharge is responsible for keeping the vagina moist, clean, and comfortable. It also contains Lactobacillus, a type of lactic-acid-producing bacteria that’s native to the vaginal microbiome (VMB). These lactobacilli create acidic conditions that are inhospitable to pathogens, so vaginal environments that are dry and low in discharge may be more vulnerable to certain bacterial and yeast infections.² 

There’s also an association between vaginal dryness and painful intercourse (although it’s worth noting that vaginal discharge is not the same as the vaginal lubrication produced during sex, which comes from small ducts called the Bartholin’s glands located on either side of the vaginal opening).³

To diagnose vaginal dryness, practitioners will usually perform a physical exam and test hormonal and/or pH levels. 

Vaginal Dryness vs. Vaginal Atrophy

The terms “vaginal atrophy” and “atrophic vaginitis” are related to (but not exactly synonymous with) vaginal dryness. Vaginal atrophy is a medical condition caused by low estrogen that usually occurs during menopause.⁵ It involves several structural and functional changes in vaginal and urogenital tissue that can be accompanied by dryness but also burning, itching, and incontinence.

This means that it’s possible to have vaginal atrophy without vaginal dryness, and vice versa. 

What Causes Vaginal Dryness?

Let’s explore a few of the most common causes of vaginal dryness, depending on age and menopausal status. 

During Perimenopause and Menopause:

Menopause causes a whopping 95% reduction in estrogen production, helping explain why more than half of postmenopausal women over 51 years old experience vaginal dryness.^2,6

Hormonal changes during menopause can also decrease collagen production and make the vaginal walls shorter and narrower, contributing to painful sex. Due to a reduction in Lactobacillus species, menopausal women also tend to run a higher risk of bacterial infections like bacterial vaginosis and UTIs.⁷ 

Just because these symptoms are common during menopause doesn’t mean that they’re inevitable or untreatable. Vaginal atrophy does not have to be a “normal” side effect of menopause or aging.

Before Menopause:

Although it’s more common during menopause due to natural reductions in estrogen, vaginal dryness can happen at any age. If you’re noticing it in your 20s and 30s, you’re not alone—and you’re not “broken.” 

Roughly 15% of pre-menopausal women experience symptoms of vaginal atrophy (including dryness), and nearly 20% of women over 18 report vaginal dryness during sex.^2,6 

Here are a few factors that can contribute to estrogen loss and dryness before you hit menopause:

• Chronic stress: Chronic stress can set off a cascade of hormonal changes, including reductions in estrogen that may cause dryness.⁸ In addition to psychological stress and anxiety, physical stressors like undereating and overexercising can also suppress estrogen and impact ovulation.^9,10 
• Hormonal birth control: Oral contraceptive pills suppress natural hormone production and have been associated with vaginal dryness in some cases.¹¹
• Childbirth and breastfeeding: Pregnancy and childbirth transform the vaginal environment in many ways—including by spurring a dramatic drop in estrogen by up to 100 to 1000 times following delivery.¹²
• Cigarette smoking: Some smokers experience menopausal symptoms earlier, potentially due to cigarette’s toxic effects on ovarian cells.¹³ 
• Certain medications: Some anti-depressants, antihistamines, and antibiotics may dry out the vagina and/or cause changes in the vaginal microbiome that promote discomfort and infection. Anti-estrogen medications prescribed for PCOS, endometriosis, and uterine fibroids can also contribute to dryness.² This isn’t to say these medications are “bad;” they should just be taken mindfully.
• Ovarian complications: Ovarian insufficiency, ovarian failure, and the surgical removal of one or both ovaries (oophorectomy) can contribute to low estrogen levels and dryness.²
• Menstruation: Pre-menopausal women also may notice the changes in vaginal dryness throughout the month. Estrogen levels peak in the days leading up to ovulation, causing a temporary increase (and subsequent decrease) in vaginal discharge during this period.

How to Ease Vaginal Dryness Symptoms 

Given the connections between the vaginal microbiome, hormonal estrogen, and vaginal dryness, any successful long-term remedies will consider all three. 

Med-Lock spoke with integrative gynecologist Tara Scott, M.D. to learn about the most promising non-hormonal tools for easing vaginal dryness and maintaining a healthy and comfortable vaginal environment.

She notes that the most common treatments for postmenopausal vaginal atrophy are estrogen-based therapies—which use creams, rings, or tablets to restore estrogen levels and alleviate symptoms.¹⁴ Applying the hormone precursor DHEA also shows promise for relieving vaginal atrophy symptoms in menopausal women.¹⁵ However, it’s unclear how these treatments impact the vaginal microbiome in the long term. Try the following hormone-free solutions as a first line of defense, and consult with your doctor if you’re still interested in medication.

1. Use a (microbiome-friendly) moisturizer.

Moisturizers can help relieve mild to moderate vaginal dryness, according to research on postmenopausal women.¹⁶ Choose a moisturizer that closely matches your natural vaginal secretions in terms of thickness, acidity (pH), and ingredients in order to reduce the risk of VMB disruption. Table 1 of this study ranks a few popular brands on their pH and osmolality (concentration) compatibility with the vagina.¹⁷

Dr. Scott usually recommends applying moisturizer daily for 14 straight days to start, then finds that many women can switch to 1-2 times a week. 

2. Avoid douching and harsh cleansers.

Despite what (low-key sexist) women’s hygiene ads might lead you to believe, douching your vagina can do more harm than good.¹⁸ Flooding the vaginal environment with water or harsh cleansers can harm its protective mucus layer and disrupt the VMB, increasing your susceptibility to pain and infection. When it comes to cleaning the vagina, less it more: Just wash the vulva (external area) with water or mild soap.

3. Experiment with ways to make sex more comfortable.

The pain of vaginal dryness causes many women to avoid intercourse entirely (understandably so!). However, research shows that as the frequency of sex decreases, vaginal lubrication only declines further. Sex improves blood circulation to the vagina, and for women who have unprotected sex with men, seminal fluid can also provide sexual steroids, prostaglandins, and essential fatty acids that further support vaginal tissue.^19,20 To make sexual activity more comfortable and enjoyable for you, try using a lube that ticks the following VMB-friendly boxes:⁶

• Free of synthetic fragrances
• Free of chlorhexidine gluconate (Pre-clinical research has found that this antiseptic ingredient harms the vaginal microbiome by reducing the growth of beneficial Lactobacillus species.)²¹
• Moisturizing (Many commercially available lubes are hyperosmotic, meaning they actually drain and dehydrate moisture from cells, potentially causing vaginal tissue to shrink further. Look for one that is moisturizing and designed to promote healthy bacterial balance in the vagina.)²²

You can also play around with getting toys involved—just be sure to clean them regularly to minimize the chance of vaginal disruption.

4. Reduce inflammatory foods.

Dr. Scott notes that diet plays an important role in hormonal health, and what you eat has the potential to impact your vaginal environment as well.²³ She recommends prioritizing anti-inflammatory foods and limiting processed foods, excessive sugar, and alcohol.

5. Eat more phytoestrogens.

Emerging research suggests that eating phytoestrogens (plant foods that contain compounds that act similarly to estrogen in the body) might help reduce vaginal dryness.²⁴ Examples include certain nuts, med-locks, tofu, and other soy products. Some fruits, including apples, pomegranates, and grapes are also sources of phytoestrogens.

A study involving 731 premenopausal women found that those who ate an apple a day reported better sexual function, particularly in terms of overall satisfaction and lubrication, compared to those who did not eat apples.²⁵ 

Studies on the effects of phytoestrogens on sexual health in larger groups are limited, so more comprehensive research is needed. But considering that phytoestrogen foods are also sources of heart- monounsaturated fats, gut-healthy fiber, and antioxidant-rich polyphenols, there’s no harm in trying to eat more of them. (Here’s more on how the state of your gut might impact your sex life.)

The Key Insight

Vaginal dryness has been a silent epidemic for too long.¹ It affects women of all ages and can have real and reverberating impacts on mental and physical health. Acknowledging the condition’s relationship to the vaginal microbiome—and the way it shifts over time—can provide a roadmap to effective treatments that make the vagina feel more like the breath: a strong and steady force you forget is even there.

The post Vaginal Dryness, Demystified appeared first on Med-Lock.

Our microbial worlds are constantly shifting—and nowhere is this more apparent than in the vaginal microbiome (VMB). 

The VMB is the community of billions of bacteria, yeasts, and other microorganisms residing within the vaginal canal.^1,2 These microbes ensure the stability of your vaginal pH, protect you against infections such as bacterial vaginosis, and can even reduce your risk of certain cancers.^3-5 And, just as you grow and change over time, the composition of your VMB naturally shifts—by the year, month, and even the day—in response to hormones and various disruptors. 

These microbial transitions are natural, but sometimes they can bring about unwanted changes or signal medical concerns—which is why body literacy and attention to symptoms are vital. “Typically, these shifts happen and the body is able to get back to homeostasis…It’s when you’re not able to get back to that normal that problems can arise,” explains Michelle Davison, Ph.D., a microbiologist and Senior Scientist at Med-Lock.  

Read on to learn how age, hormones, and daily habits can influence the vaginal microbiome, and how to protect yours through all phases of life. 

Puberty

The vaginal microbiome begins to form during and after birth, as an individual inherits their first microbes from their biological mother through a process called “med-locking.”⁶ From there, this community of microbes develops into a fairly diverse, steady-state community that exists until the first major disruption: puberty.⁷ 

Puberty is an unruly time for a whole host of reasons (all the feelings!), but for people with vaginas, it is the increase in estrogen and progesterone that causes the biggest fluctuations.⁸ These two hormones conspire to re-shape the vaginal microbiome; it goes from containing a few different bacterial species to heavily favoring a single species called Lactobacillus.⁹ 

This happens because the progressive increase in estrogen during puberty triggers an increase in glycogen deposits in epithelial cells, which form the inner lining of the vagina.¹⁰ Since lactobacilli feed on glycogen, puberty is essentially a feeding frenzy for these bacteria, which begin to outcompete other species and change the composition of the VMB to be Lactobacillus dominant.

Lactobacilli (specifically the particular species, Lactobacillus crispatus) help maintain a protective, homeostatic vaginal microbiome by creating a moderately acidic environment that’s inhospitable to various bacterial foes and pathogens.¹¹

However, many everyday disruptors can throw off the composition of lactobacilli in the VMB—one of which is menstruation.

Menstruation

While the composition of the VMB ebbs and flows from puberty to postmenopause, menstruation is a microcosm of this pattern. The makeup of your VMB can shift day-to-day during menstruation, depending on where you are in your cycle.¹² 

During the first week of the menstrual cycle, systemic estrogen levels are low. As estrogen begins to rise before ovulation, it precipitates a thickening of the vaginal epithelium and the production of glycogen. This feeds the lactobacilli needed to produce lactic acid and create a protective vaginal microenvironment.¹³

This means that when estrogen is in low supply during the menstrual cycle, it can disrupt the growth and stability of lactobacilli and make the vagina more prone to infection, sending it into a non-optimal Community State Type (CST).

In addition to these hormonal variations, menstrual blood increases the pH levels of the vagina and is rich in nutrients, including iron, which can serve as a growth factor for some non-optimal bacteria.¹² This can lead to a decrease in lactobacilli and leave the VMB vulnerable to pathogens.¹⁴ However, this change doesn’t last long: vaginal pH immediately begins to decrease to its normal level once menstruation ends, and studies have shown that vaginal microbiota typically return to baseline within about three days.¹⁵

One way you can support your vaginal microbiome during disruptions such as menstruation? Refrain from douching or using synthetic, fragranced cleansers or wipes (this advice applies to every stage of life, actually). Despite what you may have been told, there is nothing “dirty” about menstrual blood, and abrasive cleansing products only further disrupt the VMB.¹⁶ As for what you actually need to “clean” the vagina? “Only water has been shown to not disrupt the VMB,” says Dr. Davison. When it comes to caring for the vaginal microbiome, she says, “Less is more.” 

Pre-conception and Pregnancy

Menstruation signals the onset of an individual’s fertile years, and, once again, the vaginal microbiome is instrumental throughout the fertility and pregnancy journey. 

The type of birth control you choose to use during this time can affect the composition of the VMB. “People who use oral birth control, like the pill, tend to have much more stable microbiomes than people who use other forms of birth control, because the consistent hormones in the pill actually level out fluctuations,” says Dr. Davison.¹⁷ 

Other methods of birth control, such as intrauterine devices (IUDs), have also been shown to modify the VMB. “Copper IUDs are more correlated with infections like bacterial vaginosis,” says Dr. Davison, “whereas hormonal IUDs tend not to have the same effects.”¹⁸ (To note: choosing a method of birth control is an intensely personal decision that should factor in many considerations, not just microbial ones.) 

One of the most fascinating (and fruitful) areas of study when it comes to the vaginal microbiome is its implications for fertility. While this is a fairly new field, studies have shown that a Lactobacillus-dominant vaginal microbiome (specifically, Lactobacillus crispatus-dominant) seems to be associated with a healthy pregnancy and positive birth outcomes including a decreased risk of preterm birth.^19-21

How, exactly, vaginal L. crispatus modulate implantation is still unclear. It could be that VMBs with an abundance of lactobacilli and low overall diversity help decrease inflammation in the reproductive tract and/or create an acidic environment that supports embryo implantation in the uterine cavity.^22,23 Studies have also shown that bacteria from the VMB can impact everything from the composition of cervical mucus to the ability of a fertilized egg to implant in the uterine lining.^24,25 

During pregnancy, the vaginal microbiome undergoes an extraordinary transformation largely influenced by estrogen. This hormone, produced by the ovaries and placenta, surges as the pregnancy advances.²⁶ During the early months, increased estrogen and progesterone gradually shift the vaginal microbiome to become more stable.²⁷ Having a protective vaginal microbiome through pregnancy seems to help fend off infections that may pose risks to both the mother and developing fetus (thanks, anatomy!).²⁸

Postpartum

After delivery, the rapid drop in estrogen (by about 100- to 1000-fold) spurs yet another significant shift in the vaginal microbiome. Approximately six weeks after birth, 40% of postpartum people tend to exhibit a Lactobacillus-depleted vaginal microbiome, dominated instead by species associated with bacterial vaginosis.²⁷ This puts them at greater risk of developing vaginal infections—a risk undoubtedly heightened by the sleep-deprived, high-stress lifestyle of a new parent.¹⁰

While the postpartum experience is one of intense change—physical, emotional, social—it is also a vital time when it comes to protecting future pregnancies and fertility. “Everything is changing, but these changes can all mean something. Talk to your OB about what you notice, and ask them for ideas if something seems off,” advises Dr. Davison.

Perimenopause/Menopause

Like so many aspects of the female experience, menopause has been “something of a black box,” in the medical field, says Dr. Davison. Thankfully, researchers are finally now learning more about the changes the body goes through during perimenopause and beyond, and how the vaginal microbiome can help you navigate them. 

Here’s what we know so far: As we age, the body slowly begins to produce less estrogen. Since estrogen plays a role in the production of glycogen (again, a key fuel source for protective lactobacilli), menopausal women tend to have fewer of these bacteria.²⁹ As a result, the vaginal environment can become less acidic during perimenopause, making it more vulnerable to pathogens and infection-causing bacteria.³⁰ Menopausal women tend to be at higher risk of bacterial infections like BV and urinary tract infections for this reason.²⁹ 

For some people, certain effects of menopause can be mitigated by a topical estrogen product.³¹ These can increase the glycogen lining in the vagina, giving lactobacilli the energy source they need to establish dominance in the VMB and reduce the risk of discomfort and infections. 

Above all, says Dr. Davison, communication with your medical team (and with your community) is vital during this time. “Information about the physical and emotional symptoms of menopause should be discussed, to empower women not only with the knowledge of what to expect but to assist in making the best choices for their experience. Menopause is not abnormal: it is part of the process of living.” 

Embracing the Cycles of Life

Your vaginal microbiome forms the basis of your sexual, urogenital, and reproductive health—and it’s always in flux. Knowing your own normal—and, by association, knowing when something feels “off”—is the best thing you can do for your vagina throughout your life.

As we age, the changes our bodies undergo are natural, inevitable, and pretty darn incredible. And once we can accept them, the true education can begin. 

The post How Your Vaginal Microbiome Shifts Throughout Your Life appeared first on Med-Lock.

Let us explain: Being in a sexual relationship with another person means sharing touches, bodily fluids—and microbes. Every time you pursue pleasure with a partner(s), trillions of microscopic players also get in on the action, from the diverse bacteria strains of the saliva to the protective communities of the skin microbiome.

Caring for these invisible landscapes can help enhance your pleasure and that of your partner, all while supporting the overall health of everyone involved. Read on to explore a few of the friskiest microbial communities across your body and their role in sexual health.

The Oral Microbiome: Every Kiss Begins With Microbes

The oral microbiome (consisting of the gum crevices, tongue, hard palate, soft palate, cheeks, and lips) is the runner-up for the largest and most diverse microbiota in your body—second only to your gut.¹ Your mouth is home to billions of bacteria and fungi, influencing everything from bad breath (mood killer) to heart disease, and more.^1,2 And since there are so many different (and wonderful) ways to use your mouth during sex, it’s no surprise that the oral microbiome plays a major role in sexual health as well.

In one study published last year in Nature, researchers analyzed saliva samples from thousands of people across 20 countries and found that those who lived together shared 10 times more similar oral bacteria strains than those who did not. This effect was even more pronounced among romantic couples, who shared more oral bacteria species than other cohabitants.³ 

So how does bacteria migrate from one mouth to another? Kissing presents a major opportunity: One fascinating older study asked couples (both hetero- and homosexual) to provide saliva samples and answer questions on how often they smooched per day. Besides finding that men in heterosexual couples tended to over-report how much they kissed compared to their female partners (classic), researchers found that those who shared at least nine kisses daily tended to have the most similar oral microbiome makeup.⁴ 

Some bacteria shared between partners seem to only stay in the saliva temporarily, while others stay on the tongue for a long time and find a suitable place to colonize—which really gives new meaning to “swapping spit.”

EXPLORE FURTHER: How Your Relationships Influence Your Microbiome

How to Care for the Oral Microbiome 

All this sharing means that taking care of your own oral microbiome through habits such as maintaining good oral hygiene by brushing and flossing regularly, quitting smoking, and reducing sugar intake can also indirectly pay off for your partner.^5-7 

Other ways to protect this pleasure center? While it’s tempting to do a quick swish before a makeout session, antibacterial mouthwash is actually detrimental to the oral microbiome. A 2020 study showed that healthy people who used chlorhexidine (an antiseptic) mouthwash experienced a shift in their salivary microbiomes, so stick with products that are free of harsh disinfectants when you can.⁸ 

The Skin Microbiome: I Wanna Hold Your Hand 

The skin is the largest organ in the body, acting as a physical barrier to the outside world.⁹ It provides plenty of surface area for microbial communities to set up shop and protect against pathogens, assist with wound healing, and even help direct the immune system.¹⁰ 

Just as each area of your body plays a different role during sex, each individual microbial community on your skin has a slightly different purpose and function.

Take the breast microbiome—which is teeming with relatively rare bacteria not often found on other body parts.¹¹ This microbiome likely supports breast health by stimulating resident immune cells.¹² Areolar skin also has its own distinct bacterial community, which contributes to developing the infant microbiome and immune system during breastfeeding.¹³

And, as you use your fingers in all sorts of ways during sexual activity, know that you’re also engaging a completely different (and ever-shifting) ecosystem: The microbiome of the hands is constantly changing every time you pick up and spread microorganisms through contact with people, objects, and your surroundings.¹⁴ 

When the skin is engaged through intimate physical touch, a cascade of the feel-good oxytocin hormone soon follows, making the skin microbiome a living shield and arousal center.

How to Care for the Skin Microbiome 

Our fingertips and faces tend to be the most receptive to physical touch, but everyone will have their own pleasure centers on the skin.¹⁵ Traversing new areas to touch, kiss, and caress can be a steamy way to get to know your partner (and their microbial zones) during sex. 

Washing up before and after this exploration can help strengthen your personal skin microbiome. However, there’s no need to go overboard, as studies have shown that the use of antibacterial soaps can have potentially negative effects on the skin barrier.¹⁶ If you’re freshening up before sex, stick with good-old soap and water. We recommend washing your hands after sex, too, to avoid spreading genital microbes to other areas of the body. 

The Vaginal Microbiome: A Microbial Miracle

The vaginal microbiome (VMB) is unique, fascinating, and beautiful—much like the vagina itself.

When stable, the VMB is dominated by the bacterial genus Lactobacillus, which produces lactic acid to maintain a moderately acidic environment. But the bacteria, fungi, and other microscopic organisms of the vagina are extremely sensitive to disruptions. Everything from cleansers to menstruation, exercise to antibiotics, can damage these protective bacteria and elevate pH levels, leading to a host of issues, including increased risks of STIs, pelvic infections, and bacterial vaginosis (BV).^17-22

Establishing a strong, resilient vaginal microbiome can help defend against the most prevalent women’s health issues of today. From vaginal microbiome transplants for tackling chronic BV to bacterially informed treatments for cervical cancer, the research in this space has groundbreaking potential.

Sex, obviously, plays a major role in the composition of the vaginal microbiome—and it can act as a disrupter. Women who have sex with men can experience shifts in vaginal composition following penetration (more on this up next!).²³ This is also true for women who have sex with women, as vulva-to-vulva contact can create a natural vaginal microbiome transplant. In this case, studies have shown that if your partner’s microbiome is strong and protective (dominated by lactobacilli, with a low microbial diversity), you are also more likely to have a stable microbiome that is resistant to infections such as BV.²⁴ 

How to Care for the Vaginal Microbiome 

Because the vaginal microbiome is so sensitive to disruption, it’s vital to take additional care when introducing anything new to it—be it a toy, body part, or lubricant. Many commercially available lubes are hyperosmotic, meaning they drain and dehydrate moisture from cells, potentially causing vaginal tissue to shrink or thin and putting you at risk of abrasions.²⁵ Additionally, pre-clinical research has found that lube containing an ingredient called chlorhexidine gluconate potentially harms the vaginal microbiome by reducing the growth of Lactobacillus species.²⁶ Taking the extra time to seek out a microbiome-friendly lube can protect this delicate community and lead to more pleasure in the long run. 

Similarly, caring for sex toys by washing with soap and water between uses and between partners can keep your microbial partners healthy. One study found that sharing sex toys with female partners was associated with a reduced concentration of lactobacilli.²⁷ Penetrating the vagina with fingers and sex toys was also associated with increased colonization of Gardnerella vaginalis (a species of bacteria that can cause BV).

The Penile Microbiome: The Next Frontier in Sexual Health

There are a few elements of the penile microbiome—and they all seem to shift during sex. The makeup of the mucosa (skin) of the penis is influenced by sexual partners, as well as neighboring microbial niches (think: the skin, gut, and even urine).²⁸ Sperm and the male urethra—the canal that runs through the penis and carries urine and sperm—also have microbiomes that can be reshaped by vaginal sex.^29,30 

Researchers are just beginning to look at what these ever-shifting landscapes mean for our health, but they seem to play a role in reproduction and fertility. Penile microbiomes can harbor biofilms containing pathogenic bacteria like Gardnerella, which can be passed on to partners during unprotected sex.³¹ Men with seminal (sperm) microbiomes high in the bacteria Lactobacillus gasseri also seem to be more likely to have fertility challenges, leading researchers to propose that a “microbiological homeostasis” could be the ticket to establishing pregnancy.³²

Overall, though, research on this microbial world is quite new, and plenty of questions—such as how the penis microbiome might have protective effects on vaginal health, how it changes during sex with male partners, and how it responds to lubrication—remain, just waiting to be answered under the sheets. 

How to Care for the Penile Microbiome

Again, there isn’t much established research on the penile microbiome or its role in a healthy sex life. But it stands to reason that as with the vaginal microbiome, avoiding harsh antibiotic cleaners before and after sex (and really, always) is a good move in this region. Using condoms with new partners can also help shield from any potentially disruptive bacterial back-and-forth. 

The Gut Microbiome: An Unexpected Third Wheel

The most well-known (and well-studied) microbiome in and out of the bedroom, your gut microbiome is home to trillions of bacteria. You may know it for its role in strengthening your gut barrier, maintaining an acidic environment to dissuade pathogens, helping break down food, and stimulating digestion—but it also influences romance and intimacy.³³ 

Gut microbes help to get you “in the mood” by regulating emotions and behaviors along the gut-brain axis—the neural pathway by which your gut microbes communicate with your nervous system. 

New research suggests that the gut microbiome might also influence the vaginal and penile microbiomes. 

While the vagina is (obviously) not a part of the gastrointestinal tract, the proximity of the vaginal opening to the rectum makes some crossover inevitable: Microbes in the vagina can make their way to the gut, and vice versa, along the essential superhighway known as the gut-vagina axis. 

The gut-vagina axis also seems to play a role in regulating estrogen, a hormone that relates to sexual desire.³⁴ There’s a subset of microbes residing in your gut, known as the estrobolome, that can impact the amount of estrogen circulating in the body. Your estrogen levels affect the overall health, thickness, and mucus production of the vaginal lining, creating natural lubrication—which we all know can meaningfully impact sexual pleasure.³⁵ Estrogen generally correlates to an increase in sex drive, whereas too little (or, conversely, too much) can lead to low sexual desire, depression, and anxiety.³⁵ 

There is also mounting evidence for a gut-testis axis that influences sperm health and sexual function.³⁶ When in a strong, protective state, the gut microbiome maintains a symbiotic, mutually beneficial relationship with the testes. Disruption of the gut microbiome, however, can cause inflammation throughout the body—including in the testes. As such, studies have shown that gut dysbiosis is linked to lower sperm quality and quantity.³⁷ 

How to Care for the Gut Microbiome 

Thankfully, your gut microbiome benefits from all the same things you do—in other words, the healthy habits that support your whole body also support your microbial (and sexual) partners. From eating a high-fiber, mostly plant-based diet to reducing stress, getting good quality sleep to developing a healthy, pleasure-based relationship to your sexuality, there are simple, actionable ways to support your gut on the daily.^38,39 

A Happy Ending

Sex can be complicated, but it can (and should!) also be fun, liberating, experimental, and joyful. Thinking about how to involve and care for all parts of your body, including your microbes, is just another way to engage your senses, enrich your experience, and make sure everyone (yes, even your bacteria) has a happy ending.

The post Meet the Microbial Players in the Bedroom appeared first on Med-Lock.

VS-01

Born from 15+ years of leading vaginal microbiome research from the lab of renowned microbiome scientist Dr. Jacques Ravel, VS-01 is the first vaginal suppository formulated with three proprietary Lactobacillus crispatus strains clinically validated to restore a healthy vaginal microbiome, sustain regulated vaginal pH, and be safe for long-term use.

Whenever science moves forward, questions inevitably follow—and we have answers. 

We tapped our SciCare community to shed light on the five most common VS-01 questions coming in from the Med-Lock-verse. 

* SciCare is our team of experts, here for your science, health, and product-related questions. Have a question of your own? Email scicare@med-lock.com.

How does VS-01 work?

At the most basic level, VS-01 tablets work by delivering live probiotic strains (and the nutrients and molecules they need to thrive) to your vagina.

Now, let’s break that down a bit. The vaginal microbiome (VMB) is the dynamic, evolving ecosystem of bacteria, fungi, yeasts, and more that lives in your vagina and acts as the foundation of gynecological, urogenital, and reproductive health.^1,2 

However, day-to-day life (think: menstruation, sexual activity, and certain medications and cleansers) can disrupt the VMB, leaving it susceptible to imbalances and unwanted issues.² 

Scientific discoveries over the past two decades have demonstrated that the most stable, resilient vaginal environments are dominated by a single “super defender” bacterial species: Lactobacillus crispatus.³ Select L. crispatus strains produce lactic acid to maintain a moderately acidic pH and are protective against specific foes, allowing beneficial microbes to thrive.⁴

While most available solutions for gynecological issues target only symptoms (and can pave the way for further disturbances), VS-01 addresses them at their source.

VS-01 is formulated with three proprietary strains of L. crispatus identified from over 600 candidates for their genetic superiority and strong association with vaginal microbiome stability and resilience.

VS-01 begins with a one-month “Reset” of six vaginal synbiotic tablets to rapidly establish an optimal vaginal microbiome. The protocol continues with “Sustain”—a two-tablet ongoing monthly protocol to maintain a stable vaginal microbiome and regulate pH. 

VS-01 Evidence-Based Benefits at a Glance: 

• Rapidly restores a healthy/optimal vaginal microbiome
• Restores the healthy balance of vaginal microflora
• Protects against pH disruptions
• Maintains optimal/regulated vaginal pH
• Maintains a resilient vaginal microbiome
• Is safe, tolerable, and non-disruptive

Do I take VS-01 orally?

VS-01 tablets have been intentionally designed as a vaginal suppository, not an oral capsule or pill. That’s because there is no direct route for oral probiotics to positively impact or modify the vaginal microbiome. (In other words—and this is Anatomy 101—there is no way for anything you ingest by mouth to make it through your body to your vagina.)

We tested multiple candidate formulations to discern the most effective delivery method and the results are pretty clear: In our randomized, double-blind, placebo-controlled clinical trial, VS-01’s SMART Tablet rapidly converted 90% of participants to an optimal vaginal microbiome in 21 days compared to both a leading oral probiotic for vaginal health and placebo.⁵

If you’ve never used a vaginal suppository before, the process is straightforward. Simply place a VS-01 tablet securely into the applicator provided, insert it into your vagina as far as comfortably possible, and push the inner tube towards you to release, just like you would a tampon.

Can I have sex while using VS-01?

The quick and dirty: Yes, you can be sexually active while using VS-01. 

That said, we do recommend abstaining from sexual intercourse for 12 hours after inserting a VS-01 tablet; this will allow the tablet enough time to dissolve completely.

A toxicology review demonstrated no health concerns for oral consumption of VS-01 ingredients; so, that’s a green light on receiving oral sex following insertion.

Can I expect any side effects or discharge after taking VS-01?

All bodies (and vaginas!) are different, so your experience taking VS-01 will be singular to you. That said, it can take up to 24 hours for the VS-01 tablet to fully dissolve, so you may experience some increased discharge within this window.

Additionally, when first starting VS-01, you might experience a temporary acclimation period that can include mild to moderate vaginal irritation, pelvic cramps, and abdominal discomfort—all of which will vary depending on the individual and should resolve quickly.

In our clinical trial, the highest occurrence of side effects happened in about 2.5% of participants.⁵ However, these adverse events were consistent with those reported in the placebo group.

As always, if you do have any concerns, we suggest talking with a physician who is knowledgeable about your complete health history.

Can I take VS-01 and DS-01^® together?

Yes! It’s perfectly safe to take DS-01^® Daily Synbiotic for gut immune function and whole-body health while using VS-01 Vaginal Synbiotic for an optimal vaginal microbiome.

You don’t need to worry about any functional redundancy (overlaps) when taking these two together. These products were formulated for distinct and unique benefits, so the right one(s) for you depends on your body and your needs.

We receive and answer questions like these every day. Stay tuned for more SciCare roundups on Cultured. If you have any questions of your own, email us at scicare@med-lock.com.

The post Your Top Questions About VS-01™, Answered appeared first on Med-Lock.

An hour later, she drops off a tube with the morning’s swab, along with six others, identical but for their labels, at the University of Maryland’s medical school. Her work for the week is done—but the tubes she passed off are just beginning their journey.

Next, they will be frozen at a temperature of -80°C, plunging their bacteria into a state of suspended animation: cryostasis, like the kind entered by science-fiction astronauts. And just like sci-fi space voyagers, the organisms frozen inside these tubes will eventually go on to expand our understanding of the world.

They’ll join thousands of others—each indexed and neatly nestled in boxes in a laboratory freezer—to have their data analyzed by metagenomic sequencing. The results of this sequencing will then help bring stability and order to ecosystems that have gone awry. It’s all made possible largely by the work of one enterprising scientist named Jacques Ravel, Ph.D. 

This is the story of how we partnered with Dr. Ravel to bring microbial science out of the lab and into the real world with a first-of-its-kind innovation for restoring and repopulating the vaginal microbiome.

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The Beautiful Simplicity of the Vaginal Microbiome 

To appreciate Dr. Ravel’s feat, you’ll first need to understand how microbiomes work, and what makes the vaginal microbiome (VMB) so extraordinary.

Every part of the human body, from your gut to your skin, to the hair follicles of your armpit, is home to an ecosystem of bacteria: a unique microbiome adapted to its ecological niche. Of these, the gut is the most complex. It’s like a rainforest—chaotically rich, thick with life of every kind, bound in dizzyingly complex webs of interaction. At the other end of the spectrum, there’s the vaginal microbiome, which is less like a jungle and more like a row of pines.

In the claustrophobic density of a rainforest, plants grow on top of other plants. But walk through a pine forest, and you’ll notice a conspicuous, almost eerie absence of other kinds of trees. 

These forests owe their peculiar uniformity to their trees’ ability to produce chemical compounds that are toxic to most other plants. A steady-state vaginal microbiome works much the same way. It’s dominated by certain species of Lactobacillus that outcompete competitors using lactic acid, which helps keep the environment’s pH too low for most other microbes.¹ 

Researchers first learned of the existence of lactobacilli in the vaginal microbiome back in 1892, thanks to the work of a German gynecologist named Albert Döderlein.² Much more recently, we learned that specific Lactobacillus strains in the vaginal tract, such as Lactobacillus crispatus, also carry an arsenal of sophisticated defenses against specific foes.³

Without this microbial legion, VMBs are vulnerable to imbalances and unwanted issues. Nine out of 10 women now have an unstable vaginal microbiome due to everyday agitators such as certain prescriptions, “feminine washes,” lubricants, contraception, and sex (just to name a few vaginal microbiome disruptors—the list goes on).⁴ As a result, millions suffer from discomforts and have to choose between short-term solutions—which can wipe out protective bacteria and leave the vagina more susceptible to future pH imbalances—or remedies of dubious efficacy, like drinking cranberry juice or soaking tampons in yogurt.^5,6

Dr. Ravel knew that repopulating vaginal ecosystems that had fallen prey to invaders would require zooming out and examining the structure of the vaginal microbiome as a whole.

Towards a More Nuanced Understanding of the VMB

Dr. Ravel didn’t set out to become one of the world’s foremost experts on vaginal ecology; he spent his early career tracing the source of the bacteria used in the 2001 anthrax terrorism plot and inventing computational tools to “mine” bacterial genomes for new medicines. He was also working at the Institute for Genome Research when they sequenced the first gut metagenome. It was, in effect, a million-dollar project to understand a single piece of poop. 

“We didn’t get much insight from that,” Dr. Ravel says. “There was all this data, all these genes that nobody had ever seen before, and no annotation.”

Annotation, in the context of genomics, refers to the collective knowledge of what a gene does—what kind of protein or enzyme a given string of nucleotides will create when transcribed by a cell. In some senses, the diversity of the gut microbiome was an immense discovery—a library-at-Alexandria’s worth of information, but written in an alien language that could only be translated through painstaking experimental work, one word at a time. It would be years or even decades, Dr. Ravel realized, before the mess of data could be decoded and applied for good. The question became: How could he leverage his microbial knowledge to improve people’s lives today? 

Dr. Ravel found his answer when he met another scientist, Larry Forney, PhD, who had been applying the burgeoning science of genomics to understand the differences among the various lactobacilli that dominate the vaginal ecosystem.

Seen through a microscope, the Lactobacillus species found in a vagina might look no different from one that helps turn milk into yogurt, and even the complex chemical tests that microbiologists have long used to define bacterial species can rarely tell the difference.⁷ Until the early 2000s, with the advent of cheap gene-sequencing methods, there was no way to know what we know now: that Lactobacillus is a genus as diverse as the genus Canis, which includes not only every breed of dog, but also wolves, dingoes, and coyotes. 

It is composed of hundreds of sub-species and strains, each playing a unique role in vaginal health and dysbiosis.⁸ To understand just how different certain strains within the same microbial family can be, consider Escherichia coli: a species with hundreds of strains, many of which live in our intestines and are considered healthy—but at least 200 of which are pathogenic, causing foodborne illness and diarrhea.

Using then-newfangled gene-sequencing methods, Dr. Ravel and Dr. Forney endeavored to map the microbial forest of the vagina, so to speak, and gain new insights into vaginal health in the process. In 2006, they received the first-ever NIH grant dedicated to the study of the vaginal microbiome. In the decades that followed, they became familiar with billions of microorganisms that call the vagina home—thanks to the help of hundreds of women who volunteered to self-sample in the name of scientific discovery.

Identifying the 5 Types of Vaginal Microbiomes 

Through a massive feat of science at scale, Dr. Ravel and his team created a detailed map of the vaginal microbiome using samples from 396 reproductive-age women, like the Baltimore resident we met earlier.⁹ 

The team asked participants to swab their vaginas at home and store those swabs in their freezers until they could be dropped off at the lab. It might seem like an obvious move, but the same protocol once cost Dr. Ravel a research grant. “We once had a proposal to the Human Microbiome Project turned down because there was a reviewer—a clinician—who believed that women couldn’t sample themselves, even though there was already published literature at the time showing that physician-collected samples are equivalent to donor-collected ones,” he shares. It’s a demonstrative anecdote: a reminder of how subtle internalized biases—masquerading as technical or procedural concerns—have stalled progress in the women’s health space for decades.

After analyzing thousands of samples from diligent citizen scientists, Dr. Ravel was able to identify five subgroups, or “community state types” (CSTs), of the vaginal microbiome:

• CST I: Lactobacillus crispatus dominant
• CST II: Lactobacillus gasseri dominant
• CST V: Lactobacillus jensenii dominant
• CST III: Lactobacillus iners dominant
• CST IV: Non Lactobacillus dominated 

Four of these CSTs are dominated by a single Lactobacillus species (CST I, II, III, and V), while the fifth (referred to, somewhat confusingly, as CST IV) is a catchall category for any microbiome where the less friendly denizens of the vagina—which typically play only a marginal role—have supplanted the usual predominant Lactobacillus species. When that happens, the lactobacilli can no longer exert their protective effect, putting their host at risk of vaginal microbiome imbalance.¹⁰

One of Dr. Ravel’s foundational discoveries was that some CSTs appear to be more stable than others. For example, about 20-40% of vaginal microbiome samples fall into the category CST III, which is characterized by a bacterium called Lactobacillus (L.) iners.¹¹ CST III is considered healthy, but it’s significantly more prone to disruption than most of the other types, and can more readily transition to CST IV under the influence of things like sex, hormonal fluctuations, or certain prescriptions.¹² 

In CST I, on the other hand, the dominant bacterial species is L. crispatus, which appears to confer the most resilience against disruptions out of any of the four common species.¹⁰ 

Hormone levels seem to fluctuate throughout the menstrual cycle, impacting the secretions of the cells that line the vagina—and influencing the community’s architecture in turn.¹³ At menstruation, the ecosystem is inundated with blood and sloughed uterine lining, which can provide nutrients that can feed unwanted bacteria. As a result, a vagina that is Lactobacillus-dominated in one part of the cycle may transition to CST IV in the weeks during and after a person’s period, gradually reverting as the cycle progresses.¹⁴ Lifestyle factors also impact the vaginal microbiome: Take up smoking, for example, and you’re multiple times more likely to find yourself in the upwards of ~37-42% of women categorized as CST IV.^15-17

Translating Vaginal Microbiome Science Into a First-Of-Its-Kind Probiotic

Dr. Ravel’s work helped demonstrate that the vagina is a dynamic environment, and CSTs are far from a fixed feature. This foundational insight meant that it would be possible to restore L. crispatus dominance in vaginal microbiomes that had been ambushed by unwanted bacteria and fungi.

Doing so, however, would require isolating the exact strains of L. crispatus that had the most protective influence—a feat of strain-level science that was unprecedented in the probiotic industry. 

To bring back the dog analogy, two strains of L. crispatus can be as biologically distinct as a greyhound and a dachshund—both part of the species Canis familiaris. And up until this point, very few “vaginal health”-branded probiotics contained strains that had actually been tested and proven on the vaginal microbiome. 

“People have tried putting multiple different species of Lactobacillus in a single product, even though that doesn’t represent what happens in vivo (in the human body). People have tried different species that aren’t even human vaginal species,” Dr. Ravel says. The majority of these probiotics were also administered by mouth, despite the lack of any plausible mechanism for them to reach the vaginal tract. 

In 2016, we partnered with Dr. Ravel to found LUCA, a metagenomics platform and gene catalog that would leverage Med-Lock’s end-to-end product platform to fully realize the potential of his research. The first innovation: a clinically validated probiotic that would restore an optimal vaginal microbiome.

In order to find the ideal strains of  L. crispatus, our team—helmed by Dirk Gevers, Ph.D., Med-Lock’s Chief Scientific Officer—analyzed more than 10,000 samples, including daily vaginal swabs from hundreds of women over a period of 10 weeks. 

Once a consortium of L. crispatus strains was identified, it was time for months of preclinical validation that culminated in a double-blind, randomized, placebo-controlled clinical trial that pitted a handful of possible designs against one another and included one of the leading vaginal health probiotics currently on the market as a benchmark.

The clear winner: a pressed tablet, designed to be inserted directly into the vagina, containing LUCA’s three strains of L. crispatus along with a proprietary Lactobacillus-specific nutrient complex. It was 10 times more effective at increasing the abundance of beneficial bacteria than the leading oral probiotic for vaginal health, resulting in an optimal vaginal microbiome in 90% of participants who started with a low baseline of L. crispatus.

Introducing VS-01: a vaginal synbiotic rooted in enterprising science and supported by clinical trials involving hundreds of citizen scientists. We’ve used 15+ years of metagenomic research and cutting-edge microbiome technology to unlock the exponential impact that is possible when science is inclusive of a woman’s point of view—and we’re just getting started. VS-01 is just the beginning of a vaginal health movement—one that will take us from harsh, reactive treatments towards proactive, sustainable care.  

The post Our Journey to Developing VS-01™: The First-of-Its-Kind Vaginal Probiotic appeared first on Med-Lock.

From a young age, many of us are taught that vaginas should be demure. They shouldn’t smell, they shouldn’t itch, and they most certainly shouldn’t produce fluid. It’s easy to see then why bacterial vaginosis (BV)—an imbalance of the vaginal microbiome (VMB) that can lead to a fishy odor and abnormal discharge—has become so stigmatized. 

With 21 million women in the U.S. currently harboring BV (whether they know it or not), a shame-free guide is long overdue.¹ So, what exactly is BV? What causes it? And how can you treat it so it doesn’t come back? Let’s dig in. 

What is Bacterial Vaginosis and How Do I Know If I Have It?

Bacterial vaginosis is a lot like a high school house party (stick with me here). When adults are present, the festivities can stay relatively calm and uneventful. But the second the parents leave, kids let loose and invite their friends, who invite more friends, and before you know it things can get…messy. 

Similarly, without protective bacteria supervising the vaginal microbiome, pathogens can come to the party and unleash all kinds of chaos.

In this analogy, Lactobacillus species are the parents: these bacteria are responsible for producing lactic acid (which establishes a moderately acidic pH in the vagina) and bacteriocins (which inhibit the growth of certain bacterial strains).² Without dominant Lactobacillus species, the VMB becomes more susceptible to the spread of unwanted house guests.³ 

While researchers used to think that one bacterial species, Gardnerella vaginalis, caused BV, we know there are multiple BV-associated pathogens, including species of Prevotella, Mobiluncus, and more.⁴ Many of these bacteria naturally live in the vagina—it’s only when they grow in excess that they can cause imbalances (also known as “dysbiosis”).

“Ultimately, BV is not caused by the mere presence of the potential pathogens (which is common) but rather by their unrestrained increase in number, often reaching cell counts that are 100 – 1000 fold above the normal bacterial levels of the vagina,” explains one article in The Journal of Applied Microbiology.⁵

Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in women of childbearing age and affects nearly one-third of reproductive-aged women at any given time—though at least half of them will be asymptomatic.^6-8

Those who do present with symptoms tend to have an increase in vaginal discharge that is white or gray, watery, or otherwise abnormal for them. This discharge often has a foul or fishy odor, and is especially prominent after sexual intercourse.⁹ In some cases, those with BV might also experience itchiness around the vulva.⁸

If you notice any of these symptoms, it’s best not to self-diagnose, since other conditions like yeast infections and STIs can present similarly. Your doctor can make the official diagnosis after analyzing your discharge and measuring your vaginal pH to see if it falls outside the standard range (anything above ~4.5 can be indicative of BV).^7,9 

It’s best to flag symptoms quickly, as BV can be a risk factor for other vaginal issues. After being diagnosed with bacterial vaginosis, women have an increased risk of acquiring STIs like chlamydia and gonorrhea.⁹ BV pathogens have been linked to pregnancy complications, including a higher risk of preterm birth, and lower birthweight in some studies.^9,10 There is also some evidence that BV-associated organisms are associated with pelvic inflammatory disease, which can cause damage to the reproductive tract and infertility.^7,11

But again, BV is an extremely common condition that doesn’t usually cause serious complications—you just want to get it under control early if you can.¹²

Potential Causes and Contributors to BV

Despite BV’s prevalence, we’re still not sure exactly what leads to the bacterial imbalance. It’s likely that it doesn’t have one specific cause but can be set off by a confluence of factors, including: 

• Soap and douching: Washing out your vagina with soap has been shown to reduce the amount of lactobacilli in the VMB, potentially increasing one’s risk of BV. The vagina is self-cleaning and any attempt to manually wash it or flush it out with water (douching) disrupts healthy vaginal microbes, setting the scene for opportunistic, BV-causing pathogens. Sexual hygiene also seems to play a role in BV development—we’ll dig deeper into that below.^9,12,13
• IUDs: Using a copper IUD may slightly increase your risk of BV compared to other forms of birth control, according to some studies.^14,15 Researchers suspect this could be due to the fact that copper IUDs can increase bleeding.¹⁶ Since menstrual blood has a slightly higher pH than the vagina, it could temporarily lead to microbial disruption. A study published last year also found that copper ions hinder the growth of Lactobacillus crispatus (a highly protective type of Lactobacillus) in vitro and promote the growth of Lactobacillus iners (which are more volatile), as well as elevate concentrations of cytokines that signal vaginal mucosal inflammation, setting the scene for pathogen overgrowth.¹⁵
• Cigarette smoking: Some research has linked smoking cigarettes to a decrease in protective bacteria and a higher risk of BV—potentially because of BPDE, a chemical in cigarette smoke that might deplete lactobacilli concentrations.^17,18

It’s important to acknowledge that the composition of the vaginal microbiome naturally ebbs and flows, leaving us more prone to dysbiosis during certain periods of menstruation and menopause.^19,20 Ethnicity also seems to play a role in VMB profile.²¹ All of this to say, if you’re diagnosed with BV, know that it’s common, treatable, and not at all “your fault.”

The Complicated Role of Sex in BV

BV is not a sexually transmitted infection (say it louder for people in the back!). STIs happen when foreign bacteria get introduced into the vagina, whereas BV is an overgrowth of native vaginal bacteria. It can occur even if you have never had vaginal sex, or haven’t had it recently.²² 

Instead, BV has been called a “sexually enhanced” infection, since sex can create the right microbial conditions for BV to develop.²³ Having frequent unprotected sex or sex with multiple partners is often cited as a risk factor for BV infection, thanks to the way sex alters the natural balance of bacterial flora within the vagina.^9,23 There is also some research to show that having anal sex before vaginal intercourse might be associated with BV risk.²⁴

However, if you’re worried about BV, you don’t need to swear off sex altogether. Using condoms and staying on top of sexual hygiene (think: cleaning your hands and toys prior to the fun) can go a long way in reducing your risk of infection following intercourse.²⁵

BV Treatment and Prevention

If you go to the doctor with BV, chances are you’ll be prescribed an antibiotic (likely clindamycin or metronidazole) to be taken orally or vaginally. While medications are effective at clearing the initial infection, they don’t do much to restore balance in the VMB long-term—one reason why recurrent infections are quite common.⁷ An estimated 50% of women who take antibiotics for BV experience a recurring infection within three to six months (!).²⁶

Sometimes, BV pathogens can also develop what’s known as a biofilm—in essence, a shield that protects them from the body’s defense mechanisms. This could be another reason why BV can be so difficult to get rid of for good.^7,27 

Researchers are now looking into how repopulating the VMB with Lactobacillus species can address the root cause of BV infection (and prevent it from returning in the future).^28,29

Some strategies that can up your lactobacilli count include avoiding disruptors of beneficial bacteria (think: unnecessary antibiotics, cigarette smoke, douching, and soaps) and practicing good sexual hygiene. Some early research also suggests that diets that are high in fat and low in vitamins A, C, D, E, β-carotene, folate, and calcium may increase the risk of BV.^30,31 Taking a well-formulated probiotic vaginally, on the other hand, can help colonize the VMB with beneficial bacteria like L. crispatus. 

Whatever you do, don’t take treatment into your own hands. There is no evidence to show that DIY remedies like yogurt-soaked tampons help cure BV—and they might make things worse. Consult your doctor to find a solution that works for you.

Imagining a World Without BV

BV is a common vaginal imbalance that brings way too many people way too much shame. Emerging research on the vaginal microbiome reveals the intricate microbial networks that cause this fickle infection—and gives us clues about how to kick it for good.

The post Bacterial Vaginosis: Getting to the Root of the Fickle Infection appeared first on Med-Lock.

We want to put some of the power back into your hands—and that’s why we’re taking a minute to demystify the vaginal microbiome’s role in pregnancy. Here’s how the microscopic world in your vagina helps lay the foundation for new life.

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The Role of the Vaginal Microbiome During Pregnancy

Your vagina is home to roughly 10 billion microorganisms—from bacteria to archaea and fungi.^1,2 This may sound alarming at first, but it’s actually pretty amazing. When functioning as it should, this vast, microscopic landscape helps shield you from infection, keep your vagina comfortable, and more.³ 

Within the past decade, scientists have taken a closer look at this vaginal microbiome (VMB) and how it changes over time. It turns out that the makeup of your VMB can shift depending on where you are in your cycle, what medications you’re taking, and even how often you’re having sex.^4-6 Needless to say, the VMB seems to change throughout pregnancy and postpartum too.⁷

We’ve already done a deep, deep dive into how the VMB impacts fertility but to quickly recap: bacteria from the vaginal microbiome may impact the composition of the cervix—a gatekeeping barrier between the vagina and the uterus that is protected by a thick mucus lining.⁸ Changes in cervical mucus consistency and quality can impact sperm motility and their ability to reach and fertilize an egg.⁹

Once a sperm passes through the cervix and fertilizes an egg, it must be implanted into the uterine lining. The vaginal microbiome may lend a proverbial hand in this process too. A disrupted VMB may be associated with worse in vitro fertilization (IVF) outcomes and conditions caused by vaginal microbiome disruption (such as bacterial vaginosis) have been tied to increased rates of implantation failure and pregnancy complications.^10,11

As pregnancy progresses, increasing levels of estrogen and progesterone can facilitate a shift towards a more stable VMB that’s dominated by Lactobacillus—a bacterial genus that produces lactic acid and protects against infection.^7,12 Having a protective vaginal microbiome through pregnancy seems to help fend off infections that may pose risks to both the mother and developing fetus.^7,13 Plus, research suggests that protective Lactobacillus species like Lactobacillus crispatus may be associated with a decreased risk of preterm birth.^3,14

While these are fascinating early findings, researchers are still trying to untangle the exact role the VMB plays during different stages of pregnancy.

OK, So What Does This Mean for Me?

If there’s a possibility you may want to try to become pregnant one day, tending to your vaginal microbiome can only help—and you can get started right away. 

That’s because harboring bacterial species like L. crispatus will be beneficial regardless of your pregnancy status.^3,15 Research shows that having a vaginal microbiome that is dominated by this species can be protective against BV, certain STIs, and even gynecological cancer.^16-18

An optimal VMB will look different for everyone, and you can shape yours by limiting microbial disruptors like sugary, high-fat foods and introducing protective microbial strains into the vagina using a well-formulated vaginal probiotic.^19-21 Be sure to look for one that contains strains that are native to the vagina and have been clinically validated to restore (and maintain) a strong VMB. As always, consult your healthcare provider before starting a new regimen. 

Limiting your exposure to certain pollutants also seems to pay off for your microbes. Some, such as particulate matter in the air, are tough to avoid, while others, like cigarette smoke, fall more squarely within your control.^22,23 Reducing the use of unnecessary antibiotics and practicing microbiome-friendly sex (clean those toys!) can also help shape a strong, resilient vaginal ecosystem.^5,24

The Life-Giving Power of Your Microbial Entourage

A Lactobacillus-dominant vaginal microbiome, especially one with plenty of Lactobacillus crispatus bacteria, has been shown to support key conception and pregnancy outcomes. The more you can do to prepare your microbial entourage early, the better set up your reproductive environment will be—for yourself and any other future residents of your uterus.

The post Planning for a Pregnancy? Why You Should Start With Your Vaginal Microbiome appeared first on Med-Lock.

Chances are, this guidance discounts a key piece of the fertility puzzle: the dynamic microbial world that populates your vagina. We reached out to Ava Mainieri, Ph.D., a geneticist and evolutionary biologist specializing in female reproductive health, to learn about how the vaginal microbiome impacts fertility, and what this means for anyone trying to get pregnant. 

“The first thing I think you should do is take a deep breath, and know that everything is going to be okay,” Dr. Mainieri says. “Women don’t hear that enough in their care.”

So with that: inhale, exhale, and let’s begin.

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Let’s Get Microscopic: How Your Vaginal Ecosystem Impacts Fertility

Your vaginal microbiome (VMB) is a living landscape of billions of microscopic organisms, predominantly bacteria. Ideally, these bacterial communities work synergistically to help keep your vagina comfortable and infection-free.^1,2

Unlike the gut microbiome, which is more diverse, your VMB seems to operate best when it is dominated by one certain microbial genus: Lactobacillus. Dysbiosis, characterized by a decrease in Lactobacillus species and an increase in other types of bacteria in the VMB, may contribute to inflammation and an increased risk of conditions like bacterial vaginosis (BV).³ 

Dr. Mainieri explains that the VMB and lactobacilli also play an essential role during fertility and pregnancy. Once an egg is fertilized, it must be implanted into the uterine lining, and imbalances in the vaginal microbiome such as bacterial vaginosis (BV) have been associated with increased rates of implantation failure.⁴ How, exactly, vaginal lactobacilli modulate implantation is still up for debate. It could be that VMBs with an abundance of lactobacilli and low overall bacterial diversity help decrease inflammation in the reproductive tract and/or create an acidic environment that supports embryo implantation in the uterine cavity.^5,6 

Back in 2005, scientists made the first attempt to go beyond associations and show a direct causal relationship between Lactobacillus species and implantation outcomes. To do so, they gave women undergoing IVF an intravaginal probiotic during embryo transfer. In the end, the probiotic did not have any impact on implantation rates or pregnancy outcomes.⁷ 

However, this research was done before the scientific community knew which specific strains of Lactobacillus most often occurred in the vagina. You see, Lactobacillus is at the top of its bacterial family tree. Underneath it, there are at least 170 species, and within those species, there are countless strains—each with a unique role to play.⁸ We now know that some strains within the Lactobacillus crispatus species, specifically, seem to be associated with a healthy pregnancy and positive birth outcomes.^9-11

A more recent study, published in 2023, found that taking a Lactobacillus probiotic decreased the chance of miscarriage but didn’t have any impact on pregnancy rates among those undergoing IVF. However, this study also used a Lactobacillus strain not commonly dominant in vaginas (Lactobacillus acidophilus)​​.¹² 

This goes to show how important strain-level specificity is to the study of probiotics. It’s still possible that probiotics formulated with naturally occurring vaginal Lactobacillus strains could help decrease miscarriage risk and support implantation (during IVF or natural conception), Dr. Mainieri explains—but we need more granular research to be sure.

The role of the VMB in fertility also seems to expand beyond the uterine lining. The cervix, a muscular barrier between the vagina and the uterus, is protected by a thick mucus lining that facilitates the transfer of sperm to the uterus. The exact relationship between vaginal microbes, cervical mucus, hormones, and fertility is an active area of scientific investigation—but the vaginal microbiome does indeed seem to influence the composition of the cervix.^13,14 This is yet another potential way the VMB may impact fertility. 

Nine Months Later: How the VMB Impacts Birth Outcomes

Recent research from the NIH’s Human Microbiome Project (HMP) found that those who delivered preterm tended to have vaginal microbiomes lower in L. crispatus.¹¹

This is a significant and timely finding, as premature births (before 37 completed weeks of pregnancy) are once again on the rise in the U.S. after years of decline.^15,16 About 1 in 10 babies are now born prematurely in this country every year, putting them at greater risk of certain respiratory, gastrointestinal, and immune diseases.^15,17

So, how might the VMB play a role in reversing this disturbing trend? It could be that vaginal environments dominated by lactobacilli are more protective against sexually transmitted infections (STIs).¹⁸ STIs might increase the risk of preterm birth by triggering an inflammatory response that can lead to cervical remodeling and premature rupture of fetal membranes.^11,19 L. crispatus is also protective against vaginal microbiome disturbances like BV, which has been linked to an increased risk of preterm birth.^11,20

While there appears to be a genetic component to some preterm births, nutrient-poor diets, high stress levels, and some vaginal hygiene products may also be risk factors—potentially to some degree due to their influence on the vaginal microbiome.^2-24

The more we uncover about the function of the VMB, the closer we get to preventing preterm births and improving pregnancy outcomes around the world. However, research on how the vaginal microbiome impacts fertility and childbirth is still very much ongoing, and you should always work with your OB/GYN to formulate your personal care plan.

Med-Locking a Brighter Future

It’s important to protect your vaginal microbiome throughout your life—but especially when you’re pregnant or trying to get pregnant. We still have a lot to learn about what an “optimal” vaginal microbiome looks like (and it definitely varies from person to person), but existing research suggests that VMBs higher in certain strains like L. crispatus tend to be stronger and more resilient.¹⁸

Building a healthy VMB will serve you (and your child) long after birth. A mother’s vaginal microbiota imprints on their child via vaginal birth, skin-to-skin contact, and breastfeeding, helping set newborns up to develop strong microbiota of their own.²⁵ This process, appropriately called “med-locking,” reminds us that vaginal microbes are one of the first—and more valuable—gifts we can give our children.

The post Why Aren’t We Talking About How the Vaginal Microbiome Impacts Fertility? appeared first on Med-Lock.