The microbiome is getting a lot of press these days.
It’s been widely reported, for example, that the bacterial cells in the body outnumber the human cells – and that this sprawling microbial community plays a vital role in everything from proper immune function and mood regulation to healthy weight maintenance. Last year, the Obama administration established the National Microbiome Initiative specifically to study these microorganisms.
Most people visualize the gut as the capital city of this bacterial universe. Indeed, the GI tract teems with microbes. What gets overlooked, however, is that every part of the body that comes into contact with air — including the skin, lungs, and vagina — has a microbiome. To maintain optimal health, all these microbial outposts need a balance of good and bad bacteria.
“What most people don’t realize is that 80 percent of the immune system by cellular volume and IgA antibodies are in the openings of the body — and that includes the vagina,” says Christiane Northrup, MD, author of Women’s Bodies, Women’s Wisdom.
When the vaginal microbiome is imbalanced, the immune response in the reproductive tract decreases — and the likelihood of problems increases, from recurrent yeast infections to excessive discharge to bacterial vaginosis.
So what throws off the balance of bacteria in the vagina? “The biggest culprit is the belief that that area is dirty and smelly,” says Northrup. As many as one in four US women use feminine hygiene deodorants, or vaginal douches, which destroy all the bacteria in the vagina – both good and bad.
“The good bacteria in the vagina contain bacteriocins, which are beneficial toxins that go out and attack dangerous pathogens,” says Northrup. When helpful bacteria are destroyed, the vagina is defenseless against harmful bacteria and more prone to infections.
Ironically, a woman may have chosen to douche to protect against infection in the first place.
Giving up a feminine deodorant product doesn’t mean forgoing good hygiene – far from it. “The vulva sweats more than any other area of the body,” says Northrup. The best remedy? “Take a shower,” continues Northrup. “Guys know this. They just take a shower. Can you imagine a guy spraying a jockstrap with deodorant? I like to compare and contrast [with men] because then you realize how ridiculous it is.”
Even august institutions, like the US Department of Health and Human Services, have concluded that douching is unnecessary at best – and harmful at worst. The American Public Health Association (APHA) points to studies that show that douching is linked to a host of health problems, from bacterial vaginosis and recurrent yeast infections to low-birth weight, preterm birth, HIV transmission, and cervical cancer.
The APHA also notes that “Douching alters the normal vaginal pH and vaginal flora, weakening the vagina’s natural defenses and creating an environment more susceptible to the overgrowth of pathogens.” What’s more, injecting fluid into the vagina can push bad bacteria farther up the reproductive tract, causing additional problems.
“Whenever you bring in an external cleansing agent, it messes up the entire system,” adds Northrup.
Other factors wreak havoc on the balance of bacteria in the vagina. The top four are hormonal birth control, sugar, antibiotics, and stress, says Northrup.
Studies suggest that birth control may influence the immune function in the vagina and affect the risk of acquiring a sexually transmitted disease.
“Everyday you’re putting something in your body that is like nature, but not exactly,” says Northrup of birth control. “So many women who have chronic discharge? It goes away when they go off the pill.”
Eating sugar feeds internal yeast (in the gut and in the vagina), and it’s worth remembering that alcohol turns to sugar in the body, says Northrup. One night of drinking can have a direct effect on the vaginal microbiome. Northrup relayed a story of having recently been in New York City during a big holiday celebration. She remembers thinking that if she practiced medicine in the city, her office would be overflowing the next morning with women suffering from yeast infections and UTIs.
Most of the time, says Northrup, bacterial vaginosis “is not really bacterial vaginosis. It’s just a disordered microbiome, and we make it worse with the treatment [antibiotics].” Like douching, antibiotics kill all the bacteria. They don’t discriminate between good and bad microbes, leaving the body less able to defend against future infections.
Stress increases the turnover of vaginal mucosa, causing discharge. “Women see the discharge and think they have an infection, but they don’t have an infection. It’s just stress,” she continues. “The more she worries about it, however, the more discharge – and the more she thinks she has an infection.” Then she might be prescribed another course of antibiotics and the cycle begins anew.
Women who want to support a balanced vaginal microbiome should avoid any internal cleansing products or douching, eat a low-glycemic diet, limit alcohol, avoid unnecessary antibiotics, and take stress management seriously.
Those who want to actively promote the presence of more good bacteria can insert a tampon dipped in unsweetened yogurt. The live cultures in the yogurt can seed the vagina with healthy new bacteria in just one treatment, says Northrup.
Laine Bergeson is a longtime health journalist and functional nutrition educator and coach with Healthful Elements. She believes lifestyle medicine is a blockbuster drug.