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The (un)Healthy Vagina: How Lactic Acid Bacteria makes for a Healthy Vagina  

February 29, 2024 . dija

Welcome to the wonderful world of the vagina, where a self-contained environment of bacteria, yeasts, and fungi protects you. Most people know very little about vaginal health, despite its importance in overall health and wellbeing. It is observed that a deficiency of specific types of bacteria in the vagina can increase the risk of bladder infections, bacterial vaginosis, fungal infections, premature births, infertility and sexually transmitted infections (STIs). Currently, scientists worldwide are researching the intricacies of vaginal health and its maintenance. Here, for the next six months, we aim to equip you with comprehensive knowledge about this subject. 

Today in part one: what is vaginal health anyway?  

This is a story with a special starring role for lactic acid bacteria. Until recently, lactic acid bacteria never crossed my mind – and I had no idea that they resided in my vagina, working to keep me healthy and protected. Until I began researching for Yoni, delving into what vaginal health truly means, I developed a newfound appreciation for my vagina. It became apparent to me that within this unique and self-contained environment exist bacteria, fungi, and yeasts, all harmoniously working together to ensure everything functions smoothly.  

I became particularly enamoured with the “Lactobacillus Crispatus”; known as lactic acid bacteria “crispatus” by those familiar with it. Discovered by scientists Brygoo and Aladame in 1953, Crispatus is a minute rod, measuring between 2 to 11 micrometers (where one millimeter encompasses a thousand micrometers). It is among the most recognized and prevalent lactobacilli – lactic acid bacteria that reside in the vagina. If you’re lucky, that is. Indeed, it’s widely accepted that in a healthy vagina, lactic acid bacteria typically dominate.  

To better understand the exact functions of crispatus and other lactic acid bacteria within your vagina, and to comprehend why they are so vital for vaginal health, it is essential to first familiarize yourself with your vaginal microbiome. 

Vaginal micro – what?  

It’s 2024, and you – as an owner of a vagina – know little about the vaginal microbiome and overall vaginal health. It’s not surprising either, given that there is nothing about it in Biology textbooks, and scientific research on the subject has only been going on for 20 years. In any case, the female body has been disadvantaged in medical science for a long time. There are thousands of studies on sperm and only a few on menstrual blood. Even though 90 percent of women experience symptoms of PMS (which can sometimes feel as severe as a heart attack), research on erectile dysfunction has been conducted five times more often.  

So, you probably know that you shouldn’t wash your vagina with soap (although drugstores still sell many special cleansers for your nether regions, and you may be tempted at times). You probably also know that it’s better to use menstrual products without junk in them (you’re on the Yoni website for a reason). Yet, once you’re in front of the menstrual products section, you still choose the private label for financial reasons. You probably also once saw an article that said you should eat more yoghurt to keep your vagina healthy. And you probably also vaguely remember a comment from your grandmother, about not wearing thongs but ‘regular’ cotton underpants. Something to do with bacteria. But you’ve probably never heard about the vaginal microbiome. I don’t blame you. This is what I knew about the health of my vagina: absolutely nothing. 

But now that I’ve delved into it, I can tell you: there’s a beautiful world behind vaginal health. It’s not only interesting, but also very exciting. Because as we speak, scientists worldwide are researching the future possibilities of the health of vaginas – and their owners.  

A Vagina as Acidic as an Orange 

So, that vaginal microbiome. Just like every individual has a microbiome in their intestines, every person with a vagina also has one there. A microbiome is a collection of bacteria, yeasts and fungi, and is entirely unique to each individual. However, there are generally two stable situations: the first one being a favourable state where many lactobacilli (or, lactic acid bacteria) are present. In the other, less favourable state, there is a higher diversity of bacteria, but few lactobacilli. This condition is associated with an increased risk of STIs, inflammation and infections, although you may not necessarily experience complaints of this situation. 

So “healthy” vaginas are dominated by lactic acid bacteria; bacteria that produce lactic acid, ensuring low acidity. Here’s how it works: the vagina wall is made up of epithelium, much like the inside of your mouth. These cells contain glycogen. When numerous lactobacilli (lactic acid bacteria) inhabit the vagina, they convert this glycogen into lactic acid. This acidity acts as a shield, safeguarding your vagina from other harmful bacteria.  

The University of Antwerp’s (amazing) Isala large-scale research project on the vaginal microbiome in 2020, which involved 3,300 participants ranging from ages 18 to 98, discovered that 80 percent of participants had predominantly healthy lactic acid bacteria. In 43 percent of participants, crispatus bacteria were dominant (you can read more about other bacteria they found here). So, chances are, this holds true for you too.  

The fact that the vaginal environment is so rich in lactic acid bacteria is unique. No other animal has such a low level of acidity in comparison to humans. During the period between puberty and menopause, the average pH in vaginal owners is around minus four. This acidity level means that the environment in your vagina is about as acidic as that of an orange.   

Influence on Everything

Just as well because that low acidity, in other words, protects the vagina. We know from research that in the absence of the crispatus bacteria, there is a greater chance of disorders. For example, a deficiency can result in a urinary tract infection, commonly known as a bladder infection. In fact, a substantial portion of antibiotics are prescribed for this condition, which says something about the frequency and prevalence of cystitis among individuals. Also, with fewer crispatus, you’re more likely to have a vaginal yeast infection or bacterial vaginosis – another common condition; in America, 30 percent of women between the ages of 14 and 49 suffer from it regularly. A vaginal microbiome high in crispatus is actually less prone to bladder infections, as well as STIs and Human Immunodeficiency Virus (HIV)

And the list doesn’t stop here. If the vaginal microbiome were a movie, crispatus would play the lead role. Research has also shown that people with significantly more crispatus bacteria are less likely to experience premature birth during pregnancy. If you suffer from bacterial vaginosis during pregnancy, that infection can travel to the uterus and signal labor to begin – being more likely to conceive during fertility treatment. 

Last but not least, crispatus also affects the number of symptoms during and after menopause. In fact, lactic acid bacteria has much to do with hormones – but more about that will be discussed in the next blog. After learning all this, wouldn’t you rather gift your friends with vaginas a bag of crispatus for their birthday?  

Stay Tuned

“Why is such crucial information not more accessible?” I often pondered during this research. Perhaps it’s because the world isn’t built with women in mind, or maybe because science is still in its infancy. Or is it because it’s difficult to draw simple conclusions? 

Because there’s still much we don’t know for sure about the vaginal microbiome, I’ll be discussing what science does know here in the coming months. This includes topics such as how hormones, blood, and stress affect lactic acid bacteria. There is also a revolutionary suspicion that the microbiome could aid in sexual assault lawsuits. Recent research also suggests that not only is the crispatus bacteria crucial for a healthy vagina, but the presence of the bacterium Lactobacillus jensenii and combinations of other bacteria may also enhance resistance. The more main roles lactic acid bacteria play, the better it seems to me.  

So, stay tuned for more next month! 

About Daan Borrel: 

Daan Borrel is a writer and journalist who mainly writes about the female body, sexuality and intimacy. In her book Soms is liefde (2018), she writes about female sexual desire; in Jaar van het nieuwe verhaal (2020) she explores the impact of the menstrual cycle on an individual’s life. She strives for a world where information about (female) health is readily accessible. 

Illustration by Robbyn Gray

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