Your Ultimate Guide To Vaginal Probiotics

Summary

  • Probiotics contain beneficial Lactobacillus species, just like the most commonly isolated species from the vaginal niche. By keeping disruptive microbes in check, probiotics can be a great way to keep your vaginal microbiome healthy.
  • Probiotics can have different health benefits, but these characteristics are specific to certain species and strains. So select the best products for your needs. 
  • Look for probiotic products that meet scientific and industry requirements and are clinically tested.
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Probiotics are live microorganisms. When administered in adequate amounts, they benefit health [1]. While often used to support gut health, probiotics can also maintain vaginal health and even address issues like bacterial vaginosis, yeast infections, and GBS infections.

How to select the best vaginal probiotic

Probiotics can be one of the most important interventions for vaginal health. Because the market is overloaded with products, it sometimes isn't easy to find the best probiotic for your needs. 

To help navigate market shelves, our scientists have created a checklist of questions to ask yourself when selecting a product: [2], [3] 

  • Is it backed by science? Look for a product that has been studied in human clinical studies and has been shown to be effective. Sounds like a lot of work? Don’t worry, our research team has compiled an in-depth list of products and gives you personalized recommendations in your Vaginal Health Report.
  • Is it an effective dose? Probiotic concentration is usually measured as colony forming units (CFU), which you’ll find on the label. The best dose is the one that has been tested in clinical trials and proven effective. Most probiotic products have been tested at a concentration between 1-10 billion CFU/day. Keep in mind that more is not always better. Many products are offered as superior only because they contain higher dosage, but this doesn’t always mean that the product is more effective than a product with a lower amount of bacteria. 
  • Is it specific enough for the benefits you are looking for? No two bacterial strains are the same, similar to probiotic bacteria. Even though they may have the same name, each has different properties and benefits. For example, some strains might be beneficial for adult gut function, while others may help to fight vaginal infections. Select a product that has sufficient evidence for the indication you are looking for. 
  • What does the label say? The label has to contain the names of the probiotic microorganisms since no two species are the same. Quality products always include the genus, the species, and the strain name. For example, probiotic strain Lactobacillus rhamnosus GR-1: Lactobacillus is the genus name, rhamnosus is the species name and GR-1 is the strain name. Make sure that the product you buy mentions all of them [4].

In addition to the names of the probiotics in the product, look for a label that also: 

  • Clearly states the exact CFU per dose till the expiration date
  • Describes the recommended use and for which indication you can expect to see a beneficial effects
  • Points towards the recommended dose
  • Describes the storage conditions
  • Has company contact information where you can get more information about the product

Do I need to buy products with more than one strain? Are they more effective?

It’s not necessary to buy products with more than one strain. Just like with probiotic concentration, more is not always better. 

Many studies have shown health benefits of using single-strain probiotic formulation; others have shown an effect when using multispecies probiotic formulations. It all comes down to whether or not the product clinically studied and shown to have health benefits.

Always remember that no two strains are the same, so look for products that are backed by science.

Why it's a good idea to look for a vaginal probiotic with clinical results on the entire formulation

Many probiotic products contain a mixture of different strains. Such products are known as multispecies probiotics. When only one bacterial strain is included in the product we are describing these as monospecies probiotics. Scientists study many different bacteria by looking into the properties of one single strain. This would mean that some strains, especially if they were discovered a long time ago, will have a substantial amount of research. This includes clinical data indicating the health benefits of the strain. 

These days consumer companies buy probiotic strains from probiotic providers and mix up different strains with proven efficacy in clinical trials. In the end some companies add multiple different strains and claim they are clinically tested. Although this is most of the time true, companies refer to studies which have been performed for a single strain but not for the entire formulation that they are selling.

Ideally, you want to see proven efficacy of the entire formulation, or the end product on the market. The reason for this is that we don’t know how strains will affect each other when combined and if they will still show the same efficacy. 

For example some strains may prevent other strains from growing and performing their desirable effect. 

Which explains why it is important to perform studies on the end formulation. However, many probiotic products contain strains that have been well studied and tested in clinical studies, but the end product to which they have been added is not clinically proven. 

When is it recommended that you take probiotics? 

There are some situations when taking a probiotic is a very good idea. We've listed these below. You can take two probiotics for two different conditions. For example one product for gestational diabetes (GDM) and another for GBS. 

It is important to know that different products are designed to help with different types of conditions. When taking two different products, make sure to separate their intake by a couple of hours.

1. When you’re prescribed antibiotics. 

Antibiotics kill not only the pathogenic bacteria, but can also kill your beneficial gut and vaginal microbiota. This can lead to gut dysbiosis or to some vaginal issues, such as bacterial vaginosis.

The microbial shifts that take place after antibiotic use can persist for months and even years. 

It is highly recommended to take probiotics the first day you start your antibiotic treatment and continue during the entire period of antibiotic treatment. We also recommend that you continue taking probiotics for at least an additional one to two weeks after you stop the antibiotics.  

Because antibiotics can also kill the probiotic bacteria, make sure to separate antibiotic and probiotic treatment with at least two hours.

2. When you are diagnosed with Bacterial vaginosis (BV)

When it comes to BV, there’s strong evidence and research backing the use of probiotics. BV is characterized by diverse vaginal microbiota, depleted of beneficial Lactobacillus species. Therefore using probiotics can help to restore balance, since most probiotics are selected from the genus Lactobacillus. Using lactobacilli to get back to a healthy vaginal state is a logical solution, taking into account that lactobacilli are dominant in the niche. 

3. During pregnancy 

If you have a specific condition that pops up during pregnancy such as bacterial vaginosis (BV), a positive test for group B streptococcus (GBS) infection or colonization, or even gestational diabetes, you can consider taking probiotics.  

Why take probiotics for vaginal health?

Lactobacillus bacteria and vaginal health should be intrinsically linked in people’s minds, like left and right. 

The vaginal microbiome in healthy premenopausal women is Lactobacillus dominated. Since most probiotics strains are selected from the genus Lactobacillus, using probiotics products to treat or prevent vaginal infections is the logical choice. By using probiotics, you are giving the vagina missing healthy bacteria with their metabolic activity to help restore a healthy Lactobacillus-dominated vaginal environment. 

High-performing and well-researched vaginal strains like Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14 [5], can be found right alongside other lesser-known Lactobacillus and Bifidobacterium strains in vaginal products. 

Probiotic bacteria can help by:

  • Producing lactic acid to maintain low vaginal pH at around 4.5, which in turn hampers the growth of bacterial and yeast pathogens [6]
  • Producing bioactive molecules such as bacteriocins and biosurfactants that  can directly kill bacterial or yeast pathogens [6]
  • Adhering to vaginal epithelial cells and in this way, prevent binding of bacterial or viral pathogens [6]
  • Boosting host immune response and host defense to fight pathogens [6]

Final note to keep in mind about vaginal probiotics

No matter the strain source, the number of different strains, the potency, or the probiotic combination, there will always be responders and non-responders to probiotic treatment, similar to most standard drug treatments available today.

For more information about probiotics, how to use them, and what to look for when buying a product, you can refer to the website of the International Scientific Association for Probiotics and Prebiotics. 

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References

[1] Hill, C. et al. (2014) Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 11, 506–514.

[2] Binda, S. et al. (2020) Criteria to Qualify Microorganisms as “Probiotic” in Foods and Dietary Supplements. Front. Microbiol. 11, 1662.

[3] Grumet, L. et al. (2020) The Development of High-Quality Multispecies Probiotic Formulations: From Bench to Market. Nutrients 12, 2453.

[4] Jackson, S.A. et al. (2019) Improving End-User Trust in the Quality of Commercial Probiotic Products. Front. Microbiol. 10, 739.

[5] Petrova, M.I. et al. (2021) Lacticaseibacillus rhamnosus GR-1, a.k.a. Lactobacillus rhamnosus GR-1: Past and Future Perspectives. Trends in Microbiology 29, 747–761.

[6] Younes, J.A. et al. (2018) Women and Their Microbes: The Unexpected Friendship. Trends in Microbiology 26, 16–32.