Do probiotics improve vaginal health? June 12, 2019
Patients often mention that they take probiotics, thinking that probiotics will prevent vaginal infections. So what are probiotics and are they useful for the vagina?
Probiotics are live microorganisms that are expected to have health benefits. Some types of bacteria are beneficial to the human body, as we have bacteria in the gut that are necessary for digestion. Healthy bacteria in the gut are also thought to benefit the immune system and prevent inflammation that can contribute to heart disease, diabetes, and neurodegenerative disease.
Antibiotic use can alter the normal gut bacteria, as can intestinal infections. Probiotics that often can be purchased in capsule form mimic the normal gut bacteria and are often used when digestion has been adversely affected by antibiotic use, irritable bowel syndrome, or an intestinal infection. Yogurt is a good food source of helpful bacteria.
So do they work? Apparently, the data is not conclusive. One reason that the data may not be clear is that there are many different types of helpful bacteria, and studies don’t always differentiate which type was used. Probiotics are thought to be somewhat effective for some patients, but at least are not felt to be harmful.
There are also bacteria in the vagina. The normal bacteria in the vagina is Lactobacillus. We know that when women take broad-spectrum antibiotics such as penicillin, they are more at risk of developing a yeast infection because the normal flora of the vagina is altered. Yeast, which is usually suppressed in the normal vaginal environment, will flourish when the normal bacteria are disrupted with the use of antibiotics. Bacterial vaginosis is another common type of vaginitis due to an imbalance of bacteria in the vagina.
So, why not use probiotics to restore the normal vaginal environment? In July’s edition of the Harvard Women’s Health Watch, Dr. Caroline Mitchell from Harvard Medical School, admits that it makes sense that inserting a probiotic in the vagina would be helpful, but the data does not demonstrate a benefit. Oral probiotics are not believed to be helpful at all.
Probiotics are heavily marketed for many conditions, but the data for vaginal use is not supportive. Patients with chronic vaginitis may become very frustrated, and if you look on the internet, you can find treatments such as putting yogurt or garlic in the vagina, or even tea tree oil, but these can cause more harm than good. The bacteria in yogurt are a different strain than what is naturally found in the vagina, so both eating yogurt and putting it in the vagina are not thought to be useful.
Dr. Mitchell feels that there is data that taking a probiotic with an antibiotic actually results in a longer return to normal gut bacteria. Overall, she feels that using probiotics for vaginal health is a waste of money. There are ongoing studies to look at a certain probiotic for vaginal health, so in the future there may be a live biotherapy, but we are not there yet.
One note for menopausal women with chronic vaginitis: the vaginal environment is used to estrogen, and the lack of estrogen can lead to a change in the normal bacteria. Talk to your doctor about the benefits of vaginal estrogen if you suffer from chronic vaginal infections.
Marilyn C. Jerome, MD
Foxhall OB-GYN Associates
Does your vagina really need a probiotic? Harvard Women’s Health Watch, July, 2019