The Vaginal Microbiome: What It Is and Why It’s So Important for Women’s Health

The vaginal microbiome is an incredibly delicate and vital ecosystem that plays a critical role in women’s overall health, particularly in the pelvic and reproductive systems. Much like the gut, the vagina hosts a complex community of microorganisms, including bacteria, fungi, and viruses, that work together to maintain balance, support the immune system, and protect against infections. A healthy vaginal microbiome can not only reduce the risk of infection but also plays a crucial role in supporting fertility.

Understanding the Vaginal Microbiome

The vaginal microbiome is primarily populated by beneficial bacteria called Lactobacilli, which create an acidic environment (with a pH between 3.8 and 4.5) by releasing lactic acid and hydrogen peroxide. This acidity helps prevent the growth of harmful pathogens. In contrast to the gut microbiome, where diversity is beneficial, the vaginal microbiome functions best when dominated by Lactobacilli, which provides stability and protection against unfriendly bacteria.

When this balance is disrupted, harmful bacteria known as anaerobes can proliferate, leading to infections like bacterial vaginosis (BV). BV is a common cause of abnormal discharge in women under 45 and often presents as a strong, fishy-smelling discharge that may be grey or white and thin in consistency. While some women with BV don’t experience noticeable symptoms, untreated BV can lead to more serious health complications, including an increased risk of pelvic inflammatory disease (PID).

The Role of a Balanced Vaginal Microbiome in Reproductive Health

A healthy vaginal microbiome not only prevents infections but also protects against conditions like PID, which occurs when bacteria travel from the vagina into the uterus, ovaries, and fallopian tubes. PID, which can result from untreated BV or sexually transmitted infections, may cause scarring and narrowing of the fallopian tubes, leading to infertility or ectopic pregnancies.

Emerging research also suggests that a well-balanced vaginal microbiome may help reduce the risk of ovarian cancer. Studies indicate that women with higher levels of Lactobacilli have a lower incidence of ovarian cancer, suggesting that these friendly bacteria might have a protective effect.

Furthermore, an imbalanced vaginal biome doesn’t just lead to infections—it also triggers inflammation, which can affect fertility. When harmful bacteria are present, the immune system responds, creating inflammation in the reproductive tract, which can interfere with the processes involved in conception and pregnancy. Research has linked imbalances in the vaginal microbiome to unexplained infertility, recurrent miscarriage, and even preterm birth.

Getting Your Vaginal Microbiome Tested

In the UK, it’s unlikely that you’ll be able to get a comprehensive vaginal microbiome test through the NHS. While NHS providers may offer a vaginal swab, this typically screens for specific bacteria, such as those causing BV or STIs, rather than providing a full microbiome profile.

If you’re interested in a more detailed view of your vaginal microbiome, we can arrange for an at-home swab test from Invivo, which will assess the full microbial landscape. This test provides comprehensive insights into your microbiome’s balance and can be helpful if you’re experiencing symptoms like unusual discharge, or recurrent infections, or if you’re trying to optimise fertility.

If testing reveals an overgrowth of harmful bacteria, then a short course of targeted antibiotics may be necessary. It's essential to use antibiotics that specifically target the problematic bacteria, as not all antibiotics treat all types of infections. After completing a course of antibiotics, using a probiotic like Femme V by Invivo—clinically proven to survive stomach acid and reach the vaginal microbiome—can help repopulate the vagina with the beneficial Lactobacillus bacteria that support fertility. I often suggest these probiotics to my fertility clients generally.

The Link Between Vaginal Microbiome and IVF Success

A healthy vaginal microbiome, dominated by Lactobacillus, has been shown to increase the chances of a successful embryo transfer by up to seven times in IVF. Many people undergoing IVF are prescribed antibiotics during their cycle, often without any prior testing. These antibiotics are typically given as a blanket treatment to try and eliminate unwanted bacteria in the vaginal microbiome, but this approach can be a shot in the dark. Not all antibiotics are effective against all bacteria, and they can sometimes kill off both harmful and beneficial bacteria, potentially disrupting the microbiome even further.

The best approach would be to first get your microbiome tested as above, which will give you a comprehensive understanding of your microbiome's balance and allow for a more targeted treatment plan. Spending £200 on a vaginal microbiome test before investing thousands of pounds, time, and emotional energy into IVF is well worth it. A comprehensive microbiome test can provide insights that might allow you to avoid the IVF process altogether. A short course of targeted antibiotics, followed by probiotics to restore healthy bacteria, could be the key to improving fertility and potentially allowing you to conceive naturally.

A vaginal microbiome test not only helps optimise the chances of IVF success, but it can also save you time, money, and emotional stress. By addressing any imbalances with targeted treatment, you can give yourself the best chance of both a successful IVF cycle and a healthy pregnancy.

Tips for Maintaining a Healthy Vaginal Microbiome

Here are a few practical ways to help keep your vaginal microbiome balanced and thriving:

• Limit Tampon Use or Choose Safer Alternatives: Change tampons regularly, and consider “vagina-friendly” tampons or a moon cup without harsh chemicals. Certain period products may disrupt the microbiome balance.

• Avoid Scented Hygiene Products: Feminine sprays, wipes, and washes often contain chemicals that can disrupt the vaginal pH. The vagina is self-cleaning, so these products are unnecessary and may even lead to irritation or infection.

• Skip Douching: Rinsing the vagina with water or cleansing agents disturbs the natural pH, increasing infection risk. Douching is not only unnecessary but can actually worsen hygiene.

• Be Mindful During Menstruation and Sex: Blood and semen have a neutral-to-alkaline pH, which can raise the vaginal pH temporarily. While using condoms can help, maintaining balance in other ways can be especially helpful.

• Consider Your Diet and Lifestyle: Healthy eating, balanced hormones, and a strong immune system contribute to a stable vaginal microbiome. Include probiotic foods in your diet, like yoghurt, kimchi and sauerkraut. Minimising antibiotic use can also be beneficial, as antibiotics may disrupt the balance of friendly bacteria.

Because up to 80% of women will experience a vaginal microbiome imbalance at some point in their lives, understanding how to maintain this delicate ecosystem is essential. A healthy vaginal biome protects against infections and may help reduce the risk of conditions like infertility, miscarriage, and even some cancers. Taking proactive steps to support this vital biome is an investment in your reproductive health and overall wellness. If you’re interested in testing your vaginal microbiome or have concerns, feel free to reach out to learn more about our testing and support options.