Vaginal Microbiome Testing

Question 1

Bacterial vaginosis

Answer 1

Bacterial vaginosis = an imbalance of the Lactobacilli dominant vaginal composition

Question 2

When to test the VMB (vaginal microbiome)

Answer 2

Bacterial vaginosis (BV), recurrent t infertility, miscarriages, endometriosis and to provide an insight into vaginal ecology and its interaction with host immunity.

Question 2

Vaginal testing markers:

pH:

Answer 2

A healthy vagina (of a reproductive age woman) has an acidic pH of around 3.8 to 4.5. This should prevent pathogenic microbes from growing. Lactobacilli play a major role in producing hydrogen peroxide to maintain the pH.

• Low vaginal pH indicates high levels of lactic acid and a healthy vaginal microbiota.
• High vaginal pH (>4.5) is indicative of overgrowth of BV-associated bacteria and vaginal dysbiosis.

Question 3

Vaginal testing markers:

Interleukin beta-1:

Answer 3

An inflammatory marker made when epithelial cells break apart (e.g., infection)

• Healthy: <220 pg / ml
• Elevated: >220 pg / ml BV or candida overgrowth

Question 4

Vaginal testing markers:

Lactobacilli

Answer 4

• Lactobacilli produce lactic acid, creating an acidic environment that is inhospitable to many non-Lactobacillus commensals and potential vaginal pathogens.
• Vaginal health is associated with low community diversity, but Lactobacilli dominance. More diversity = a shift in pH and host immune response modifications.
• Look to see that Lactobacilli are taking up the most space.

Question 5

Supporting the VMB

Answer 5

• Avoid: Soap in the vagina (wash with water only); antibiotics; the copper coil (↑ the colonisation of BV-associated microbiota); common lubricants (opt for jojoba oil which is similar to semen pH); excessive simple carbohydrates and alcohol; smoking (by-products are secreted into the vagina); vaginal douching.
• Include: Vaginal probiotics. Optimise the oral and GI microbiomes which have been shown to have an impact on the vaginal flora.
• Menopausal oestrogen support (e.g. flaxseeds, black cohosh etc.)
• Diet: Focus on a diverse range of prebiotic and probiotic foods to support Lactobacilli growth, as well as polyphenols.