Probiotic supplements, which sport beneficial bacteria, are practically synonymous with gut health these days. Though the research is still iffy on how certain types could ease tummy troubles, there’s logic behind the hype: A gut microbiome that’s off-kilter, or running relatively low on those supportive critters, is linked with GI (and other) woes. The same type of thing can happen with the community of microbes in the vagina; when it’s out of whack, you can wind up with an infection and symptoms like itch and discharge.
So it’s no wonder plenty of probiotics – both in the form of oral supplements and suppositories you slide into your vagina – now purport to infuse this organ with good bugs too. These days, there’s no shortage of products that claim to do everything from “maintain your vaginal health” to “replenish microflora” and “eliminate odour.”
To be clear, some of these would-be benefits are just drawn from the age-old marketing playbook of preying on women’s insecurities. Contrary to what they might imply, your vagina does not inherently need special maintenance or preventative care in the form of a daily product – in fact, experts agree that if you’re feeling just fine down there, you’re better off not intervening. (And remember: Healthy vaginas naturally have an odour that isn’t exactly fresh or floral.)
But what if you are dealing with a hurting vagina – say, one prone to yeast infections (an excess of a fungus called Candida) or bacterial vaginosis (an overload of not-so-great bacteria)? Some vaginal probiotic claims suggest they could offer support.
The research, however, is far from definitive. Like the probiotics claiming to heal your gut, vaginal ones haven’t undergone the stringent safety and efficacy testing necessary for FDA approval. Yes, there are a handful of studies, albeit small ones, that suggest probiotics may help clear or slash the recurrence of BV and possibly yeast. (This research shows they may be especially effective in folks who take them with the standard treatment – an antibiotic for BV or an antifungal for yeast.)
But it’s important to note many of these trials were funded by probiotics companies or lacked consistent follow-up with participants, among other parameters of quality research, which makes them tricky to trust, says Dr Caroline Mitchell, director of the Vulvovaginal Disorders Program at Massachusetts General Hospital. Not to mention, they run the gamut in terms of which probiotic species participants used, the dose, whether they took it orally or vaginally, and how long they were on it, all of which complicates drawing concrete conclusions.
And yet, these findings aren’t nothing, particularly when you consider that “medicine has very few solid science-based answers about vaginal health,” Dr. Mitchell says. (You can blame good ol’ sexism for that.) Case in point: “Our treatment for recurrent bacterial vaginosis is terrible,” she says, noting that we’ve relied on the same two categories of antibiotics (metronidazole and clindamycin) to resolve it since the 1980s, and a whopping 50 to 80% of people with BV get another infection within a year of treatment. The antifungals for yeast work a bit better, FWIW, but as many as 28% of people still wind up with recurrent yeast infections. And if you’ve been plagued by repeat appearances of either, you know how the constant itching, burning, and discharge can wreck your quality of life. It makes sense why you might turn to probiotics, even if the science is still catching up.
The good news is, experts like Dr. Mitchell are also optimistic about vaginal probiotics – future research could help unlock their potential to tweak our vaginal ecosystem for the better. But before you click “add to cart,” read on to learn what we do (and don’t) know about using these encapsulated bugs for vaginal health, and when, if ever, it may be worth ingesting or inserting them.
To understand why probiotics could theoretically “balance” your vaginal microbiome, it’s helpful to know how it can get messed up in the first place.
When it comes to your gut, an unbalanced microbiome is typically marked by a dearth of variety – a few bad actors have seized control, and taking a probiotic filled with good guys could ostensibly repopulate things for a healthier overall mix. But your vagina is totally different, says Smita Gopinath, PhD, an assistant professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health, who studies the vaginal microbiome. The fewer species present, “the stronger and more resilient it is,” she says. Specifically, what you want to see is “all Lactobacillus, all the time, and primarily Lactobacillus crispatus,” Dr. Mitchell says. These bacteria pump out lactic acid, which keeps the pH of your vagina in the acidic zone (roughly 3.8 to 5) and kills off or prevents the overgrowth of microbes like yeast and various harmful bacteria.