What Is The Vaginal Microbiome? Experts Break Down The Science

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As you bop around from work to Pilates class—or every time you soak in the bath or change a tampon—there’s a unique community of microorganisms keeping you healthy below the belt. You probably didn’t even realize it, as this environment humbly operates on autopilot and does its own thing. Even so, new technology and emerging research are shedding light on how the fascinating ecosystem known as the vaginal microbiome might be the key to unlocking exciting health discoveries.

The V microbiome is a topic that’s “never gotten enough attention,” despite being a complex and incredibly important system, says Johanna B. Holm, PhD, an assistant professor in the department of microbiology and immunology at the University of Maryland School of Medicine. For starters, the microbiome helps ward off unwanted bacteria and may even play a role in reducing the risk of sexually transmitted infections (STIs) and preterm birth, recent research found. And while it’s all still new, scientists are starting to develop diagnostic tests to make sense of the vaginal microbiome in a meaningful way.

But with these advancements, an expanding product market has arrived. Just visit your local drugstore and you’ll spot probiotics and suppositories claiming to keep flora functioning. In tandem with that bubbling interest comes misinformation about how it all works, as well as burning questions such as, Do you actually need those supps from IG? Could my vaginal microbiome be off, and I don’t even know it? Ahead, doctors set the record straight on how to monitor the health of your vaginal microbiome, why it matters, and what it means for your wellness.

Meet the experts: Johanna B. Holm, PhD, is an assistant professor in the department of microbiology and immunology at the University of Maryland School of Medicine. Anna Powell, MD, is an ob-gyn and assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. Caroline M. Mitchell, MD, is an associate professor of obstetrics, gynecology, and reproductive biology and director of the Vulvovaginal Disorders Program at Massachusetts General Hospital. Catherine Goodstein, MD, is an ob-gyn based in New York City. Andrew Rubenstein, MD, is the director of the generalist division of obstetrics and gynecology at NYU Langone Health.

What is the vaginal microbiome and why is it important?

Put simply: The vaginal microbiome is the combination of microorganisms—bacteria, viruses, fungi—“that almost uniquely exist in the vagina,” says Holm. “It’s capable of protecting from pathogens like STIs, urinary tract infections, and yeast infections.” If there’s dysbiosis (an imbalance) in your microbiome, for instance, you could be more prone to infections like bacterial vaginosis (BV), which impacts roughly 30 percent of women in the United States.

Although the vaginal microbiome is not a brand-new discovery, research about the topic is still relatively young—and it’s becoming more of an area of medical interest and investment. Even 15 years ago, the medical community didn’t have the DNA technology that’s available today to identify a lot of the species that live in the various microbiomes in the body, including in the vagina. Historically, what doctors knew about the microbiome was limited only to culture tests, says Anna Powell, MD, an ob-gyn and assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. But now, DNA-based testing is revolutionizing the space—and allowing experts to use this network of organisms to diagnose vaginal conditions more efficiently.

It’s important to remember, though, that your system is unique, dynamic, and constantly in flux. “The vaginal microbiome itself is a living entity, responding to everything that’s happening around it,” says Holm. “We know that the microbiome can change during menstruation, before, during, and after menopause, during pregnancy, and from sexual intercourse.”

During your period, for example, you might be more sensitive to BV and other vaginal changes because menstrual blood is a medium in which bacteria can grow. “The blood changes the pH too,” says Dr. Powell. Sex can also alter the environment.

Throughout pregnancy, on the other hand, your vaginal microbiome becomes “more favorable in the sense that you trend toward lactobacillus dominance over the course of pregnancy,” says Dr. Powell. (That means good bacteria rule the land!) Although peer-reviewed studies haven’t absolutely confirmed it just yet, Dr. Powell speculates that having a healthy vaginal microbiome during pregnancy could help protect you against issues like infections after C-sections, which are associated with BV.

Pause Before Probiotics: Tempted by an Instagram or TikTok ad recently? There is no high-quality evidence that probiotics pegged to vaginal wellness can improve health down there—at least not yet. Many oral pro­bio­tics on the market don’t include species or strains that are actually found in the vagina (yes, you read that right). In short, the products you’re seeing probably won’t translate to aiding your V health.

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How to Know If Your Microbiome Is Healthy

If everything feels normal, your vaginal microbiome is most likely healthy. (What that might look like: occasional discharge that’s clear or white, a slight odor, and minimal to no signs of itching or discomfort.) If occasional symptoms like itching, strong odor, or irritation suddenly pop up, and you’re curious what it could mean, always ask your doctor—but in general, your flora is probably still A-OK.

In most cases, special tests are usually unnecessary, especially if there are no signs of imbalance.

So, where do trendy products like vaginal microbiome at-home testing kits come into play, if at all? While they may sound helpful, experts agree that, in most cases, special tests are usually unnecessary—especially if there are no signs of imbalance. For people without symptoms, there is no reason to test, because we don’t have reliable interventions to change the microbiome with that information, says Caroline M. Mitchell, MD, an associate professor of obstetrics, gynecology, and reproductive biology and director of the Vulvovaginal Disorders Program at Massachusetts General Hospital. Another reason to be wary: At-home tests give you just a snapshot in time of your biome—but in reality, it’s constantly changing.

Signs Something Is Off With Your Microbiome

Vaginal health can be mystifying, but generally speaking, “symptoms of vaginal infections can include discharge, odor, itching, and irritation,” says Dr. Mitchell. If you notice these symptoms, make an appointment with your doc to be evaluated for an infection and treated if one is present. (When seeking care, you’ll probably want to get tested for BV, yeast, trichomoniasis, gonorrhea, and chlamydia.)

Having acute or recurring BV is a sign that your microbiome is off, says New York City–based ob-gyn Catherine Goodstein, MD. If this sounds like you, take it as a sign to make an appointment with your doctor. And if you want to get the most specific and accurate diagnosis, you can even go as far as asking if the tests being employed for BV look at multiple types of bacteria.

How To Care For Your Vaginal Microbiome

Overall, less is more with cleansing habits. Putting any soap in the vagina can disrupt the microbiome. Think of it like this: You wash your face, get soap in your eye, and then it gets irritated. Similarly, aggressive cleaning in the vagina “can shift the flora and cause a similar reaction,” says Andrew Rubenstein, MD, director of the generalist division of obstetrics and gynecology at NYU Langone Health. Use a mild, unscented soap around the labia and vaginal opening only.

Make sure that anything going internal—like lube or prescription suppositories that go in your vagina—is properly tested and recommended by your doctor. And be mindful of lifestyle habits. Dr. Powell points to research that shows douching is the only “feminine hygiene behavior” significantly associated with BV. Some experts also recommend wearing cotton (vs. nylon) underwear, and using unscented tampons and pads, but there’s no strong literature that suggests those interventions make a difference—do what feels best for you.

Eating a balanced diet with protein, whole grains, fruits, and vegetables, and limiting sugar, may also help. Higher glucose levels can affect the vaginal microbiome, so if you have polycystic ovary syndrome or a metabolic syndrome associated with higher glucose, you may want to moderate your sugar intake. Antibiotics can also disturb the vaginal microbiome and up risk for conditions like yeast infections. If you’re on them, talk to your doctor about a prophylactic antifungal to help prevent infections, Holm says.

No matter what, if you have noticeable itching, burning, or other symptoms, see your doctor. Exams may involve DNA-based tests that target specific organisms, enabling them to be ID’d even in small numbers, Dr. Powell says. A doctor touch-base? Always best.

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What The Future Holds

Experts like Holm are excited and encouraged that the focus on the vaginal microbiome will continue to increase. Holm also hopes for more research. Menopause and conditions like BV, fibroids, and endometriosis—which affect hundreds of millions of women every year—currently have received less than 0.1 percent of federal dollars for research.

In the meantime, she’s working with her colleagues at the University of Maryland to develop new treatments to ultimately improve women’s genital and reproductive health, which could include therapies and drugs that can alter the mechanisms of the vaginal microbiome.

The team is currently developing and testing a next-generation live biotherapeutic product (LBP)—what probiotics are called when going through the formal FDA drug-approval process—as part of a new clinical program. This LBP has the potential to prevent BV recurrence, which eliminates a major risk factor for many conditions, including STI and some adverse obstetrics outcomes. Meanwhile, a first-generation LBP developed by other researchers (called Lactin-V) finished phase 2 clinical trials and showed promise for preventing recurrent BV and preterm birth—but the treatment is not on the market just yet.

TL;DR: The vaginal microbiome and women’s health are finally starting to get the attention they deserve, and more innovations are on the horizon.

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