The human body is colonized by billions of microorganisms of different species, collectively defined as “microbiota” (or “microbiome”). They are beneficial and protective germs, with a perfect balance – between the various colonies that compose it. However, if this balance goes haywire, disturbances may occur in the affected apparatus.
The most famous microbiota is the intestinal one (the “second” brain), but for women it is also important to have a vaginal microbiota in excellent condition. In recent years, interest in the latter has greatly increased. Recent scientific research has shown great diversity of the vaginal microbiota in different geographical areas, even if the ability to produce lactic acid seems an indispensable characteristic of the microorganisms that compose it.
Particular attention is also paid to the role of the microbiota at the time of conception, during pregnancy and childbirth. Just as breastfeeding plays a fundamental role in “delivering” a good intestinal flora to the baby, the maternal vaginal microbiota also has an important influence on the newborn: babies born passing through the vaginal canal acquire bacterial communities dominated by lactobacilli similar to those of the mother; babies born by caesarean section are instead colonized by cutaneous bacteria (Staphilococcus, Corynebacterium and Propionibacterium) and the impact of this difference on adult health is being studied.
How the vaginal microbiome changes
“The vaginal microbiota is a very dynamic environment, which varies throughout life, and in particular in some key moments,” explains Alessandra Graziottin, director of the Center for Gynecology and Sexology of San Raffaele-Resnati in Milan.
After birth, the vagina is colonized by a large number of microorganisms, most of them of gastrointestinal origin. In the phase that precedes development, low estrogen levels result in a thin layer of the mucosa, low levels of glycogen and lactobacilli.
“With puberty, estrogens mature the mucous membrane of the vagina that produces glycogen, and here they appear and become dominant (up to 90%) lactobacilli, microorganisms typical of the fertile age”, continues Professor Graziottin. “The latter transform glycogen into lactic acid, a substance that lowers the acidity of the vaginal environment. The vagina is healthy when in childbearing age the pH is around 4-4.5. If the pH rises, the proportions between the different microorganisms present change: a dominance of lactobacilli, which are “friends” of the vagina, or an increase in other strains of microorganisms (which from 1-0.5% reach 10-15%) which completely changes the situation. Lactobacilli are also reduced by physiological events: during the puerperium, because estrogens disappear because the woman is breastfeeding, and become even less numerous after menopause».
Attention to pH
But in addition to the variation of circulating hormones, there are numerous conditions that can change and even knock out lactobacilli: “A repeated cause is menstrual blood, because the pH, that is, the degree of acidity, is 7.39, so it is slightly basic. When the woman has a long and / or abundant cycle she has an increase in vaginal pH and immediately after menstruation she may have secretions with an unpleasant smell (“not fresh fish”): the result of the variation in the proportions between the microorganisms present in the vagina ».
“Another factor is frequent sexual intercourse: sperm have a pH of 7.39 and can, again, alter the vaginal pH and change the condition of the flora naturally present. Other important situations: constipation or irritable bowel syndrome (also favored by stress), because they cause inflammation of the wall of the intestine and the passage of allergens and germs that colonize the vagina. Finally, even medical therapies, antibiotics in particular, can have the effect of an “atomic bomb” on the vaginal ecosystem (just as happens in the intestine), changing the microbiota and causing suffering.
Symptoms
The symptoms are the first sign that the pH – and therefore the microbiota – vaginal has changed: “When the woman notices that the secretions have a more acidic or frankly unpleasant smell it means that a germ, the Gardnerella – which is normally present in the vagina in minimal quantities – has grown because the pH has changed, fermenting substances and causing the bad smell. An associated symptom can be burning,” continues Alessandra Graziottin.
To confirm the diagnosis, the gynecologist does a screening by measuring the pH with a small stick in the vagina: if it is yellow the pH is 4, if it turns green the pH is 5, if it goes blue it is 7 (typical of postmenopausal).
“Today women can also do this test alone, buying the stick in the pharmacy and if the pH is altered they can contact the gynecologist for a visit and a possible deepening (pap smear, vaginal swab) and talk to the pharmacist to find a solution in the meantime”.
What about nutrition? In 1996, a significant reduction in bacterial vaginitis episodes was reported for the first time in women taking lactobacilli-containing yogurt compared to controls, taking pasteurized yogurt. Subsequently, other studies were published that demonstrated the discovery in the vagina of lactobacilli taken orally, with combinations capable of normalizing bacterial vaginitis.
Vaginosis or vaginitis?
But what happens when the vaginal microbiota loses its balance? “When there is a variation in the proportion of microorganisms that are normally present in the vagina it is called ‘vaginosis’. The infection, on the other hand, is defined as “vaginitis” and can be caused either by the arrival of foreign germs or by the “arrogance” of a habitual tenant, Candida, also favored by predisposing factors, such as diabetes», explains Professor Graziottin.
“Candida normally sleeps in spore form. An antibiotic therapy, however, can act, as well as where it is needed, also at the intestinal and vaginal level, destroying enemy bacteria but also friendly ones. And Candida, until then silent, begins to proliferate, becomes hyphae and causes vaginitis, which have two characteristics: whitish discharge, “ricotta”, and, in women with immune-allergic vulnerabilities, also an inflammation of the vaginal entrance that causes pain during sexual intercourse (vaginal vestibulitis)».
A second factor that can cause vaginitis is the aggression of germs that are normal for the intestine, such as Escherichia coli and Enterococcus faecali, but become pathogenic if they change location. Constipation or irritable bowel causes these germs to cross the intestinal walls and colonize the vagina causing inflammation and, often, even anticipating cystitis.
The third great cause of vaginitis is the invasion of external germs, in particular contracted through sexual intercourse: they can be bacterial or viral microorganisms, particularly aggressive and with more or less long incubation times, which give rise to what are called sexually transmitted diseases. The best prevention of these diseases is the use of condoms in case of occasional intercourse.
Intimate hygiene: yes, but without exaggerating
Over-cleaning or the use of too aggressive cleansers can play a role in altering the delicate vaginal ecosystem, opening the door to germs and irritations.
To be cleaned, just wash when you wake up and in the evening before going to bed. Additional washes should be an exception and not the rule, because in addition to the danger of changes in vaginal pH, there is also a risk of dehydrating the skin, depriving it of the natural layer of sebum that protects it from irritation due, for example, to linen and bacteria.
If you really feel the need to cool off more often (after sports, in case of menstruation, etc.), it is better to use only water and, at most, Marseille soap. The use of waterless wipes specific for intimate hygiene, soft and based on substances compatible with vaginal pH (such as lactic acid) and soothing (for example, chamomile or aloe extract) is also allowed.
During menstruation, for deeper hygiene you can switch to a detergent with a more acidic pH. Be careful, however: blonde, red or very fair skin women are more sensitive and delicate, so they must always prefer products that are not too acidic (pH 4.5-5) and with moisturizing action, to avoid irritation to the vaginal vestibule.
After sexual intercourse, just wash with a detergent with physiological pH, preferably enriched with soothing and calming substances.
The douches are not necessary and run the risk of introducing into the vagina any harmful bacteria located on the surface of the cannula or, in any case, of impoverishing the natural flora facilitating, among other things, possible infections transmitted by the partner or aggravating a possible infection already in progress.
American researchers carried out a clinical study on 368 young people at Vanderbilt University, published in the American Journal of Obstetrics and Gynecology, finding that girls who use vaginal douches too much are twice as likely to fall victim to sexually transmitted infections compared to those who use them only occasionally. It is always better to talk about this first with the gynecologist, who, if necessary, will recommend the right product.
The douches with benzidamine, for example, associated with a cream are useful against inflammation, while disinfectant ones (for example with thymol, carvacrol and eugenol or with an antiseptic such as povidone-iodine) are used to make therapy with drugs (eggs, tablets by mouth or ointments) more effective against chronic bacterial or fungal infections such as Candida.
Panty liners should be used only when it is essential, for example at the end of the cycle, choosing cotton fiber ones: continuous use promotes inflammation and the proliferation of fungi and bacteria. Absorbents (preferably also in cotton fiber) and tampons should be changed often. If the latter suddenly bother, it is possible that there is an infection.
Even the chlorine of the pool tests the vaginal flora, as well as poolside, trampoline and changing rooms can be receptacles of germs and viruses: be careful to always protect yourself with a personal towel.
If you suffer from recurrent Candida, it is good to prefer cotton linen, white or light colors and quality brands: the genitals inflamed by synthetic linen cause a half-degree increase in temperature and the “right” climate for the fungus. There is also a line of breathable healing lingerie in natural silk (fibroin) treated with an antimicrobial that fights and prevents bacterial and fungal vaginal infections.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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