Bacterial Vaginosis

Probiotics & Bacterial Vaginosis: Can They Really Help?

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By Dr. Amanda Olson, DPT, PRPC

 

Among health professionals and in the media, there is a lot of buzz about the benefits of probiotics on digestion, mental health, the immune system, and even some allergy symptoms. 

Recently, health experts have started to explore the impact that probiotics have on vaginal health, particularly with conditions such as yeast infections and bacterial vaginosis (BV). 

Read on to learn more about what research suggests about the relationship between probiotics and BV.

What Are Probiotics?

Your body’s unique microbiome, or its collection of microorganisms, contains certain “good” bacteria. These bacteria are naturally found in the gut, lungs, mouth, urinary tract, vagina, and also on the skin. 

The bacteria that are typically found in the vagina are called Lactobacilli.These bacteria line the vagina, making it difficult for harmful bacteria to grow, and can also kill harmful bacteria by adhering to them directly.

Some circumstances such as unprotected sex, menstruation, hormonal changes, douching, and antibiotic use can cause an imbalance in the vagina and a subsequent reduction in the number of lactobacilli.

A decrease in the number of lactobacilli can make the vagina more prone to yeast infections or BV. 

Probiotics are ““live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (Hill et al., 2014). Put simply, probiotics are “good” bacteria found in fermented food like yogurt, sauerkraut, kimchi, and kombucha, to name a few.

Probiotic supplements, both in oral and vaginal form, are also available. These probiotics help fight bad bacteria that cause infection, keep your body in balance, and help control inflammation. 

Oral probiotic supplements are absorbed by the gut and are thought to reach the vagina by passing from the rectum. Vaginal probiotics are inserted directly into the vagina.

How do Probiotics Help with Bacterial Vaginosis?

Bacterial vaginosis is the most common vaginal condition affecting women between the ages of 15-44. The exact cause of this infection is unknown, but it typically only affects women who are sexually active and has been increasingly linked to an imbalance between good and bad bacteria in the vagina. 

Symptoms of BV include itching and burning in the vaginal area; a white or grayish discharge with a fishy odor; and pain and burning while urinating. While in most cases BV does not lead to serious illness, the symptoms can be very uncomfortable, and repeated scratching can irritate the skin, leading to an increased risk of other infections. 

BV does increase the risk of becoming infected with sexually transmitted diseases, including HIV. If you are pregnant, having BV can also increase the risk of premature birth or low birth weight.

The usual treatment for BV is a course of antibiotics, but there can be a high risk of recurrent infection within a year, despite antibiotic treatment. In light of recent interest in the impact of the vaginal microbiome on vaginal infections, research has turned its attention to the role of probiotic supplements in treating BV. 

Though results are not fully conclusive, a recent analysis of multiple randomized controlled trials (meta-analysis) suggests that treating BV with probiotics alone was safe and led to improved short- and long-term results compared to either a placebo or antibiotics, and was more effective than treatments that involved antibiotics plus probiotics (Wang et al, 2019). 

Another earlier review supported these same findings, concluding that no adverse effects are noted with probiotic use and they can help prevent and treat BV (Homayouni et al., 2014).

Both of these reviews come with the caveat that variability in the quality and structure of the studies they looked at make it difficult to make a definitive statement on whether and how probiotics should be used to treat BV.

Bottom Line  

Probiotics, whether in the form of food or supplements, have many health benefits, may help prevent BV or its recurrence, and are safe to use for most healthy people. 

Because conclusive evidence is lacking, some health providers are hesitant to recommend probiotic supplements as an exclusive treatment for BV, although evidence is growing and new clinical trials are underway.  

If you do have diagnosed BV or suffer from recurrence of this condition, talk to your provider about whether a probiotic supplement is appropriate and recommended for your specific situation. 

References

Hill, C., Guarner, F., Reid, G., Gibson, G.R., Merenstein, D.J., Pot, B., Morelli, L., Berni Canani, R., Flint, H., Salminen, S., Calder, P., & Sanders, M.E. (2014). The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology, 11, 506-14.

Homayouni, A., Bastani, P., Ziyadi, S., Mohammad-Alizadeh-Charandabi, S., Ghalibaf, M., Mortazavian, A. M., & Mehrabany, E. V. (2014). Effects of probiotics on the recurrence of bacterial vaginosis: a review. Journal of lower genital tract disease, 18(1), 79–86. https://doi.org/10.1097/LGT.0b013e31829156ec

Wang, Z., He, Y., & Zheng, Y. (2019). Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. International journal of environmental research and public health, 16(20), 3859. https://doi.org/10.3390/ijerph16203859