The vaginal microbiome is often mentioned in passing - sort of as an afterthought - usually when we’re really talking about the gut microbiome. We’ve decided to give the vaginal microbiome centre stage today, and with good reason - it’s a huge factor when it comes to the quality of a woman’s life and health, and has implications for fertility, pregnancy and childbirth, and risks associated with sexually transmitted infections.
Here’s the outline of this interview with Megan Hall:
[00:02:30] Why care about the vaginal microbiota?
[00:03:55] Megan's outline for this podcast.
[00:04:50] What is the vaginal microbiome (VM)?
[00:05:52] 5 core vaginal microbiome community state types (CSTs).
[00:07:40] Why lactobacilli are beneficial.
[00:10:52] Lucy Mailing, PhD; Podcasts: 1, 2, 3.
[00:12:06] Diagnoses associated with vaginal dysbiosis.
[00:13:47] Direct to consumer VM testing.
[00:15:48] Changes throughout a woman's lifespan.
[00:18:02] Podcast: You Are Not Broken: A Modern Approach to Women’s Sexual Health and Desire, with Kelly Casperson, MD.
[00:18:38] Common vaginal microbiome dysbiosis pathologies: Bacterial Vaginosis (BV), Vulvovaginal Candidiasis (VVC), and Group B Strep (GBS).
[00:26:16] Pregnancy: protection from preterm labor, preeclampsia, and infertility.
[00:29:44] Studies on the effects of the microbiota and success with infertility treatment: 1. Moreno, Inmaculada, et al. "Evidence that the endometrial microbiota has an effect on implantation success or failure." American journal of obstetrics and gynecology 215.6 (2016): 684-703. and 2. Moore, Donald E., et al. "Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization." Fertility and sterility 74.6 (2000): 1118-1124.
[00:31:06] NBT Podcasts with Dr. Malcolm Kendrick: 1, 2.
[00:32:15] Causes of disruption to the vaginal microbiome: menses, gut dysbiosis, diet, smoking, contraceptives, antibiotics, general hygiene, stress, tampons, lubricants, hygiene products.
[00:35:49] Women who eat a vegetarian diet have higher vaginal microbial diversity (which is unfavorable); Study: Song, Stephanie D., et al. "Daily vaginal microbiota fluctuations associated with natural hormonal cycle, contraceptives, diet, and exercise." Msphere 5.4 (2020): e00593-20.
[00:37:05] Compounds from cigarette smoke can be found in cervical mucus; Study: Prokopczyk, Bogdan, et al. "Identification of tobacco-specific carcinogen in the cervical mucus of smokers and nonsmokers." Journal of the National Cancer Institute 89.12 (1997): 868-873.
[00:37:24] Microbial composition of man's penis can predict BV incidence in female sex partner: Study: Mehta, Supriya D., et al. "The Microbiome Composition of a Man's Penis Predicts Incident Bacterial Vaginosis in His Female Sex Partner With High Accuracy." Frontiers in cellular and infection microbiology 10 (2020): 433.
[00:38:53] Maternal stress alters proteins related to vaginal immunity and abundance of lactobacilli; Study: Jašarević, Eldin, et al. "Alterations in the vaginal microbiome by maternal stress are associated with metabolic reprogramming of the offspring gut and brain." Endocrinology 156.9 (2015): 3265-3276.
[00:39:34] Maternal vaginal microbiome mediates responses to prenatal stress; Study: Jašarević, Eldin, et al. "The maternal vaginal microbiome partially mediates the effects of prenatal stress on offspring gut and hypothalamus." Nature neuroscience 21.8 (2018): 1061-1071.
[00:42:44] Summarizing lifestyle practices that most affect the vaginal microbiome.
[00:43:07] The BBC More or Less Podcast: Has the number of periods a woman has in her lifetime quadrupled?
[00:43:49] Best options for contraceptives; Fertility Awareness Method. Podcast: The Truth About Fertility and the Fertility Awareness Method, with Torea Rodriguez.
[00:45:08] Personal hygiene products - be wary.
[00:46:49] Podcast: How to Manage Stress, with Simon Marshall, PhD.
[00:47:22] How to rebalance the vaginal ecosystem (before resorting to antibiotics and antifungals).
[00:48:19] Vaginal pH test strips.
[00:48:33] Probiotics: Jarrow Fem-Dophilus has two good strains.
[00:52:34] Intervaginal vitamin C can help treat BV; Study: Petersen, E. Eiko, and Paola Magnani. "Efficacy and safety of Vitamin C vaginal tablets in the treatment of non-specific vaginitis: A randomised, double blind, placebo-controlled study." European Journal of Obstetrics & Gynecology and Reproductive Biology 117.1 (2004): 70-75.
[00:52:46] Medical grade honey, thyme and garlic.
[00:55:13] The next frontier in VM study.
[00:57:02] Seeding with fecal microbiota transplantation in C-section infants; Study: Korpela, Katri, et al. "Maternal fecal microbiota transplantation in cesarean-born infants rapidly restores normal gut microbial development: a proof-of-concept study." Cell 183.2 (2020): 324-334.
[00:58:30] Microbiome-based biologic drug being studied (L crispatus probiotic); Study: Lagenaur, Laurel A., et al. "Connecting the dots: Translating the vaginal microbiome into a drug." The Journal of Infectious Diseases 223.Supplement_3 (2021): S296-S306.
[01:00:09] 4-quadrant model.