Reoccurring vaginal infections – why do they come back and what to do about it
So for a part of the human anatomy that is so closely linked to the procreation of the human species, there has actually only been good research around the vagina in the last few years and really the research is only just starting.
And what I mean by that is the actual structure and function of the vagina is researched but the ENVIRONMENT that exists within it and what the relationship is to reoccurring infections is not overly well studied or even understood.
Turns out, the vagina has its own microbiome.
Yep, the vagina has its own little bacterial and fungal communities that is constantly competing for space. Whoever has the numbers will determine the health of your vagina. This gives us a clue as to why infections occur and also why they reoccur.
Thrush is likely to occur in 75% of those with vagina’s with about 6% will develop reoccurring thrush (defined as more than four bouts a year)
Bacterial vaginosis is likely to reoccur in 50 – 70% of cases within 12 months after antibiotic treatment.
Unlike your gut where a diverse microbiome community is more likely to result in good health, your vagina tends to be dominated by one main species, that is the Lactobacilli species. It actually likes one of those strains in particular, Lactobacilli crispatus.
L crispatis is an acid forming bacteria so this makes the vagina a mostly acidic environment. This is a good thing for protecting the vagina from pathogens that cause infections as they usually don’t like an acid environment. It’s not a good thing for pregnancy though as sperm are alkaline so for a couple of days around ovulation the acidity drops which allows sperm to exist in the vagina.
The acidity drops because of the direct relationship between oestrogen levels and the colony numbers of L crispatus. Acidity also drops around menstruation due to the influence of menstrual blood. This gives us clues as to why vaginal infections can reoccur at particular times in a menstrual cycle and why you should track symptom flare ups if you suffer from reoccurring vaginal infections.
In any microbiome in the body, real estate is king. By that I mean if some microbe moves out another one will move in. if there are lower numbers of L crispatis in the vagina then there are likely higher numbers of something else – and that may be a bacteria or fungi that is associated with a condition like Bacterial Vaginosis or thrush (Candida), two of the most common infections that I see in clinic. (Side note that there is more than one strain of candida. If you get reoccurring thrush then please get this tested through you GP so that identification of the correct strain is done as treatment differs).
What is Vaginal dysbiosis?
When there is lower numbers of L. crispatus and higher number of less helpful bacteria this is often termed vaginal dysbiosis.
Vaginal dysbiosis can be caused by hormone levels but can also be influenced by a bunch of other things; gut microbiome (did you know that bacteria in different microbiomes talk to each other – amazing), hygiene, medications, lots of ejaculatory sex (remember sperm is alkaline), diet and a bunch of other things.
Why treatment regimens don’t always work for thrush and BV
Current medical treatment regimes focus on kill therapy, ie. lets kill the bacteria / fungi that caused the infection. Seems logical and it is to an extent but remember, real estate is king when it comes to any microbiome. When that bacteria / fungi dies and moves out it leaves a space for something to move in. And what moves in may be the neighbour from hell. Or, it might have been the same resident that was hiding in the basement when the kill took place waiting for the opportunity to regrow. Bacteria and fungi pre date humans, they have figured out strategies to stay alive.
The strains that cause bacterial vaginosis and thrush are particularly good at this. They can actually create something like a shield (called a biofilm) that protects them. So after kill therapy there is some time where the vaginal infection seems to have gone but then infection comes back because the bacteria or fungi that caused it was never really eradicated in the first place and / or the environment in which it thrived is still the same.
No doubt that vaginal infections need to controlled and symptoms need to be eased as they can be uncomfortable and traumatic. However in order to break the cycle of continuous vaginal infections we need to be looking at the picture from a more holistic perspective.
Focus on changing the vaginal environment
Instead of solely focusing on kill therapy we need to focus on grow therapy.
• How can we encourage a healthy vaginal microbiome that then protects the environment in future from the growth of bacteria / fungi that cause vaginal infection?
• Do we need strategies to grow more of the L crispatus to take up some of the real estate so that there is no room for the infectious bacteria / fungi to live?
• How can we change the environment of the neighbourhood so that infectious bugs / fungi don’t want to live there?
This is where diet changes, specific strain probiotics, specific herbs and nutrients really come into their own. The whole point is to use these to influence the vaginal microbiome to one that is more associated with a healthy vagina. This can lessen the reinfection cycle and all of the trauma that comes with that.
Whilst this blog is primarily concentrating on bacterial and fungal infection like bacterial vaginosis and thrush (candida), it is important to note that the vaginal dysbiosis has also been associated with infertility, HPV infections, and urinary tract infections and is often completely overlooked in these conditions.
Yep, the vaginal environment can have a greater impact that what we give it credit for!
If you think yours is impacting your overall health and quality of life, give me call to see if we can improve it.
– Wendy