Historical Aspects, Health Effects, and Care of Vaginal Bacterial Communities
The vagina is a complex and dynamic ecosystem, home to a diverse array of microorganisms collectively known as the vaginal microbiome. This microbiome plays a crucial role in maintaining vaginal health, and variations in its composition can have significant implications for women's wellbeing.
Firstly, it's important to clarify that conditions like BV (bacterial vaginosis) and vulvovaginal candidiasis are not sexually transmitted infections (STIs).
The vaginal microbiome is influenced by a multitude of factors. Key contributors include host genetic factors, hormonal fluctuations, behavior, diet, and environmental influences.
Genetic polymorphisms in immune-related genes, such as TLR2, MBL2, MYD88, and TIRAP, shape microbial diversity and the susceptibility to dysbiosis. This, in turn, influences the microbiome composition and stability.
Hormonal fluctuations throughout a woman's life, such as during puberty, menstrual cycles, pregnancy, and menopause, significantly impact the vaginal microbiome. Estrogen promotes epithelial glycogen, which supports Lactobacillus growth and acidifies the environment, favouring Lactobacillus dominance. Lower estrogen states, like menopause, reduce Lactobacillus abundance and increase diversity, though these shifts reflect physiological responsiveness, not necessarily disease.
Behavioral factors, such as sexual activity, hygiene practices, parity (number of births), and contraceptive use, also correlate with differences in vaginal microbiome structure and stability.
Diet substantially modulates the vaginal microbiome. Higher intake of animal proteins, especially processed and red meats, is associated with vaginal dysbiosis characterized by Gardnerella and Prevotella dominance. Conversely, consumption of α-linolenic acid (plant-based omega-3), carbohydrates, vegetable proteins, fiber, and starch correlate with Lactobacillus-dominated, healthier microbiomes.
Environmental and sociodemographic factors, such as age, stress, and possibly socio-demographic variables, also modulate the vaginal microbiome, though further research is ongoing to clarify these effects.
Maintaining vaginal health involves adopting practices that minimise disruption to the vaginal microbiome. Douching is not recommended as it can change the balance of flora and natural acidity in the vagina, potentially leading to health problems like BV, vaginal irritation, and pelvic inflammatory disease.
Sexual intercourse or other sexual activity can introduce bacteria that can disrupt the balance of vaginal flora, potentially leading to BV or vulvovaginal candidiasis. To prevent this, a person may wish to use barrier methods of protection, such as condoms or dental dams.
Smoking has a detrimental effect on vaginal flora, diminishing lactobacillus and increasing pathogenic bacteria. Consuming probiotic Lactobacillus can help restore and maintain vaginal flora.
Medical treatment is available to restore the balance of vaginal flora (for BV) and to treat vulvovaginal candidiasis (with over-the-counter medications like pessaries). Stress hormones, such as cortisol, can decrease the abundance of beneficial Lactobacilli, causing inflammation and worsening symptoms of vaginal infection.
It's worth noting that the vagina is self-cleaning and does not require any cleaning products. By understanding the factors that influence the vaginal microbiome, women can make informed decisions to maintain their vaginal health.
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