Highlights from this article
- Probiotics are live bacteria that support your microbiome health. They come in the form of food, pills, or suppositories.
- Probiotics can help to reintegrate protective bacteria, like lactobacilli, when the vaginal microbiome has been disrupted.
- Direct application of probiotics to the vagina (i.e. suppositories) have been shown to be more effective for vaginal health compared to oral probiotics like food or pills.
- If you’re taking antibiotics, have bacterial vaginosis (BV), or think you may benefit from using probiotics, speak to your doctor and make sure to test your vaginal microbiome before taking them. Sometimes you don’t need them—and there can be too much of a good thing!
When it comes to vaginal health, there aren’t many magic bullets. Everyone’s vaginal microbiome is unique, meaning that what works for some people might not be right for you. And nothing is more frustrating than spending money on something that is actually doing nothing (or making a problem worse!).
Probiotics have been advertised as a cure-all for health issues, from vaginal infections to digestive and skincare issues. So you’re not alone if you’ve hoped that a probiotic may be all you need to make your pesky vaginal symptoms go away . We rounded up the latest research to dig into the nuance of probiotics, including which ones target vaginal health and who might benefit from using them below.
What are probiotics?
Probiotics are live bacteria that you can consume or administer to yourself (either in the form of food, a pill, topically, or as a suppository) in order to support your microbiome health. Typically, probiotics are sold for gut health, which all makes sense if taken orally! But unfortunately for people with vaginas, the options for vaginal probiotics tend to be scarce. And it’s important to remember that probiotics designed for the gut likely have different strains of bacteria than those meant to support vaginal health. The most common strains of bacteria found in women’s health probiotics belong to a genus of bacteria called Lactobacillus and Bifidobacterium. They’re also naturally found in fermented foods (think yogurt, kombucha, kimchi, etc.).
There are also “prebiotics”, which are non-living materials that probiotic bacteria consume. Some products, called synbiotics, combine both prebiotics and probiotics. Wondering about the difference between prebiotics and probiotics? We have a whole article on it!
What can probiotics do for my vagina?
Your vagina has a unique microbiome––a complex microcosm of organisms, including bacteria and fungi. Your vaginal microbiome can shift over time due to a number of factors including sex, hormone fluctuations, and using vaginal products. Sometimes those changes lead to a decrease in lactobacilli (protective bacteria), which then allows disruptive pathogens to overgrow. This is called vaginal dysbiosis.
Which brings us back to probiotics, as they can help to prevent or fight back against these disruptions in a few ways.
First, probiotic bacteria such as Lactobacillus can physically attach themselves to the surfaces in your vagina, taking up space so that less-desirable microbes can't live there too.
Second, Lactobacillus makes the environment in your vagina more acidic by producing lactic acid. The acidic environment keeps out some less-desirable microbes, since they prefer neutral surroundings. (Need a review on the pH scale and the difference between acidic vs. basic? Check out our post on vaginal pH for more info!).
TL;DR: Lactobacillus are the local heroes of your vaginal microbiome and probiotics help to reintroduce them so they can do their thing.
Which kind of probiotics should I take (oral vs vaginal)?
As investment in microbiome research has increased dramatically over the last decade, you may be hearing more chatter or getting advice to take a probiotic supplement or increase your yogurt intake.
It’s not that they can’t have an effect: some studies show an effect on the vaginal microbiome when oral probiotics with a high dose of bacteria are taken for a long period of time. It’s likely just not the most efficient approach.
That is why vaginal suppositories or other direct applications are currently being tested. Because bacteria are administered directly to the body part you’re targeting, there is less risk of them dying along the way. (This can happen when probiotics have to journey all the way from the digestive tract to the genitals). Unfortunately, these products are still being tested and are not currently approved for use in the US.
Some people follow the direct application method by putting yogurt directly in the vagina, but this can actually cause more harm than good. While yogurt does have probiotics, the sugars in yogurt can actually feed bacteria. Most store bought yogurts also do not have a measurable amount of lactobacilli. So we suggest keeping yogurt for your smoothies and sticking with suppositories made for vaginal use!
What bacteria should be in the probiotic?
Lactobacillus bacteria are the ‘it’ girls of most vaginal probiotics. To put this into context, as of 2019, 22 vaginal probiotics evaluated across 34 clinical studies all contained Lactobacillus. That being said, researchers are still figuring out which specific types of Lactobacillus might be best. (This is the exact kind of research question Evvy is working towards being answered to close the gender health gap!)
When should I consider using vaginal probiotics?
Existing research shows that there are specific instances in which using a vaginal probiotic can improve the balance in your vaginal microbiome.
- After taking antibiotics: If you take an oral antibiotic, or have an antibiotic directly applied to your genital area, it’s possible that the antibiotic can mess with your vaginal microbiome. While antibiotics are great for clearing out bacterial infections, like BV, UTIs, or even a sinus infection, many antibiotics broadly destroy lots of bacteria, without sparing the good ones. Probiotics can come in and save the day by helping replenish the good bacteria that may have become diminished from antibiotic treatment.
- If you have bacterial vaginosis (BV): If you’re dealing with the nightmare that is bacterial vaginosis (BV), probiotics may become your new best friend. A clinical study published in 2010 demonstrated that after oral antibiotics, once-a-week vaginal treatment with Lactobacillus rhamnosus for 6 months helped keep BV signs from returning for one year. Another study from 2010 also saw that just 5 days of treatment with a vaginal probiotic after antibiotic treatment helped keep BV symptoms away longer. While more clinical trials are needed, the research currently suggests that lactobacilli-containing vaginal probiotics have promise for preventing and treating BV. It’s definitely something worth asking your gyno about if you are struggling with BV.
When should I not take probiotics?
Even though probiotics can be a great addition to your vaginal health toolkit, they aren’t necessarily right for everyone. If you already have a high amount of vaginal lactobacilli, then adding more may actually cause irritation. In the world of microbiomes, you can have too much of a good thing! Taking an Evvy test is a great first step to determine the levels of lactobacilli in your vaginal microbiome.
Speaking of which, people who have cytolytic vaginosis (CV) should also not take probiotics. CV is caused by an overgrowth of lactobacilli, which causes unpleasant symptoms like pain while peeing or during sex, itching or burning, and increased discharge (frustratingly, many of the same symptoms as BV and yeast infections).
CV is treated by decreasing the amount of lactobacilli in your system, and since probiotics do the opposite it’s best to stay away.
Recurrent symptoms? Meet Evvy's at-home vaginal microbiome test, approved by leading OB-GYNs.
Does Evvy recommend probiotics? And if so, which ones?
Evvy recommends talking to your doctor about probiotics only if you need to increase protective bacteria (specifically the most optimal strains of lactobacilli) in your vaginal microbiome. An Evvy test can give you a report of which specific microbes are in your microbiome, and you can bring the results to your doctor to discuss the best next steps. Remember, there are cases when probiotics can make irritation worse, so having a microbiome report can help guide your decision!
When selecting a probiotic, consider those that include strains which specifically target the vaginal microbiome. Research suggests that brands that include one of the two combinations would be most effective, based on the results of these strains in trials:
Probiotics are not one-size-fits-all but two of the brands we typically recommend are Optibalance Probiotic (contains dairy) and RepHresh Pro-B Probiotic. Your GYN is the best resource for vaginal suppositories and topicals. Anecdotally, some people say you can break open the probiotic, put it in a veggie capsule, and then insert it vaginally but there is no research or clinical data to back up the effectiveness of this strategy.
Finding out more about your vaginal microbiome with an Evvy test can take some of the guesswork out of whether or not you would benefit from using probiotics. It may take some trial and error to find the best probiotic routine for you, but we’re here to help every step of the way!