When it comes to vaginal health, there’s no one-size fits all. 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’s doing nothing for your vaginal health (or making a problem worse).
Probiotics are often advertised as a cure-all for health issues, from digestion to skincare and even vaginal infections like bacterial vaginosis (BV) or yeast infections. So you’re not alone if you’ve hoped that a probiotic supplement may be all you need to make your symptoms like odor or unusual vaginal discharge go away.
But how do probiotics help vaginal health? We rounded up the available (albeit minimal and conflicting) research to dig into the nuance of probiotics, including which ones target vaginal health and who might benefit from using them.
What are vaginal probiotics?
Probiotics are live bacteria you can consume or administer to yourself (as food, a pill, topical, or a suppository) to support your microbiome health. Vaginal probiotics are simply probiotic supplements specifically designed to support the vaginal microbiota. You can find them sold as oral tablets or suppositories that can be inserted vaginally.
You may have heard that probiotics can be really beneficial for your gut health. It’s important to note that probiotics designed for the gut have different strains of bacteria than those meant to support vaginal health. The most common strains of bacteria found in “women’s health” focused probiotics belong to the Lactobacillus and Bifidobacterium genera. These are some of the same species of bacteria also naturally found in fermented foods (think yogurt, kombucha, kimchi, etc.).
There are also “prebiotics,” which are non-living compounds that act as a food source for the bacteria that live in your body. Some products, called synbiotics, combine both prebiotics and probiotics.
How do probiotics help vaginal health?
Your vagina has a unique microbiome –– a complex ecosystem of organisms (some good, some not as much), including bacteria and fungi. Your vaginal microbiota can shift over time due to several factors, including sex, your period, and medication. Sometimes, those changes lead to decreased lactobacilli, allowing harmful bacteria and disruptive pathogens to overgrow and changing your normal vaginal flora. This is called vaginal dysbiosis.
Probiotics work by promoting the growth of protective bacteria, such as Lactobacillus, in the vaginal microbiome, which helps prevent dysbiosis or fighting back against these disruptions in a few ways:
- Lactobacilli can physically attach themselves to the surfaces in your vagina, taking up space so that less-desirable microbes can't live there too.
- Lactobacilli produce lactic acid and keeps the vaginal pH acidic. The acidic environment keeps out some less desirable microbes since they prefer neutral surroundings.
- Lactobacilli can also produce molecules that attack and kill other potentially harmful microbes nearby.
Lactobacillus are the local heroes of your vaginal microbiome, and probiotics may help to promote them so they can do their thing.
What probiotics are good for vaginal health (oral vs vaginal)?
Investment in human microbiome research has increased significantly in the last decade. As a result, you might have heard people talking more about the benefits of probiotic supplements or fermented foods. While these types of probiotics can be beneficial for your gut microbiome, several studies have concluded that taking oral probiotics probably won't have much of an impact on your vaginal flora.
Another issue is that there are millions of probiotic strains, and no two vaginal microbiomes are the same, which makes researching probiotics' effect on vaginal bacteria pretty tricky. Ultimately, we need more high-quality, placebo-controlled research on which probiotic strains are effective in maintaining vaginal health (and at which doses).
This doesn't mean that all oral probiotics are totally useless for the vaginal microbiome, though. Some studies suggest that taking oral probiotics with a high dose of bacteria over an extended period may help.
Excitingly, there may also be more efficient approaches in the form of vaginal suppositories or other direct applications. Because bacteria are administered directly into the vaginal canal, they are less likely to die before colonizing — which can happen when probiotics have to journey from all the way through the digestive tract to get to the genitals.
One way to access medical grade vaginal probiotics is through Evvy’s Clinical Care programs, which may include compounded vaginal probiotic suppositories if an Evvy-affiliated provider prescribes them in your treatment plan.
When should I consider using vaginal probiotics?
Although there’s no consensus on whether probiotic supplements can improve the balance of your vaginal microbiome, existing research shows that there are specific instances in which using a vaginal probiotic could be beneficial.
- After taking antibiotics: If you take antibiotics (orally or vaginally), it’s possible that the antibiotic can mess with your vaginal ecosystem. While antibiotics are excellent for clearing out vaginal infections like bacterial vaginosis or urinary tract infections, they can kill both bad and good bacteria. Probiotics can save the day by helping replenish the beneficial bacteria that may have become diminished from antibiotic treatment.
- If you have BV: If you’re dealing with chronic bacterial vaginosis, probiotics may become your new best friend. A clinical study from 2010 showed that after oral antibiotics, once-a-week vaginal treatment with Lactobacillus rhamnosus for six months helped keep BV symptoms from returning for one year. Another 2010 study also saw that just five 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 BV in conjunction with traditional antibiotic treatment. It’s something worth asking your gyno about if you are struggling with recurrent bacterial vaginosis.
Most people don't need to do anything special to keep their vaginal health in check. Your vagina is pretty good at fixing itself if anything goes out of whack — that's precisely what the vaginal microbiome is there for.
That said, if you're someone who deals with recurrent yeast infections or BV on a regular basis, taking a probiotic might give you a better chance of preventing these uncomfortable and unpleasant conditions. As we said above, everyone's vaginal environment is unique, so treatment and prevention should be designed with your provider and tailored to your specific needs.
When should I not take probiotics?
Even though probiotics can be a great addition to your vaginal health toolkit, they aren’t necessarily suitable 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.
People who have been diagnosed with cytolytic vaginosis (CV) should also stay clear of 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 vaginal discharge (frustratingly, many of the same symptoms as bacterial vaginosis 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.
Taking an Evvy vaginal microbiome test is a great first step to determine the levels of lactobacilli in your vaginal microbiome.
How to choose a vaginal probiotic
In general, when choosing a probiotic, look for one that includes a probiotic combination of Lactobacillus strains that 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 human trials:
- Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
- Lactobacillus rhamnosus HN001, Lactobacillus acidophilus GLA-14 + lactoferrin
All of Evvy’s probiotic options through Clinical Care with Evvy contain strains optimized for the vaginal microbiome.
Keep in mind that products classed as “supplements” in the U.S. aren’t regulated by the FDA, so many other brands take advantage of this and embellish the efficacy of their probiotics.
If you’re looking for an OTC option, two of the brands we typically recommend are Optibalance Probiotic (contains dairy) and RepHresh Pro-B Probiotic, but your OBGYN is the best person to ask about probiotics. So, if you're considering taking one, it's always a good idea to check with your healthcare provider first. They can help you decide if it's right for you and how to take it safely as a supplement.
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, and if so, connect you with a provider who can prescribe the most effective vaginal probiotic for you. Finding the best probiotic routine for you may take some trial and error, but we’re here to help every step of the way!
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 vaginal microbiome test can give you a comprehensive report of 700+ bacteria and fungi in your microbiome, including all strains of lactobacilli, and their relative amounts (meaning you can see how much of each type of bacteria/fungi you have.) This can help illuminate your levels of protective bacteria and whether a probiotic might be beneficial! Remember, there are cases when probiotics can make irritation worse, so having a microbiome report can help guide your decision.
If you’re eligible for Clinical Care with Evvy, a provider will review your results and determine a custom set of treatments for you. This can include prescription medication and research-backed supplements, like probiotics.
Because our probiotics are prescribed by a doctor, they can come in both an oral pill and a vaginal suppository format. If you’re prescribed a vaginal probiotic suppository, that means those helpful lactobacilli strains can make it straight to your vaginal microbiome without a trip through your gut!
FAQs
What do vaginal probiotics do?
Some research shows that taking probiotics might help support your vaginal health by promoting the protective bacteria in the vaginal microbiome, mainly lactobacilli. This can help restore the vaginal pH, keeping infections and uncomfortable symptoms at bay, but more research is needed to determine how effective this strategy is.
Will vaginal probiotics cure BV?
There’s no evidence that probiotics are effective for treating BV. The only proven treatments for BV are antibiotics. That said, some studies show that taking Lactobacillus-based probiotics in combination with antibiotics can reduce the likelihood of BV coming back after treatment (which it has a habit of doing). That said, it’s still an emerging area of research!
Fact check: can putting yogurt in your vagina help vaginal health?
No — putting yogurt in your vagina can cause more harm than good. While yogurt does contain probiotics, the sugars in yogurt can actually feed bacteria and yeast present in your vagina. Most store-bought yogurts also don’t have a measurable amount of lactobacilli. Just remember: nothing should go into your vagina that was not designed specifically for that purpose!
