INTIMATE CARE Its composition depends on factors like
genes, age, ethnic background, environment and hormone levels. It is also influenced by the menstrual cycle, sexual partners and lifestyle factors. Interestingly, differences in the microbiota can especially be seen between different ethnic groups. In childhood, the vaginal microbiome is mainly
made up by anaerobic microbiota and a mix of skin and gut microbes. With the rise of estrogen levels during puberty and the preparation for potential pregnancy, glycogen is accumulated in the vaginal epithelium. This aids the growth of microorganisms like Lactobacilli, that metabolize glycogen to glucose and lactic acid. With lower estrogen levels in (post-)menopausal women, glycogen is less available, decreasing the number of Lactobacilli. This can result in less protection from pathogenic organisms.9
Different types of vaginal microbiomes Lactobacilli are the cornerstone species for the vaginal milieu of women of childbearing age. The most dominant species are the facultative anaerobic Lactobacillus crispatus, L. gasseri, L. iners and L. jensenii. Other, anaerobic species are Prevotella, Dialister, Atopobium, Gardnerella, Peptoniphilus and Megasphaera. Lactobacilli protect the vaginal flora
from harmful microorganisms, that could trigger bacterial, fungal and viral infections. They produce antibacterial compounds like bacteriocins as well as the powerful antiseptic agent hydrogen peroxide (H2
O2 ), lactic acid, a
potent bactericide and virucide, bacterozines. The formation of biofilms, the competition for nutrients or the modulation of the immune system are used to inhibit pathogenic microbes.10 Lactic acid is responsible for the low, i.e.
acidic, vaginal pH, which is usually defined as normal between 3.8 - 4.4.11
In comparison: The
average pH of saliva is 6.7 and the different parts of the gut are between 5.7 and 7.4.12,13 The vaginal pH varies between women of
different ethnic backgrounds: Hispanic and black women have a higher vaginal pH of 5.0 and 4.7, compared to Asian (4.4) and white women (4.2). This can be explained with different genes, differences in the innate and adaptive immune systems, sexual behaviors, hygiene, etc.14 While every woman has her own unique vaginal microbiome, research found five major
7.3% 19.8% IV 25% II 5.2% 42.5% III I 10.3% 45.5% 26.8% 8.2%
Figure 2: The ethnic differences in the vaginal microbiome25 Asian (96)
www.personalcaremagazine.com White (97) Black (104) Hispanic (97) May 2023 PERSONAL CARE II III 31.4% III I IV 40.4% IV II 4.8% V
■ L. crispatus ■ L. gasseri ■ L. iners ■ Diversity group ■ L. jensenii
27% 5%
27% 6% 35%
79
Figure 1: The distribution of Community-State Types24,25
types of microbial communities. These so-called ‘Community-State Types’ consist of different amounts and species of Lactobacillus. Four of the types are dominated by Lactobacilli, the fifth is more by anaerobic species (Figure 1). Ethnic differences are also seen here; the
vaginal microbiome of Asian and white women is mainly dominated by Lactobacilli, which is not necessarily the case for black and Hispanic women, who seem to have a more anaerobic flora (Figure 2). This also leads to the above- mentioned differences in pH levels.15
Factors that disrupt microbial balance The vaginal microbiome is healthy, when it is in balance or homeostasis. Yet everything that comes in contact with this fragile ecosystem, can potentially cause disruption, leading to dysbiosis and unwanted symptoms. This includes things like tampons, menstrual pads, lubricants, intimate showers, lotions, parfums, underwear (shape and fabric), sexual partners, condoms, sex toys, as well as less obvious factors like antibiotics, medicines, hormonal contraceptives, smoking, stress etc.
The results of a dysbiotic vaginal microbiome With the Lactobacilli’s antimicrobial defenses, the vaginal microbiome in its natural state can fend off pathogenic invaders. If, however, the microbial equilibrium is disrupted by the above- mentioned factors, the number of beneficial microbes decreases and pathogenic organisms like Gardnerella vaginalis and Atopobium vaginae can grow.15
V 1% 9.3% V 22.1% 38.1% 36.1% III IV I This can result in the most common dysbiotic
state in women of reproductive age: Bacterial vaginosis. This condition is characterized by itching, unusual discharge, fishy odour, and burning and can lead to reproductive health problems like pelvic inflammatory disease, sexually transmitted infections, preterm birth, low birthweight, miscarriage and maternal and neonatal infections. Other common diseases related to microbial dysbiosis are vaginal candidiasis or yeast infections and urinary tract infections.16
The dangers of the most common treatment Despite the vast knowledge about their damaging effects, to this day, one of the most common forms of treatment, is antibiotics. When antibiotics travel through the body, they do not only impact the microbes in the targeted body site, but also those they meet on the way. As they cannot distinguish between pathogenic and beneficial organisms, both get killed. Another downside of antibiotic use is the
adaptive nature of bacteria. In order to survive, they can develop antibiotic resistance. After a treatment with antibiotics, the remaining bacteria can transfer their antibiotic-resistant genes to other species, possibly creating multi-resistant superbugs. They also proliferate more easily, as the beneficial bacteria that usually keep them in check have been killed off. This often leads to a reoccurrence or worsening of symptoms. Every course of antibiotics weakens or wipes out the microbiome. Starting a dangerous vicious cycle, where a symptom is being treated with
V 4.1% 14.4% II 7.2% I
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119
