Welcome to the Vagibiome! Understanding it will upgrade your health.

With permission, we have copied Kate Muir's article on substack about our testing service.  Original article can be found here: Welcome to the Vagibiome!

A powerful ecosystem

How exciting is it to discover a thriving, powerful ecosystem in your body that you had no idea existed? I certainly didn’t know the phrase ‘vaginal microbiome’ until a few years ago, and it’s been a joy to discover what it does and how we can control it. The vaginal microbiome is pictured above in all its complex, microscopic glory - and it’s about to provide us with a ocean of knowledge about women’s health.

The vaginal microbiome, or vagibiome for short, has received a great deal less attention than the gut microbiome (much ballyhooed by Professor Tim Spector and his Zoe app), and that’s probably because only half the planet has a vagibiome, and it’s all a bit embarassing. But today on Substack, we’re bringing the vagibiome out of the darkness of the crotch into the light, and celebrating its wonders.

The comic phrase ‘lady garden’ turns out to be almost accurate: the vagibiome is basically a constant bacterial party going on in your whole vulva area, and the key is to keep your good, protective Lactobacilli bacteria thriving, so they stop pathogenic bacteria like E.coli and Streptoccocus taking over. Those bad bacteria can cause urinary tract infections, discharge and bacterial vaginosis (here are some evil e-coli below, with those spiky ‘flagella’ which help them to move.)

Analysing the good and bad bacteria that live in women’s vulvas, vaginas, and urethras - the playground of the biome - is changing how we diagnose and treat many conditions – common urinary tract infections, infertility, risk of miscarriage, menopause and even cancer.

It's war down there... 

The good bacteria are lactobacilli - including lactobacillus crispatus, rhamnosus, gasseri, jensenii and others.  These are lactic acid-producing bacteria that lower the surrounding pH in the vagina. E-coli and other bad bacteria prefer an alkaline environment, and the acid keeps them at bay and thus helps prevent UTIs.  Basically, it’s war down there, and if you regularly take antibiotics for urinary tract infections, you’re killing large numbers of the good lactobacilli, and you need to reintroduce them, either by taking lactobacillus probiotic pills or eating foods like yogurt, kefir or kimchi.

The Vaginal Microbiome 

All my life, until menopause, I’d suffered from cystitis and urinary tract infections, and taken tons of antibiotics.  But after menopause, taking steady Hormone Replacement Therapy seemed to improve things, and the addition of topical vaginal oestrogen gel helped even more. Oestogen feeds glycogen which provides fuel for the lactobacilli.  It keeps the microbiome party going. The decrease in oestrogen levels associated with menopause causes a sudden rise in UTIs among women, so it makes sense to top up. Vaginal oestrogen is incredibly low dose and safe for everyone, including women who have had breast cancer.  Collagen in the skin everywhere goes down by 30% in the first few years of menopause, so estrogen cream is key, and free on the NHS. Think of it as ‘Chanel for your Vagina’.

MHRA's promotion of the vaginal microbiome 

I spoke to Eleanor Gardner, CEO and founder of Pelvic Relief, who had a lightbulb moment about all this back in 2014 when she set up the company. She is pleased that the UK Medicines and Healthcare regulatory Agency (MHRA) has now picked up on using vaginal microbiome tests for precision medicine to diagnose conditions from infertility to cancer. (Low levels of beneficial bacteria in the microbiome seem to put women at higher risk of miscarriage and infertility - link.)

Obviously we occasionally need antibiotics to see off a UTI, but prevention is much better than mass destruction of the vagibiome.  Eleanor explained to me about the harm constant antibiotics can do: ‘If you were looking at a flowerbed and saw one stinging nettle, would you blast the whole thing with weedkiller? That’s what we’re doing when we use antibiotics to stop UTIs.’

She is excited by the growing web of health connections to the vaginal microbiome. ‘It has huge implications in fertility.  Bad bacteria really impact fertility, plus they cause BV (bacterial vaginosis) and thrush, chronic infections which are often wrongly treated.  They impact PCOS and endometriosis too.  Analysing the bacteria could be a powerful tool for personalised, non-invasive treatment and earlier diagnosis.’

This is brilliant, and the MHRA is not just interested in the vagibiome as a personal information bank on women’s health, but is also working on ways to support microbiome-based approaches to fight antibiotic-resistant infections. Saba Anwar, a senior scientist at the MHRA said, ‘With the right tools, we can move away from a ‘one-size-fits-all’ approach and towards truly personalised women’s healthcare. This is a major opportunity to address long-standing inequalities in how women’s health is understood, diagnosed, and treated.’

Kate's testing experience. 

So let’s go from the political to the personal now, and take a deep dive into my vagibiome (sometimes I wonder how far I’ll go for investigative journalism, but bear with me).  Here’s the test box (below), with a vaginal swab stick and a pH test.  It took two weeks for my results to arrive, and you’re also given a consultation afterwards with a pelvic health specialist, in my case Jessica Childs.  We went through my results, and perhaps for the first time in my life I can say it was pretty much A-stars all round.My pH was 4.7, acidic enough, though 4.5 would have put me in the smugly perfect zone. But my score for beneficial bacteria was…100%.  Round of applause. I had no evil ‘opportunistic’ bacteria at all.  They also told me which Lactobacilli strains were present - I had nearly four million of the good Lactobacillus crispatus, and 30,000 plus of good Lactobacillus mulieris. (Interestingly, different ethnicities and communities have different dominant bacteria.)

Jessica explained that, ‘Unlike the gut microbiome, where you want diversity, the vaginal microbiome is in really good health with just a few dominant strains’.  That’s me with my friendly crispatus.  She wasn’t surprised to hear I had been using vaginal oestrogen for years. ‘Oestrogen is such a big driver of health in the vagina - there are receptors everywhere, plus good nutrition is also helping your microbiome to thrive.’ Jessica is also a nutritional therapist and keen on the probiotic Ks - Kefir, Kimchi, Kombucha etc, and lots of live yogurt.  She also explained that sperm carries its own microbiome, and it’s alkaline, which can sometimes unbalance the vagibiome and cause UTIs. (That instinctive business of drinking a pint of water after sex to avoid cystitis now makes sense.)

Jessica explained the bladder has its own microbiome too.  It wasn’t long before we’d gone from discussing the gut-brain axis into revealing the powers of the vaginal-brain axis, the existence of which, frankly, I’d always suspected. ‘Some papers have suggested the imbalance in the vaginal microbiome is linked to increased anxiety,’ said Jessica. Here’s a paper about mental health in perimenopause and the vagibiome. 

Even if you can’t afford to take a test to find out exactly what’s going on, and which bacteria are missing and could be encouraged or ‘seeded’ with lactobacillus probiotics, you can still consider vaginal oestrogen (even before menopause) and eating vagi and gut-friendly foods.  With this knowledge a whole generation will be empowered and able to take action, unlike our mothers’ generation who suffered, unheard and often untreated.

The vagibiome is very much a feminist issue, and we should talk about it more, publicly.  But if you put ‘vaginal microbiome’ or ‘vaginal oestrogen’ on social media, Meta’s algorithm will often ‘disappear’ or downgrade the post as sexual - when it’s an essential part of discussion of women’s bodies.  The censorship of the language around women’s health is a scandal, and I’m glad there’s space on Substack to speak the whole truth. Welcome to the vagibiome.

Thanks so much to Kate Muir for writing about our Vaginal Microbiome testing service and the wonderfully termed ‘vagibiome’.   Kate is a Writer & Filmmaker, and an educational journalist covering all things women’s health on her substack here: Substack.com/@katemuir