Introduction

The vaginal microbiome is made up of billions of microorganisms that work together to maintain vaginal health. Among the most important are Lactobacillus bacteria, which help create a protective environment and support the natural balance of the vagina.

When Lactobacillus levels are reduced or disrupted, the vaginal microbiome may become less stable. This can be associated with symptoms such as recurrent bacterial vaginosis (BV), recurrent thrush, irritation, changes in discharge, or ongoing vaginal discomfort.

Understanding Lactobacillus and its role within the vaginal microbiome is an important step in understanding recurrent vaginal symptoms.

What Is Lactobacillus?

Lactobacillus is a group of beneficial bacteria commonly found in a healthy vaginal microbiome. Different species of Lactobacillus play different roles in supporting vaginal balance.

Common vaginal Lactobacillus species include:

• Lactobacillus crispatus

• Lactobacillus jensenii

• Lactobacillus gasseri

• Lactobacillus iners

The types and amounts of Lactobacillus present can vary between individuals and may also change due to factors such as hormones, menstrual cycles, sexual activity, medications and other individual factors.

What Does Lactobacillus Do?

Lactobacillus helps maintain a healthy vaginal environment in several ways.

Maintains an acidic vaginal pH

Many Lactobacillus species produce lactic acid, which helps maintain a lower vaginal pH. This acidic environment can make it less favourable for the overgrowth of certain microorganisms associated with vaginal dysbiosis.

Supports the vaginal microbiome

Lactobacillus contributes to a balanced microbial environment by occupying space and using available nutrients within the vaginal ecosystem.

Supports natural protective mechanisms

A healthy Lactobacillus-dominant microbiome is associated with vaginal health and may help reduce the likelihood of microbiome imbalance.

What Happens When Lactobacillus Levels Are Low?

A reduction in Lactobacillus can be associated with changes in the vaginal microbiome.

Some women may experience:

• Recurrent bacterial vaginosis (BV)

• Recurrent vaginal thrush

• Changes in vaginal discharge or odour

• Vaginal irritation or discomfort

• Persistent or recurring symptoms despite treatment

Low Lactobacillus does not always mean a person will experience symptoms, and symptoms can have multiple causes. Understanding the broader clinical picture is important.

Why Does Lactobacillus Become Disrupted?

Many factors may influence the vaginal microbiome, including:

• Antibiotic use

• Hormonal changes

• Menstrual cycle changes

• Sexual activity

• Menopause

• Underlying vaginal conditions

• Individual variations in the microbiome

Research into the vaginal microbiome continues to evolve, and our understanding of Lactobacillus and its different species is continually developing.

Can Lactobacillus Levels Be Restored?

The approach to managing vaginal symptoms depends on the individual, the underlying cause and the overall clinical picture.

For women experiencing recurrent symptoms, a comprehensive assessment may involve reviewing symptom history, previous investigations, past treatments and factors that may be contributing to ongoing imbalance.

How I Can Help

I am Kylie Sayce, a Nurse Practitioner with a special interest in recurrent vaginal symptoms, sexual and reproductive health, and the vaginal microbiome.

Many women who come to my clinic have:

• Experienced recurrent bacterial vaginosis (BV) or thrush

• Completed multiple courses of antibiotics or antifungal treatments

• Been told their tests are “normal” but still have symptoms

• Seen multiple healthcare providers without finding clear answers

My approach focuses on understanding your individual history, reviewing previous investigations, considering possible contributing factors and developing an evidence-based management plan tailored to your situation.

If you are experiencing recurrent vaginal symptoms or ongoing concerns about your vaginal health, you can book a consultation to discuss your symptoms and explore the next steps.

Key Takeaways

• Lactobacillus is an important part of the vaginal microbiome.

• It helps maintain a healthy vaginal environment through the production of lactic acid and supporting microbial balance.

• Reduced Lactobacillus may be associated with recurrent vaginal symptoms.

• Vaginal symptoms can have multiple causes, and assessment should consider the whole clinical picture.

• Management should be individualised based on symptoms, history and investigation findings.

Medical Disclaimer

This information is intended for educational purposes only and does not replace individual medical advice, diagnosis or treatment. If you are experiencing symptoms, please seek personalised advice from an appropriately qualified healthcare professional.