The vagina is a very strong, tube-like, extremely elastic muscular organ that connects the external vaginal organs to the uterus. pH in the vagina ranges from 3.8-4.5 (slightly acidic) for most of the menstrual cycle, providing an important barrier to harmful organisms. During ovulation, the pH moves into the 7 plus range, making conditions favorable for conception. The vagina is home to many types of bacteria, most of which belong to the lactobacillus group.
Vaginal health and fertility
Research has increasingly underlined the important influence of the composition and structure of the inhabiting vaginal microbial communities on reproductive health and fertility outcomes.
Bacterial vaginosis (BV) is the most common genital tract disorder in reproductive aged women and is characterized by a shift from a healthy vaginal microbiome – one dominated by acid-producing bacteria (the healthy bacteria, such as lactobacillus) – to a vagina dominated by unhealthy bacteria. The most prominent and often the most disconcerting symptom of BV is a strong fishy vaginal odor, but some women with BV also see increased amounts of discharge that is gray in color.
In infertile women, bacterial vaginosis is three times more common than in fertile women.
BV, and other infections in general, can decrease fertility by:
- increasing inflammation and immune system activity, making a toxic environment for reproduction.
- causing damage to sperm and vaginal cells.
- interfering with the production of healthy cervical mucus during ovulation.
- blocking the Fallopian Tubes through scar tissue damage from infections, so that sperm and egg can’t meet.
Once pregnancy has occurred, bacterial vaginosis is associated with a two-fold increase in risk of preclinical pregnancy loss, sometimes called a chemical pregnancy, following IVF.
For women with BV present during pregnancy, there may be an increased risk of miscarriages, preterm birth, and low birth weight complications for the newborn, as well as postpartum infections.
Paying attention to your vaginal health is an important facet of a lifestyle that promotes healthy fertility. Take notice of any changes you experience. Learn what’s normal for you and what’s not. If you experience changes that worry you, share your questions with your Ob/Gyn. Also, there are a few simple steps to maintain vaginal health and prevent problems in the first place.
How to maintain vaginal health
Use antibiotics only when absolutely necessary
Vaginal health correlates to the presence of good bacteria and antibiotics kill off the good bacteria along with the ones that they are intended to kill. Therefore, antibiotics must be used only when absolutely necessary.
The vagina is, for the most part, self-cleaning. It does not require an intense cleansing routine. Normal vaginal discharge helps to cleanse the vagina, forms a protective barrier, and boosts natural fertility. Still, vaginal changes caused by intercourse, menstruation and hormone fluctuations can benefit from a gentle cleansing routine.
For cleansing, avoid strong soaps; commercial douches or cleansers with artificial fragrances. Essential oils are not suggested either. Instead, use pure water and a small amount of natural vaginal wash for hygiene needs.
An American study from 2018 has revealed that women who smoke show alterations in vaginal microbiome and may have increased susceptibilities to urogenital infections. In addition to all the other problems smoking may pose for yourself, your fertility and the health of your future child, it is yet another reason to stop smoking.
With your diet you can help to protect your vaginal health. Science has shown that any foods that help promote gut health can also help promote a healthy balance of vaginal bacteria. For best effects, combine prebiotics and probiotics in your daily diet. Put simply, prebiotics are fibers that can only be used by our “good”, health-promoting bacteria. Good sources of prebiotics include parsnips, asparagus, garlic, onions, leek, oats, rye. It is not difficult to incorporate these foods into the daily diet. Some examples could be oatmeal or porridge for breakfast, a yummy salad with asparagus tips for lunch and pumpkin parsnip soup in the evening.
Probiotics are special living microorganisms that are resistant enough to survive the digestive process in the stomach and small intestine and to reach the intestine and the vagina in sufficient quantities. Foods that contain many probiotics include yoghurt (with live cultures), kefir, sauerkraut, miso, kombucha, tempeh and kimchi.
You can further support vaginal health by avoiding processed foods, sugars, as well as too much meat and dairy products. On the other hand make sure you get enough healthy fats like those found in nuts, olive oil, and avocados and stay hydrated.
Blaser MJ. Stop the killing of beneficial bacteria. Nature 2011; 476:393–394
García-Velasco JA et al. What fertility specialists should know about the vaginal microbiome: a review. RBM online 2017;35:103–112
Nasioudis et al. Bacterial Vaginosis: A critical analysis of current knowledge. BJOG 2017;124:61-69
Nelson TM et al. Cigarette smoking is associated with an altered vaginal tract metabolomic profile. Sci Rep. 2018 Jan 16;8(1):852.