In January this year I wrote about cystitis and other urinary tract infections and how probiotics and cranberry could be useful for prevention and treatment of such conditions.
Three other common genitourinary complains in women are vaginal thrush, vaginitis and vaginosis.
* Vaginal thrush usually occurs due to over proliferation of yeast in the vagina, most commonly Candida yeast, for this reason vaginal thrush is often known as Candidiasis.
* Vaginitis involves inflammation of the Vagina. It is usually caused by a disruption in the normal chemical balance of the vagina or from infection by detrimental microorganisms (bacteria, virus and yeast). However, the chemicals found in perfumed soaps, laundry detergents and fabric softeners can also cause or aggravate the condition. Vaginitis is usually characterized by a vaginal discharge and may be accompanied by itching and irritation.
* Vaginosis usually involves a disruption in the normal bacterial and yeast balance in the vagina and is characterized by increased vaginal discharge (which is often odorous) without inflammation, sometimes there is itching.
Normally a healthy vagina contains mainly lactobacilli bacteria, ‘friendly’ or beneficial bacteria, which protect it from invading pathogens (detrimental bacteria) such as those which cause urinary tract infections, thrush and vaginitis. A healthy digestive system will also be dominated by a variety of different non-pathogenic bacteria. If the vagina and digestive system are mainly colonised with ‘good’ bacteria these provide a barrier to the entry of pathogenic/harmful bacteria into the vagina. Personal hygiene is important to protect against vaginal infections since bacteria from the anal area may enter the vagina during sex or when wiping after a bowel movement (this is why women are always taught to wipe from front to back).
Women diagnosed with thrush, vaginitis or vaginosis are normally prescribed oral or vaginal antibiotics or anti-yeast agents. However, these kinds of treatments are associated with frequent recurrences of the condition and there is growing concern over antibiotic resistance. The antibiotics may clear up the original infection but they also tend to destroy all the good bacteria in the vagina and/or digestive system and therefore disrupt the bacterial balance in the reproductive and digestive systems, this often exacerbates the issue or leads to quick recurrence of the condition.
Studies now show that probiotic supplements or foods may be helpful in order to boost the number of good bacteria in the vagina and digestive system. The evidence for the use of probiotic supplements and vaginal suppositories in the treatment and prevention of vaginal thrush and vaginitis in women is still preliminary but ever growing. There is a lot of logic behind the rationale and in practice many women, especially those who have undergone repeat antibiotic treatment, find probiotics to be really helpful in preventing recurrence and treating these conditions.
Probiotic creams, vaginal suppositories and tablets are readily available, they usually contain the bacteria lactobacillus acidophilus. Oral probiotics (and prebiotics) may also be useful in order to help keep an overall balance of good bacteria in the vagina and digestive and system.
Even over ten years ago the benefits of eating unsweetened ‘live’ natural yoghurt was known to help prevent and treat vaginal infections. Yoghurt was also used by women vaginally to help clear up thrush. In 1992 a study (1) assessed whether daily ingestion of yogurt containing Lactobacillus acidophilus (a probiotic yoghurt) could prevent vaginal yeast/candida infection (thrush). Women with recurrent vaginal candidiasis received a yogurt-free diet for 6 months and a yogurt-containing diet for 6 months. A threefold decrease in vaginal candida infections was seen when patients consumed yogurt containing Lactobacillus acidophilus. Eating a daily yogurt containing Lactobacillus acidophilus decreased candidal yeast colonization and infection.
Research has continued to show the benefits of probiotics in the prevention and treatment of vaginal infections. A recent laboratory study (2) found that a probiotic (lactobacillus) bacteria could attach well to vaginal and cervical cells and could also prevent the growth and multiplication of vaginosis associated bacteria and yeast. The authors of the study suggest that probiotic vaginal suppositories or oral supplements containing lactobacilli could be really useful in maintaining the normal composition of vaginal bacteria or re-colonising the vagina with these friendly bacteria after infection.
Another recent study (3) looked at the use of probiotic lactobacilli in conjunction with a commonly prescribed anti-fungal treatment (fluconazole) for the treatment of vaginal candidiasis (yeast infection). The study involved 55 women diagnosed with vaginal candidiasis who exhibited vaginal discharge and at least one further symptoms e.g. itching and burning vaginal feeling, dyspareunia (pain during sex) and dysuria (painful urination). The women were treated with a single dose of fluconazole and then supplemented every morning for the following 4 weeks with either two placebo capsules or two probiotic capsules. After 4 weeks the group who were taking the probiotic showed significantly less vaginal discharge associated with any of the other symptoms as well as a lower presence of yeast. The authors of the study conclude that probiotic supplements can increase the effectiveness of an anti-fungal pharmaceutical agent in treating vaginal disease.
There are many other recent studies (e.g. 4,5,6,7) which indicate that oral probiotic supplements and vaginal probiotic suppositories are very helpful in the treatment and subsequent prevention of vaginitis, vaginosis and vaginal thrush. As mentioned previously, such probiotic supplements, vaginal creams and suppositories are widely available to buy. These may be particularly useful after receiving antibiotic or anti-fungal treatment. Women who frequently suffer from thrush or other vaginal infections may wish to take a daily probiotic and prebiotic supplement in order to prevent further problems.
Women who are suffering with vaginal thrush, vaginosis or vaginitis are usually recommended not to use tampons since they can often aggravate symptoms. Also, some women are affected by the bleach and other chemicals that are frequently found in tampons. These chemicals can affect the normal bacterial/yeast balance in the vagina and make some women more susceptible to vaginal infection.
Recently I came across a nifty alternative to regular tampons and sanitary towels, called the Mooncup. Makers of the Mooncup say that it will not cause irritation and is suitable for women with sensitive skin, thrush, eczema or allergy.
The Mooncup is a reusable menstrual cup around two inches long and is made from a special medical grade non-allergic silicone. It is worn internally like a tampon but collects menstrual fluid rather than absorbing it. Unlike tampons the Mooncup is not a disposable product, so you only need to buy one. The Mooncup contains no bleaches, deodorisers or absorbency gels and does not interfere with your healthy vaginal environment, nor has it been associated with toxic shock syndrome. For more information take a look to see if the Mooncup is something you might like to try.
(1)Hilton E et al. 1992. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Annals of Internal Medicine. 116(5):353-357.
(2)Coudeyras S, Jugie G, Vermerie M, Forestier C. 2009. Adhesion of human probiotic Lactobacillus rhamnosus to cervical and vaginal cells and interaction with vaginosis-associated pathogens. Infect Dis Obstet Gynecol. 2008:549640. Epub 2009 Jan 27
(3)Martinez RC et al. 2009. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 48(3):269-74.
(4)Cianci A et al. 2008. Efficacy of Lactobacillus Rhamnosus GR-1 and of Lactobacillus Reuteri RC-14 in the treatment and prevention of vaginoses and bacterial vaginitis relapses. Minerva Ginecol. 60(5):369-76.
(5)Marcone V et al. 2008. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol. 31(3):429-33.
(6)Petricevic L et al. 2008. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 141(1):54-7.
(7)Drago L et al. 2007. Activity of a Lactobacillus acidophilus-based douche for the treatment of bacterial vaginosis. J Altern Complement Med. 13(4):435-8.
Written by Ani Kowal