For proper health, vaginal tissues must have a correct balance of various micro-organisms including bacteria and yeast. Most of the organisms are bacteria and a healthy vagina has mostly Lactobacilli of various species. These are “good” bacteria in that they can help keep the tissues free of infection from other types of organisms by keeping the proper ph balance (lower than 4.5ph) and by attaching to the tissues more effectively than the “bad” bacteria.
Many women experience vaginal infections due to imbalances in the normal levels of micro-organisms which are normally present. The infections can be other bacteria, yeast, or trichomoniasis.
The most common vaginal imbalance problem is an infection called bacterial vaginosis, which is characterized by high levels of many different species of bacteria. The normal situation is for women to have fewer species (primarily the lactobacilli) and lower total numbers of bacteria. These extra numbers and the additional species of bacteria tend to raise the ph of vaginal tissues (make it more alkaline), which will kill off most of the remaining lactobacilli. Symptoms of this imbalance include itching, a gray or milky discharge, fishy odor, or burning while urinating. Treatment of bacterial vaginosis will typically require antibiotic therapy either orally or locally, but some practitioners will recommend probiotic therapy in addition to (not in place of) the antibiotics.
Yeast infections are another sign of an imbalance of the normal levels of organisms. In this situation, a yeast, normally Candida Albicans, overgrows due to one or more of several factors. These factors include: oral contraceptives or other hormone therapy, pregnancy, diabetes, an impaired immune system, and antibiotics which could kill too many of the good bacteria like lactobacilli. Symptoms of this type of imbalance are similar to Bacterial Vaginosis, but are sometimes more severe. They include: rash, pain/soreness, burning during sex/urination, thick white or watery discharge, and more intense itching. A short course of antifungal medication either as directly applied creams, ointments, or suppositories or an oral medication are required to clear up this type of infection. Many women do a course of probiotics if they have to take antibiotics since they have experienced a yeast infection from previous antibiotic use.
The third type of vaginal infection is sexually transmitted infection Trichomoniasis. If you experience a change in vaginal discharge (considerably more and it could be clear, greenish, yellow or white with an unusual fishy smell), this might indicate Trichomoniasis. Probiotics would not treat or prevent this type, but it should be noted that having a vaginal imbalance such as Bacterial Vaginosis increases the chances of getting trichomoniasis if exposed to it.
Clinical studies so far have not conclusively determined that probiotics are effective in treating or preventing vaginal flora imbalances, but some small scale studies point to some benefit. The most studied Lactobacilla species are Lactobacillus rhamnosis GR-1 and Lactobacillus reuteri RC-14. These strains have been shown to resolve about 50% of bacterial vaginosis cases without any antibiotics. Another small study showed that after consistent use for 60 days, there was a statistically significant reduction in transfer of yeast and pathogenic bacteria from the rectum to vagina, indicating less chance of yeast overgrowth. These 2 species of Lactobacilla are available in a product from Metagenics called Ultra Flora Women’s Probiotics.