Category: Vaginal Health

Vaginal Community State Types: Which of These 5 Are You?

From mother to employee to wife, women are very dynamic. The vaginal microbiota that comprises their reproductive organs is just as much so. While research on the vaginal microbiome is in its infancy (pun sort of intended), all scientific evidence alludes to one thing. The relative abundance of Lactobacillus species within the vaginal microbiome heavily dictates women’s health. Just as women are dynamic, so are the various Lactobacillus species (and other microbes). That’s why vaginal health is broken down into five general vaginal community state types.

 

What is the vaginal microbiome?

 
Before jumping into vaginal community state types (CSTs), let’s dive into a crash course about the vaginal microbiome. The vaginal microbiome is a name to collectively describe the various microscopic beings living around the vagina.
 
Microbes include:
Fungi
Bacteria
Viruses
Yeast
Archaea
 
The majority of bacteria that comprise vaginal microbial communities are of the Lactobacillus species [1]. Lactobacilli regulate the vaginal pH, making it inhospitable for most other anaerobic bacteria and microbes to successfully attempt vaginal colonization.

 

Vaginal Lactobacilli: Key role in health

 
The relevance of the vaginal microbiota plays a significant function in women’s health. Having a predominance of a specific Lactobacillus species is a good predictive indicator of the vaginal health of a person.
 
Various Lactobacilli play a protective role to their host, which is you! The key role of this microbial network is to maintain the pH balance of the human vagina.
 
The goal of vaginal bacteria is to keep levels between 3.4 and 4.5 [2]. That sweet spot makes it very challenging for opportunistic pathogens to disrupt a healthy vaginal bacterial community composition. Through this regulation, Lactobacilli act as local immune mediators.
 
Lactobacilli accomplishes this goal by producing lactic acid. Between these acidic levels and the presence of Lactobacilli, a healthy vaginal microbiome plays the ultimate defense game in Red Rover. Opportunistic pathogens that promote inflammatory cytokines can’t break through and wreak the havoc they desire!
 
Having a dominant Lactobacilli species can improve various vaginal complaints, including:
 
Bacterial vaginosis [3]
Aerobic vaginitis (AV) [4]
Preterm birth [5]
Pelvic inflammatory diseases (PID) [6]
Recurrent yeast infections [7]
Recurrent urinary tract infections (UTIs) [8]
Skin irritations, itching, and burning [9]
Painful sex [10]
 
There are 170 known Lactobacillus spp [11]. However, just a handful is the most dominant vaginal Lactobacilli. While they all fall under the same genus, these species have unique traits.
 
Therefore, they can create an environment conducive to different bacterial communities. These variations in vaginal commensal microorganisms might cause a local immune response or other vaginal complaints. It can also leave the vaginal microbiome susceptible to opportunistic pathogens.

 

Why a microbiome assessment for the human vagina important

 
According to the Centers for Disease Control (CDC), 84% of women with an imbalance within the vaginal microbiome are asymptomatic [12]. These knowledge gaps can cause long-term problems, such as PID. PID can result in reproduction issues or cervical cancer.
 
That’s why it’s so important for women to get a yearly examination from their doctor. Please take note of any changes in sensations, odors, and recurrence of infections. All of these factors are key indicators that you might have a microbial imbalance.
 
If you believe you might have low levels of Lactobacilli spp, consider a Thryve Vaginal Health Test in 2021. This vaginal microbiome assessment gives you everything you need to safely procure a vaginal sample from your own home.
 
All vaginal samples are analyzed with 16s rRNA gene sequence technology. We then breakdown the analysis of the microbiome into insights you can follow to make improvements in your overall wellness routine.
 
We follow the general vaginal community state types (CSTs) as recommended by many leading gynecologists and specialists of the vaginal microbiome. We use your insights to give you a CST classification. That way, you and your doctor can make educated decisions about your health.

 

What are the 5 general vaginal community state types?

 
 
One of the most pivotal elements of the Thryve Vaginal Health Program is learning which of the vaginal community states types (CSTs) represent your current microbial network. These insights can provide information about reproductive health, vaginal comfort, and other immune factors. Here is a breakdown of each vaginal community state type.

 

Vaginal Community State Type I (CST I)

 
Of the vaginal community state types, CST I is deemed the healthiest. It is heavily dominated by Lactobacillus Crispatus. L. Crispatus doesn’t play well with others. When there is a relative abundance of this Lactobacilli, it comprises 80% to 90% of the entire vaginal bacterial community composition.
 
L. Crispatus produces an abundance of lactic acid. Therefore, it drastically prohibits the spread of pathogenic bacteria, such as Prevotella and Gardnerella Vaginalis [13]. Also, those with an abundance of L. Crispatus have a stronger immune response to sexually transmitted infections (STIs), including chlamydia [14].
 
Those with this CST classification tend to be women of childbearing age. Those who have a CST I classification during pregnancy have an increased chance of full-term delivery. Bifidobacteria may also be found within healthy vaginal biomes. Bifidobacterium contributes to the development of a baby’s immune system [15]. 
 
Confirming you have a CST I classification with a Thryve Vaginal Health Kit is an excellent first step in the conception process. That way, you can rule out potential hurdles that might create an increased risk of preterm delivery.
 

 

Health effects of Vaginal Community State Type I (CST I)

 
Overall vaginal health
Most protective: highest lactic acid production & bacteriocins production
Anti-inflammatory
Reproductive health
Lower risk of urinary tract infections (UTIs), bacterial vaginosis, and sexually transmitted infections (STIs)

 

Vaginal Community State Type II (CST II)

 
A CST II categorization means you have a healthy vaginal microbiome. However, this vagina is not acidic as a CST I. That’s because the dominant Lactobacillus spp in CST II is Lactobacillus Gasseri.
 
Lactobacillus Gasseri might not produce as much lactic acid as Lactobacillus Crispatus, but they still show clinical significance in promoting a healthy vagina [16]. People with a CST II classification have a decreased risk of developing bacterial vaginosis, UTIs, and STIs.
 
As women enter perimenopause, their vaginal bacteria community composition changes. This alteration is due to less estrogen in the body. When these needs change, Lactobacillus Gasseri steps up to ensure a healthy environment. That’s why many perimenopausal women have a CST II classification.
 

 

Health effects of Vaginal Community State Type II (CST II)

 
Vaginal health, relatively stable microbiome
Protective
Lower risk of urinary tract infections (UTIs), bacterial vaginosis, sexually transmitted infections (STIs)

 

Vaginal Community State Type III (CST III)

 
A vaginal community state type of CST III is still considered healthy. It is dominated by Lactobacillus iners. While we’re fans of vaginal Lactobacilli, a CST III categorization is not as optimal as CST I. It’s like a yellow traffic light warning you that a hard stop might need to come soon.
 
A CST III classification may indicate an unstable vaginal microbiome. It’s often associated with vaginal dysbiosis, also known as leaky vagina.
 
Those with a CST III classification may have:
 
A microbial imbalance that’s not D-lactate Lactobacilli dominant
High microbial diversity
Inflammation and other immune responses
 
The goal of a healthy human vagina is to have as little bacterial diversity as possible. When other microorganisms take up residence, you become more prone to opportunistic pathogens entering the system.
 
A person with a CST III classification is at an increased risk of human papillomavirus (HPV), cervical dysplasia, and UTIs.
 

Health effects of Vaginal Community State Type III (CST III)

 
Decreased protection against pathogenic growth
Low anti-inflammatory properties
Higher risk of vaginal dysbiosis, bacteria vaginosis, HPV infections, cervical dysplasia, and urinary tract infections (UTIs)

 

Vaginal Community State Type IV (CST IV-A and CST IV-B)

 
A CST classification of IV may indicate a bacterial imbalance in the vaginal microbiome. That generally indicates you have a high diversity of microbial species in the region. Even worse, the levels of Lactobacillus species are low. 
 
Being classified as CST IV suggests you may be at risk for the growth of harmful bacteria. Those with a CST IV classification may need to inoculate the vaginal microbiome with supplemental Lactobacilli.
 
Women most susceptible to a CST IV classification are postmenopausal. When estrogen levels taper off, it causes the presence of Lactobacilli to deplete. In turn, the vaginal microbiome has less lactic acid protection. This drop-in probiotic bacteria creates an open field susceptible to pathogenic overgrowth.
 
There are thousands of known bacteria in the microbiome. These microorganisms are all fighting for survival. For specific bacteria to survive, they must find other bacteria in which they coexist. Groups of bacteria that hang out together are known as commensal bacteria.
 
When it comes to vaginal health, you don’t want diversity. For opportunistic pathogens, it’s about strength in numbers when various species are vying to compete against a spectrum of vaginal Lactobacilli.
 
There seem to be specific recipes of commensal bacteria that can help create an environment that decreases Lactobacillus levels. This split in cohabitators is broken down into two types of CST IV classifications.
 
The two types of CST IV include:
 
CST IV-A – High levels of Anaerococcus, Peptoniphilus, Prevotella, and Streptococcus
CST IV-B – High levels of Atopobium vaginae, Megasphaera, and others
 
It is not uncommon for both classifications to have elevated levels of Gardnerella Vaginalis. This opportunistic pathogen is extremely dangerous to women’s health. Gardnerella Vaginalis creates a biofilm that promotes antibiotic resistance. It also can lead to recurrent vaginal infections [17].
 
Those with a CST IV classification are at an increased risk of human immunodeficiency virus infection (HIV) transmission. They might also encounter pregnancy issues, including preterm delivery.
 

Health effects of CST IV

 
Bacterial vaginosis 
Not protective
High diversity, not considered a healthy vaginal microbiome
Proinflammatory
Symptoms associated include burning, itching, urgency to urinate, and discharge
Recurrent urinary tract infections (UTIs)
Higher risk of HIV 
Gynecological and vaginal infections and disorders

 

Vaginal Community State Type V (CST V)

 
Last is certainly not the least here. It’s just rare. A vaginal community state type V (CST V) is dominated by Lactobacillus Jensenii. Lactobacillus Jensenii produces an adequate amount of lactic acid [18]. So, it’s hard for pathogenic bacteria to penetrate the system in its presence.
 
Those with a CST classification V tend to be peri and post-menopausal women. They will have a lower risk of developing bacterial vaginosis, STIs, or recurrent UTIs.
 

 

Health effects of CST V

 
Vaginal health
Protective
Lower risk of UTIs

 

Determining vaginal community state types

 
Knowing your vaginal community state type can help you make invaluable decisions about your reproductive (and overall) health. One of the most efficient ways to learn more about your own vaginal microbiome is with a Thryve Vaginal Health Test Kit in 2021.
 
We use DNA testing to determine your vaginal CST. With that information, we provide you with actionable suggestions, such as food and probiotic recommendations. Please use this test, along with a yearly examination, to make conscious health decisions with your healthcare provider.

 

Click Here To View Resources

 

Resources

 
[1] Amabebe, E., & Anumba, D. (2018). The Vaginal Microenvironment: the Physiologic Role of Lactobacilli. Frontiers in medicine, 5, 181. https://doi.org/10.3389/fmed.2018.00181.
 
[2] Happel, Anna-Ursula, et al. “Exploring Potential of Vaginal Lactobacillus Isolates from South African Women for Enhancing Treatment for Bacterial Vaginosis.” PLOS Pathogens, Public Library of Science, 4 June 2020, journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1008559.
 
[3] Minkin, MD, Mary Jane. “New Study Supports Benefits of Probiotics with Vaginal Lactobacillus.” BioSpace, BioSpace, 18 June 2020, www. biospace.com/article/releases/new-study-supports-benefits-of-probiotics-with-vaginal-lactobacillus/.
 
[4] Kaambo, E., Africa, C., Chambuso, R., & Passmore, J.S. (2018). Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis. Frontiers in public health, 6, 78. https://doi.org/10.3389/fpubh.2018.00078.
 
[5] Tabatabaei, N., Eren, A. M., Barreiro, L.B., Yotova, V., Dumaine, A., Allard, C., & Fraser, W.D. (2019). Vaginal microbiome in early pregnancy and subsequent risk of spontaneous preterm birth: a case-control study. BJOG: an international journal of obsetrics and gynaecology, 126(3), 349-368. https://doi.org/10.1111/1471-0528-15299.
 
[6] Sharma, H., Tal, R., Clark, N. A., & Segars, J. H. (2014). Microbiota and pelvic inflammatory disease. Seminars in reproductive medicine, 32(1), 43-49. https://doi.org/10.10555/s-0033-1361822.
 
[7] Superti, F., & De Seta, F. (2020). Warding Off Recurrent Yeast and Bacterial Vaginal Infections: Lactoferrin and Lactobacilli. Microorganisms, 8(1), 130. https://doi.org/10.3390/microorganisms8010130.
 
[8] Grin, P. M., Kowalewska, P.<., Alhazzan, W., & Fox-Robichaud, A.E. (2013). Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis. The Canadian Journal of Urlology, 20(1), 6607-6614.
 
[9] Cribby, S., Taylor, M., & Reid, G. (2008). Vaginal microbiota and the use of probiotics. Interdisciplinary perspectives on infectious diseases, 2008, 256490. https://doi.org/10.1155/2008/256490.
 
[10] Vadala, M., Testa, C., Coda, L. Angioletti, S., Giuberti, R., Laurino, C., & Palmieri, B. (2018). Vulvovestibular Syndrome and Vaginal Microbiome: A Simple Evaluation. Journal of clinical medicine research, 10(9), 688-692. https://doi.org/10.14740/jocmr3480w.
 
[11] Goldstein, Ellie J.C., et al. “Lactobacillus Species: Taxonomic Complexity and Controversial Susceptibilities.” Oxford Academic, Clinical Infectious Diseases, 18 Apr. 2015, academic.oup.com/cid/article/60/suppl_2/S98/379146.
 
[12] “CDC – Bacterial Vaginosis Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2020, www.cdc.gov/std/bv/stats.htm.
 
[13] Petrova, M. I., Lievens, E., Malik, S., Imholz, N., & Lebeer, S. (2015). Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health. Frontiers in physiology, 6, 81. https://doi.org/10.3389/fphys.2015.00081.
 
[14] Nardini, Paola, et al. “Lactobaciollus Crispatus Inhibits the Infectivitiy of Chlamydia Trachomatis Elementary Bodies, in Vitro Study.” Nature News, Nature Publishing Group, 29 June 2016, www.nature.com/articles/srep29024.
 
[15] Freitas, A.C., & Hill, J. E. (2018). Bifidobacteria isolated. fromvaginal and gut microbiome are indistinguishable by comparative genomics. PloS one, 13(4), e0196290. https://doi.org/10.1371/journal.pone.0196290.
 
[16] Atassi, Fabrice, et al. “Diverse Expression of Antimicrobial Activities Against Bacterial Vaginosis and Urinary Tract Infection Pathogens by Cervicovaginal Microbiota Strains of Lactobacillus Gasseri and Lactobacillus Crispatus.” Frontiers, Frontiers, 2 Dec. 2019, www.frontiersin.org/articles/10.3389/fmicb.2019.02900/full.
 
[17] Tomusiak, A., Strus, M., & Heczko, P. B. (2011). Lekowrailiwosc szczepow Gardnerella vaginalis wyizolowanych z przypadlow bakteryjnej waginozy [Antibiotic resistance of Gardnerella vaginalis isolated form cases of bacterial vaginosis]. Genkologia polska, 82(12), 900-904.
 
[18] Hütt, P., Lapp, E., Stsepetova, J., Smidt, I., Taelma, H., Borovkova, N., Oopkaup, H., Ahelik, A., Rööp, T., Hoidmets, D., Samuel, K., Salumets, A., & Mändar, R. (20160. Characterisation of probiotic properties in human vaginal lactobacilli strains. Microbial ecology in health and disease, 27, 30484. https://doi.org/10.3402/mehd.v27.30484.

 

 

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Vaginal Microbiome: Everything YOU Need To Know

As women, no one needs to tell us that our bodies are dynamic. We are continually reminded of its complexity. One highly dynamic and vastly influential area that continual growing research is focusing on is the vaginal microbiome. This biome is a collection of microorganisms, their genes, genomes, and metabolites that reside in the vaginal area. Our vaginal microbiota continually influences our gynecologic health, reproductive health, and overall quality of life.

 

What is the vaginal microbiome?

 
What is the vaginal microbiome?
 
The vaginal microbiome is a microbial community that protects the vagina, and really the entire body, from potential pathogens that can invade its host…which is you [1]!
 
Now, our vaginal microbiome communities can be a bit cliquey. While that can be traumatic in high school, it’s great for vaginal health. Our protective vaginal microbial communities produce an abundance of lactic acid [2].
 
Lactic acid, specifically D-lactate, makes the vaginal pH intolerable for potential predators to claim dominance over our microbiome. Sorry, this party is “invite-only”! Let’s discuss how your vaginal microbiota is beneficial for disease control and immunity.

 

What does the vaginal microbiome do?

 
Vaginal microbiota can provide protection against invaders that try to drive up infections. However, different species within our vaginal microbial communities can also become the pathogens that ignite inflammation.
 
Unlike the gut microbiome, the vaginal microbiome doesn’t like diversity. When other pathogens overtake the vaginal biome, or specific nonprotective species exert dominance, it can contribute to life-altering symptoms that are all too familiar to some.
 
A healthy vaginal microbiome has been shown to be helpful in the prevention of:
 
Urinary Tract Infections (UTIs) [3]
Yeast Infections [4]
Bacterial Vaginosis
Infertility [5]
Miscarriages [5]
Preterm Delivery [5]
Pelvic Inflammatory Disease (PID) [6]
Sexually-Transmitted Infections and Diseases (STIs, STDs), such as Chlamydia and Gonorrhea Risk [1]
HIV Infection Risk [1]
 
When symptoms of these conditions rile up, there’s a good chance that you are suffering from vaginal microbiome imbalances and the attack of pathogens. That’s why your vaginal bacterial community composition is so important. Let’s discuss how your vaginal microbiome works to fight off fungi, viruses, and other potential threats to your body!

 

Hormones and the vaginal microbiome

 
Our protection against vaginal imbalances is dependent on the type of bacteria that reside within the vaginal biome. During the birthing process, depending on delivery mode, most females take on their mother’s vaginal bacteria. Bacteria in which we have relative abundances during pregnancy tend to be high in protective species. Hey, we’re warriors. It’s in our DNA!
 
As we age, the abundance of these protective bacteria declines due to the fluctuations of one essential molecule, estrogen.
 
Estrogen levels in women
 
Levels of these hormones tend to be high during:
Pregnancy
Second half of follicular Phase of Menstrual Cycle
Mid-luteal Phase of Menstrual Cycle
 
Even when these events aren’t happening in the life of premenopausal women, our amount of hormones are up. We are fertile and in the prime of our lives, so our dynamic bodies get ready for anything.
 
As premenopausal women, protective species of bacteria are generally high if within an optimal environment. That’s why it’s so important to know the bacteria that comprise your vaginal microbiome. According to the Centers for Disease Control (CDC) 84% of women show no signs of the most common bacterial infection, bacterial vaginosis [7]!
 
At Thryve we will offer a Vaginal Health Kit that uses DNA sequencing to isolate 16s rRNA genes from your vaginal microbiome. This information will give us a snapshot of your vaginal bacterial community composition. With this info, we can determine your vaginal community state types (CSTs), so we can help you fight off infectious diseases and live your best life. We’ll discuss CSTs in a bit!
 
Now, knowing your vaginal microbiome isn’t just useful for menstruating women. Whenever estrogen levels drop, such as in postmenopausal women, protective species of bacteria tend to decline as well. Our innate instincts to protect potential life growing inside of us lessens. So, producing these hormones seems unnecessary to our system. Meanwhile, we’re left to deal with the uncomfortable side effects of this decline in estrogen.
 
Lower estrogen levels dictate a lot of things in a woman’s life. For one, it causes us to retain less calcium. That’s why postmenopausal women are prone to osteoporosis. Lastly, this shift in hormones also changes the influential bacteria found within our vaginal microbiome.

 

Which bacteria are best for vaginal health?

 
Within a healthy vaginal microbiome, specific bacteria species will dominate the majority of the ecosystem and leave little room for additional microbes to grow. These bacteria are critical to gynecological and reproductive health. They protect us from pathogenic overgrowth and make the environment so inhospitable that even when we are exposed to pathogens, they tend not to stick around.
 
These protective vaginal superheroes fall within the Lactobacillus family [8]. In a perfect vaginal environment, the good bacteria Lactobacillus outnumber the bad anaerobic bacteria. Specific vaginal Lactobacilli species produce the lactic acid, hence the name! As I discussed earlier, lactic acid contributes to a low pH; that’s a good thing.
 
 
D-lactate helps inhibit the growth of potential pathogens and anaerobic bacteria, such as:
 
Escherichia coli (E. coli)
Gardnerella vaginalis
• Candida species
Atopobium Vaginae
 
Vaginal Lactobacilli also contribute to vaginal lining integrity guarding against “leaky vagina [9].” Leaky vagina is the vaginal microbiome equivalent of Leaky Gut Syndrome. It’s an imbalance that drives up inflammation and has been suggested to contribute to endometriosis and reproductive organ disease damage.
 
A Lactobacillus-dominated vaginal microbiome can protect against UTIs, enhance fertility and delivery outcomes, and reduce the risk of sexually transmitted infections. A vaginal Lactobacilli dominance can also potentially be helpful in cervical cancer prevention [10].
 
Overall when thinking about vaginal health, think Lactobacillus, and think lots of it!

 

Vaginal Lactobacilli and community state types

 
Now, depending on which species of Lactobacillus, or lack thereof, that make up the abundance of your vaginal bacteria, you will fall under one of five general “community state types.” These groupings have been created within the research to help us understand possible risks associated with the bacteria inhabiting our vagina.
 
According to the National Institute of Health, there are five general CST categories [11]. CSTs I and II mean you have a healthy vaginal microbiome where Lactobacilli are exhibiting dominance.
 
CST III and CST V are indicators of a healthy vaginal microbiome but should be tested regularly to ensure there aren’t potential pathogens stirring since these are less protective community types. Of the two, CST V cases are very rare. CST III is the least protective Lactobacillus type, due to a lack of D-lactate-producing bacteria.
 
CST IV means a microbial imbalance. This category indicates that you need to make lifestyle changes that will limit the diversity in your vaginal microbiome. You may also need to introduce Lactobacillus species to help with high diversity.
 
 
The relative abundances of bacteria in the following CSTs include:
 
• CST I: Lactobacilli Dominant, Namely L. crispatus
• CST II: Lactobacilli Dominant, Namely L. gasseri
• CST III: Lactobacilli Dominant, Namely L. iners and 
• CST IV: No Dominance, High diversity and High Proportions of Anaerobic Bacteria, Namely: Prevotella, Dialister, Atopobium Vaginae, Gardnerella, Megasphaera, Peptoniphilus, Sneathia, Eggerthella, Aerococcus, Finegoldia, and Mobiluncus.  In the case of CST IVs, this imbalance is due to a lack of dominant species. You want a Lactobacillus species to take over the area and regulate the area like a well-meaning helicopter mom.
• CST V: Lactobacilli Dominant, Namely L. jensenii
Much like our dynamic lifestyles, our CST placement can change, too.

 

What causes a change in CSTs?

 
We are all unique beings with our own set of genetics. There are also thousands of microorganisms in this world that science has discovered. Then, there are our lifestyle choices, exercise, and dietary preferences.
 
There are many factors that can cause a change in CST status, including:
 
Estrogen Levels
Ethnicity
Hygiene Practices
Specific Hormonal Contraceptives
Sexual Intercourse
Diet
Weight
Dysbiosis
Leaky Vagina
 
These factors are as dynamic as our lifestyles. That’s why it might be a good idea to regularly test your vaginal microbiome health.
 

Vaginal dysbiosis, bacterial vaginosis, and pregnancy issues

 
Imbalances within the vaginal microbiome, such as a wide variety of bacteria, pathogenic microbes, and elevated non-Lactobacillus bacteria, tend to contribute negatively to vaginal health. One term often used to describe vaginal imbalances is vaginal dysbiosis. This term is considered when there are imbalances within the microbial composition that disrupt homeostasis.
Symptoms associated with vaginal dysbiosis may include:
Vaginal Discharge
Fishy Odor
Itching
Pain During Intercourse
Burning Sensation When Urinating
 
The most common vaginal bacteria imbalance that affects over 50% of women is bacterial vaginosis (BV).
 
What is bacterial vaginosis?Learn about bacterial vaginosis
 
BV is associated with a lack of protective Lactobacilli. The symptoms associated with bacterial vaginosis are the most common reasons women seek medical help addressing vaginal discomfort.
 
There are two basic types of bacterial vaginosis- symptomatic and asymptomatic. Both carry gynecological and obstetric risks. Even those with asymptomatic BV (no symptoms) are still at elevated risk for future vaginal infections or possible disease due to low protective bacteria levels. Most treatment plans for BV are antibiotics; however, relapse is prevalent since there is a lack of protective bacteria to inhibit future pathogenic growth.
 
Vaginal imbalances can affect more than our day to day living; they can contribute to changes that affect our life. Specific diseases, such as pelvic inflammatory disease (PID), a painful condition that can result in infertility, have been associated with vaginal imbalances. Preterm delivery and miscarriages have also been linked to specific microorganisms within the vaginal microbiome. Lastly, imbalances resulting from low protective bacteria levels can increase our risks of sexually transmitted infections, HIV infection, and diseases.

 

Who should get their vaginal microbiome tested?

 
As I mentioned, our wellness journeys are as unique as a snowflake. We all have different environmental, physical, and emotional stressors that can comprise our health. Here are some instances where you might want to get your vaginal bacteria tested.
 

 

Those suffering from recurrent vaginal infections

 
While antibiotics can help address some of the more common vaginal infections, antibiotics are a catch-22. They also negatively affect protective Lactobacillus levels. An unprotected vaginal microbiome can result in frequent recurrence within 3-4 weeks after treatment.

 

Those planning a pregnancy or have infertility issues

 
Knowing your bacteria lets you know more about your own body. Understanding which bacteria help to contribute to vaginal and reproductive health is essential for creating a healthy environment for conception. Using 16s rRNA gene sequences, Thryve will also be able to rule out any pathogenic growth that might contribute to miscarriages, low birth weight, premature birth, infertility, and intra-amniotic fluid infections.

 

Those looking to reduce the risk of STIs and HIV

 
While we may not always know if we have been exposed to sexually transmitted pathogens, the vaginal bacteria that make up our vaginal microbiome know for sure. They help build up your immunity to diseases. Unfortunately, those who have BV are at an increased risk of contracting HIV [12]. Those who are HIV+ are also more likely to infect their partner if they have BV. Your vaginal Lactobacilli are the very first line of defense against sexually transmitted infections (STIs). So, getting a Vagina Health Test in 2021 might be a good idea if you’re sexually active, especially if when you’re meeting new sexual partners.

 

Those hoping to boost overall health

 
Women can be asymptomatic and healthy but potentially have an increased risk for vaginal infections, STIs, or additional vaginal or reproductive imbalances. Understanding our level of protection and risk associated with the bacteria that make up our vaginal microbiome is a preventative health strategy similar to our yearly checkups.
 
We use to think that addressing common vaginal symptoms such as itching, discharge, malodor, painful urination, or intercourse, was to flush away all these bacteria. We now know that we need these bacteria. Our attempts to target the harmful bacteria with antibiotics and douches also negatively impacts our protective bacteria vital to our gynecological and reproductive health.
 

How to improve your vaginal microbiome

 
First, we gain insight into which bacteria are influencing our vaginal health and overall quality of life. Do we have a good abundance of protective bacteria? Are there pathogens driving up inflammation and resulting in recurrent infections? Do we have high amounts of non-protective bacteria that are opening the door for eventual pathogenic growth, infections, and even diseases?
 
Next, we remove the daily and lifestyle influencers and practices that may be negatively impacting our vaginal bacteria. When we completely alter the microbial environment through hygiene practices, diet, and lifestyle factors, we can open the door to recurrent imbalances such as ongoing UTI’s, bacterial vaginosis, or vaginal infections.
 
Then we support the Gut-Vagina axis.
 
Gut-Vaginal Axis is a term used to describe the relationship between the gut and vaginal health. When the gut is inflamed (due to gut microbiome dysbiosis and or high inflammatory food choices), the immune system can ignite inflammation throughout your entire body. This immune response directly affects your vaginal microbiome. 
 
The increase in inflammation can suppress protective Lactobacillus growth. A lack of vaginal Lactobacilli encourages pathogenic bacteria that negatively affect vaginal health. Find out which foods may be contributing to your vaginal imbalances and which foods may encourage vaginal health.
 
Finally, we directly target the bacteria and pathogens within the vaginal microbiome.
 
Specific strains within probiotic bacteria have been supported in the research to reach the vaginal microbiome. These specific strains not only reach the vaginal environment, but they additionally have been shown to inhabit the microbiome. This integration positively addresses specific vaginal infections such as bacterial vaginosis, yeast infections, and UTI’s. 
 
Strain-specific bacteria, such as those found within Thryve’s Women’s Health probiotic (coming in 2021), optimizes the vaginal microbiome. This supplement encourages protective bacteria to grow. Their presence effectively corrects vaginal imbalances.
 
At times, antibiotics are needed to address elevated vaginal imbalances. Continually treating with topical antibiotics or oral antibiotics can further disrupt our protective bacteria in our gut and our vaginal microbiome. To guard against the common relapse vaginal infection seen with antibiotics, incorporate a research-supported strain-specific probiotic that will help guard your much needed protective bacteria.

 

How to test your vaginal microbiome

 
Thryve has created a Vaginal Health Kit due out in 2021. This breakthrough in women’s wellness uses 16s rRNA sequencing to impart for you an easy-to-understand report on the bacteria that make up your vaginal microbiome.
 
With this information, we provide for you the tools you need to best optimize your vaginal health by way of specific diet recommendations, suggestions of lifestyle factors that can contribute to your vaginal health as well as those that may be contributing to your vaginal imbalances, and recommended probiotic strains that have shown to inoculate the vaginal microbiome and address vaginal infections and imbalances.
 
Our bodies are dynamic, and so is our vaginal microbiome. Understanding how this influential environment contributes to our overall quality of life and protection is a valuable tool that we as women can now utilize to gain access to our optimal health.

 

Click Here To View Resources

Resources

 
[1] Lewis, F. M., Bernstein, K. T., & Aral, S. O. (2017). Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstetrics and gynecology, 129(4), 643–654. https://doi.org/10.1097/AOG.0000000000001932.
 
[2] FA. Guédou, L. Damme, et al. “Vaginal PH Measured in Vivo: Lactobacilli Determine PH and Lactic Acid Concentration.” BMC Microbiology, BioMed Central, 1 Jan. 1970, bmcmicrobiol.biomedcentral.com/articles/10.1186/s12866-019-1388-8.
 
[3] Stapleton A. E. (2016). The Vaginal Microbiota and Urinary Tract Infection. Microbiology spectrum, 4(6), 10.1128/microbiolspec.UTI-0025-2016. https://doi.org/10.1128/microbiolspec.UTI-0025-2016.
 
[4] Tortelli, B. A., Lewis, W. G., Allsworth, J. E., Member-Meneh, N., Foster, L. R., Reno, H. E., Peipert, J. F., Fay, J. C., & Lewis, A. L. (2020). Associations between the vaginal microbiome and Candida colonization in women of reproductive age. American journal of obstetrics and gynecology, 222(5), 471.e1–471.e9. https://doi.org/10.1016/j.ajog.2019.10.008.
 
[5] Zhao, Changying, et al. “Characterization of the Vaginal Microbiome in Women with Infertility and Its Potential Correlation with Hormone Stimulation during In Vitro Fertilization Surgery.” MSystems, American Society for Microbiology Journals, 25 Aug. 2020, msystems.asm.org/content/5/4/e00450-20.
 
[6] Sharma, H., Tal, R., Clark, N. A., & Segars, J. H. (2014). Microbiota and pelvic inflammatory disease. Seminars in reproductive medicine, 32(1), 43–49. https://doi.org/10.1055/s-0033-1361822.
 
[7] “CDC – Bacterial Vaginosis Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2020, www.cdc.gov/std/bv/stats.htm.
 
[8] Public Library of Science (PLOS). “Probiotics with Top-Performing Lactobacillus Strains May Improve Vaginal Health.” ScienceDaily, ScienceDaily, 4 June 2020, www.sciencedaily.com/releases/2020/06/200604152114.htm.
 
[9] Brusselaers, Nele, et al. “Vaginal Dysbiosis and the Risk of Human Papillomavirus and Cervical Cancer: Systematic Review and Meta-Analysis.” American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, 19 July 2019, pubmed.ncbi.nlm.nih.gov/30550767/.
 
[10] Yang, X., Da, M., Zhang, W., Qi, Q., Zhang, C., & Han, S. (2018). Role of Lactobacillus in cervical cancer. Cancer management and research, 10, 1219–1229. https://doi.org/10.2147/CMAR.S165228.
 
[11] Ma, Z. S., & Li, L. (2017). Quantifying the human vaginal community state types (CSTs) with the species specificity index. PeerJ, 5, e3366. https://doi.org/10.7717/peerj.3366.
 
[12] Alcaide, M. L., Chisembele, M., Malupande, E., Arheart, K., Fischl, M., & Jones, D. L. (2015). A cross-sectional study of bacterial vaginosis, intravaginal practices and HIV genital shedding; implications for HIV transmission and women’s health. BMJ open, 5(11), e009036. https://doi.org/10.1136/bmjopen-2015-009036.
 

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Bacterial Vaginosis: What is BV and How To Treat This Vaginal Infection?

Bacterial vaginosis (BV) is a common bacteria infection experienced by over 21.2 million women in the United States alone [1]. The vagina has a delicate balance of bacteria that offer disease control by regulating the pH levels within the area. When the normal balance of bacteria becomes compromised, women can become more susceptible to sexually transmitted infections (STIs), such as chlamydia and gonorrhea. Left untreated, BV can lead to pelvic inflammatory disease (PID) and fertility issues.
 
So, what is BV? What are the symptoms, and what should you do if you get a diagnosis of bacterial vaginosis? Here is everything you need to know about this common vaginal infection!

 

What is Bacterial Vaginosis?

 

What is bacterial vaginosis?

 
Our bodies are teeming with trillions of cells only visible with a microscope. These microbes include thousands of species of probiotic bacteria, bad bacteria, viruses, fungi, yeast, and more. A healthy gut microbiome is dependent on microbial diversity. The same cannot be said of the vaginal microbiome.
 
Vaginas require a balance of specific bacteria for disease control. Namely, these good bacteria are of the Lactobacilli genus. This crew is ride-or-die, helping each other regulate pH levels and preventing unfavorable vaginal health issues, such as candidiasis, Human Papillomavirus (HPV), and STIs.
 
The average pH level of a healthy vagina is around 4. A vaginal microbiome with BV is less acidic. It has a pH level of at least 7. 
 
According to research, some of the most common bacteria associated with bacterial vaginosis are Leptotrichia amnionii and Sneathia sanguinegens [2]. When they’re around, the vaginal microbiome tends to have less abundance of the Lactobacilli genus. Unfortunately, women are at high risks of bacterial imbalances. 
 
There are many factors that can potentially cause BV, which we’ll get to in a bit. However, the official diagnosis of bacterial vaginosis means one of your vaginal bacteria species have become predominant. In general, BV is a drop in protective bacteria and a rise in potentially bad bacteria. BV is easy to treat. So, it’s imperative you talk to your health care provider if you show symptoms of BV.

 

Bacterial Vaginosis Symptoms

 
Bacterial vaginosis symptoms

 
What makes BV so nerve-wracking is that you might not know you have an imbalance. According to the Centers for Disease Control and Prevention (CDC), approximately 84% of women show no symptoms of bacterial vaginosis [1]. With that said, here are the most telling BV symptoms.

 

Abnormal Vaginal Discharge

 
Vaginal discharge is normal for women. It’s part of the self-cleaning process of the vaginal microbiome. These fluids consist of dead cells and bacteria that are being removed by glands within the vagina and cervix. Typically, they are clear to milky. When the color changes, there is a reason for concern.
 
As Justine Burris, CNM, MSN explained to Unity Point Health,
 

“There are times when discharge amounts can change. Immediately after a period, there is almost no discharge. Two to three days after the period ends, there is a thick, white discharge. A few days later, the consistency changes to appear more like mucous. Before ovulation, the discharge becomes clear and sticky, and before the next period, discharge is thick and white in consistency [3].”

– Justine Burris, CNM, MSN explained to Unity Point Health

During pregnancy, vaginal discharge can become thinner. You will notice the amounts of vaginal discharge increase during this time period. However, if the vaginal discharge changes colors, you should contact your health care provider.
 
Types of vaginal discharges include:
 
Thick, White: Might Be Post-Menstrual Vaginal Discharge or Signs of a Yeast Infection
Cottage Cheese White: Potential Yeast Infection
Yellow: Signs of Bacterial Infection, Gonorrhea, Chlamydia, or HPV
Brown: Irregular Period Cycles, Uterus Cancer, or Cervix Cancer
Green: Signs of Parasitic STIs, such as Trichomoniasis
 
If you have brown, green, or long-term yellow vaginal discharge, please seek a health care provider. You should get a thorough pelvic exam and might need to use a course of antibiotics to treat the issues. Any of these colors can also be signs of bacterial vaginosis.
 
Vaginal discharges are also regulated by hormones. It’s ubiquitous for women going through menopause not to experience vaginal discharge. Therefore, some women might miss out on symptoms of BV. 
 
While that sounds delightful to be symptom-free, you might be missing out on key clues about your vaginal health. That’s why it’s important to test your vagina bacteria regularly with a Thryve Vaginal Health Kit.

 

Fishy Odor

 
It is common for genitals to have a slight odor. They’re very moist and are void of much ventilation. 
 
These odors might increase with the presence of vaginal discharge or during pregnancy. They also tend to be at their highest potency following sexual intercourse.
 
Even when vaginal discharge is at its peak, it should never have the pungent odor associated with odor. If you notice a fishy odor, talk to your health care provider about a potential whiff test.

 

Vaginal and Vulva Itching

 
While women are warriors who put up with discomfort on the reg, itching inside or outside the vagina should be a reason for worry. Itching is always a sign of irritation.
 
Irritation is essentially inflammation. Therefore, you’re having an immune response to something. In the case of BV, that immune response is being caused by a bacterial imbalance.

 

Painful Urination

 
Don’t try to tough through painful urination. This common issue for women can be a sign of many health-related issues. Be proactive and seek medical help and get a thorough pelvic exam if you suffer from painful trips to the bathroom.

 

What Causes Bacterial Vaginosis?

 
What causes BV?

 
There is no specific known cause of BV. Rather, there is a list of factors that might increase your risk of developing BV. Here are some of the most common.

 

Douching

 
For centuries, women have been conditioned to believe that their genitals should smell like a pristine flower. This expectation is unrealistic and dangerous. It’s caused women to turn to using a douche to achieve what they believe to be cleanliness.
 
Sure, douching rids the vaginal microbiome of bad bacteria. However, it also leaves the vagina void of the Lactobacilli strains it needs to maintain optimal pH levels. Once you change the protective pH, the bad bacteria can flourish. 
 
Even worse, women are using douches that have artificial scents. Scented douches can cause potential allergic reactions. In turn, you may experience skin irritations or itchiness.

 

Sexual Intercourse

 

There is no evidence that a male can transmit bacterial vaginosis to a female directly. However, the CDC does note that the risk of developing BV increases when the number of sex partners increases [1].
 
Subsequently, men who have been diagnosed with nongonococcal urethritis tend to have higher levels of Leptotrichia amnionii and Sneathia sanguinegens in their gut microbiome [4]. As we mentioned earlier, these bacteria strains tend to facilitate BV development.
 
Cases of BV are more likely to increase when someone becomes intimate with a new sex partner. It kind of makes sense if you think about it. You’re allowing new bacteria and other microbes within and around your body. They’re bound to create new reactions and disrupt the current state of your vaginal microbiome.
 
The findings that BV risk increases with the number of sex partners infers that bacterial vaginosis might be spread based on bodily fluids exchange. Many doctors recommend using condoms and dental dams as forms of BV prevention.
 
Furthermore, research suggests that women are more likely to contract BV after being with a female partner rather than a male sexual partner. One study looking at the prevalence of BV among the lesbian community found that lesbians are 2.5 more likely to develop bacterial vaginosis [5].

 

Low Levels of Lactobacilli

 
Lactobacilli are the true regulators of the vagina. Without them, you are pretty much prone to complications with BV. It’s important to find out if you have adequate levels of good bacteria in your vagina. Use our upcoming Thryve Vaginal Health Kit in 2021 to help keep potential dangers at bay!

 

Long-Term Complications of Bacterial Vaginosis

 

Ignoring bacterial vaginosis can set your body up for bigger challenges down the road. It is important you seek medical help to prevent any other conditions that might impact your wellness, comfort, or ability to reproduce.

 

Risk of Preterm Birth

 
The CDC notes that those with BV while pregnant are at increased risk of having a premature baby. They note that the average child born from a mother with bacterial vaginosis has a birth weight of 5.5 pounds [6].

 

Increased HIV Problems

 
Women who have BV are more susceptible to contracting Human immunodeficiency virus infection (HIV) if their sexual partner is infected with the virus. Additionally, women who have HIV and BV are more likely to transmit their infection to their sexual partners [7].

 

Susceptibility to STIs

 
A lack of good bacteria in the vagina is the perfect criteria for an STI to develop. Protective vaginal bacteria make the area more acidic so that harmful microbes that cause STIs don’t survive.
 
That’s why BV has been linked to increased risk of:
 
Gonorrhea [8]
Chlamydia [8]
Herpes Simplex Virus [9]
Human Papillomavirus (HPV) [10]
 
It is important to get a pelvic exam regularly and use a Thryve Vaginal Health Kit coming 2021 to ensure you have optimal levels of good bacteria.

 

Pelvic Inflammatory Disease (PID)

 
One of the most common long-term effects of bacterial vaginosis is the development of Pelvic Inflammatory Disease (PID). PID is an infection that spreads from the vagina to the womb. It causes inflammation around the ovaries and fallopian tubes [11].
 
Left untreated, PID can cause swelling and scar tissue within the fallopian tubes. Therefore, eggs won’t make it to the uterus. So, developing PID from BV can cause fertility and reproductive issues.

 

How To Know If You Have BV?

 
How to Know if You Have Bacterial Vaginosis

 
There are many ways to determine if you have bacterial vaginosis. Doctors use BV tests to determine certain factors about vaginal health. If three out of the four criteria are met, then a doctor determines a positive BV result.
 
The four BV criteria under Amsel’s criteria include:
 
Wet Mount (Tested for Clue Cells)
Vaginal Discharge (Test Vaginal Discharge for DNA and Bacteria)
Vaginal pH (A Vaginal pH of 4.5 or More)
Whiff Test (Fishy Odor in the presence of 10% Potassium Hydroxide)
 
Here are some of the most common ways to test vaginal bacteria. Make sure you talk to your doctor about your options.

 

Wet Mount

 
A wet mount test uses vaginal discharge samples to check for bacteria, white blood cells, and other cells in the body, known as clue cells. 
 
Clue cells are vaginal epithelial cells that comprise the vaginal wall [12]. If at least 20% of the sample contains clue cells, then you might have bacterial vaginosis.

 

Vaginal Discharge Test

 
During this test, a physician might look for clue cells. They will determine if it’s necessary by analyzing the color of your vaginal discharge first.

 

Vaginal pH Test

 
Under 4 is considered the ideal pH level of the vaginal microbiome. Anything over 4.5 leaves the body susceptible to infection. Low acidity in the vagina usually means a good amount of protective bacteria in the area.

 

Whiff Test

 
Vaginal discharge is integrated with 10% potassium hydroxide. The bacteria in the discharge has a chemical reaction with this solution. As a result, it lets off a fishy order that doctors correlate with BV.

 

Thryve Vaginal Health Test

 
The Thryve Vaginal Health Test will be the ultimate resource for your doctor as they run their laboratory tests. This kit has everything you need to swab your vaginal microbiome at home. Within weeks, your doctor will know the bacterial levels throughout your vaginal microbiome.
 
Based on this information, your doctor can help you create a diet plan conducive to vaginal health. Plus, you might be able to receive a custom probiotic recommendation that can help bring balance to your overall wellness.
 
A Thryve Vaginal Health Test Kit doesn’t just help once you have BV. It’s also the perfect resource for infection prevention. This kit is extremely helpful for people planning to conceive or someone who has a new sexual partner.

 

Bacterial Vaginosis Prevention

 
Bacterial vaginosis prevention

 
Bacterial vaginosis is the most common vaginal infection for women. Luckily, there are a few things you can do to prevent the development of this infection.

 

No Douching

 
Douching is ruining your vaginal microbiome. It’s unnecessary. Your vagina is pretty self-cleaning! Instead, stick to a healthy lifestyle. Maintain regular exercise and eat a balanced diet. These lifestyle changes will ensure you have the proper hormones necessary to keep your vagina healthy and clean.

 

Stay Clear of Harsh Soaps and Bubble Baths

 
We all love to lounge in a nice bubble bath. However, these luxuries are sometimes laden with abrasive chemicals and artificial scents. These items can end up drying up some of a woman’s natural lubricants. In turn, your body is more susceptible to bacteria overgrowth.
 
Scented soaps come with many of the same issues that douches do. Let your body clean itself naturally. Limit your bubble baths and use as many organic ingredients in your beauty routine as possible.

 

Practice Safe Sex

 
Limiting your sexual partners might prevent the development of BV. When you do encounter a new sexual partner, be sure to use condoms. They will prevent unwanted pregnancy or STIs.
 
Plus, condoms will lower the risk of transmitting any infections you have to a partner. Remember, those who are HIV+ and have BV put their sexual partners at greater risk, too.
 
If you are with an HIV+ sexual partner and have BV, consider getting on PrEP. Research on Oral PrEP found that this medication had a 77% success rate in preventing women with BV from contracting HIV from a sexual partner [13].

 

Regular Pelvic Exams

 
As much as a woman knows her own body, sometimes things can slip through the cracks. There is so much of a woman’s body they can’t see. So, rely on an expert. Be proactive and get a thorough pelvic exam regularly.

 

Thryve Vaginal Health Kit

 
The hardest part about dealing with BV is that the recurrence of this condition is extremely common. That’s why you should get your vagina tested regularly. You can skip the expensive copays of laboratory tests by getting an at-home vaginal health test kit from Thryve next year.
 
This breakthrough program in women’s health gives in-depth insights into your unique vaginal microbiome. You get actionable results such as dietary recommendations and personalized probiotics. We work with you every step of the way in trying to prevent the recurrence of BV.

 

How to Treat Bacterial Vaginosis

 
how to treat BV

 
Bacterial vaginosis is curable. You might need medication to make it go away. However, all cases can be cured with a course of antibiotics. While antibiotics are excellent for destroying bad bacteria, they can also harm good bacteria. So, a meaningful way to stop bacterial vaginosis is through prevention.
 
That’s why it’s essential to do your own due diligence by using a Thryve Vaginal Health Kit in 2021 to determine bacterial ratios in your vaginal microbiome. Take these results to your doctor and get a full pelvic exam regularly. Once you speak to your doctor, here are some treatments they might suggest.

 

Metronidazole

 
This medication can be taken orally as a pill or as a topical gel that goes into the vagina. You will want to reduce alcohol intake when on Metronidazole. It can cause nausea or abdominal pain.

 

Tinidazole

 
This oral treatment can also cause nausea, similar to Metronidazole. Try to steer clear of alcohol up to three days after treatment.

 

Clindamycin

 
Clindamycin is a topical cream that gets inserted into the vagina. Sexually active people should be careful using contraceptives while on Clindamycin. This topical can weaken latex condoms up to three days after applying.

 

Live a Healthy Life Without Bacterial Vaginosis

 
Bacterial vaginosis can make life a bit uncomfortable. Why grin and bear it? Reclaim your wellness and peace of mind by being proactive with your health.
 
If you show symptoms of BV, be sure to contact your health care provider immediately. Stay up-to-date with regular exams. Also, keep track of your vaginal health by enrolling in the Thryve Vaginal Health Program in the New Year!

 

Click Here To View Resources

Resources

 
[1] “CDC – Bacterial Vaginosis Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2020, www.cdc.gov/std/bv/stats.htm.
 
[2] Thilesen, Carina M., et al. “Leptotrichia Amnionii, an Emerging Pathogen of the Female Urogenital Tract.” Journal of Clinical Microbiology, American Society for Microbiology Journals, 1 July 2007, jcm.asm.org/content/45/7/2344.
 
[3] Burris, CNM, MSN, Justine. “5 Types of Vaginal Discharge & What They Mean (Infographic).” 5 Types of Vaginal Discharge and What They Mean – UnityPoint Health, 6 Dec. 2020, www.unitypoint.org/livewell/article.aspx?id=06f8f035-9f6e-4a79-bb58-9045b9d7d0d8.
 
[4] Manhart, L. E., Khosropour, C. M., Liu, C., Gillespie, C. W., Depner, K., Fiedler, T., Marrazzo, J. M., & Fredricks, D. N. (2013). Bacterial vaginosis-associated bacteria in men: association of Leptotrichia/Sneathia spp. with nongonococcal urethritis. Sexually transmitted diseases, 40(12), 944–949. https://doi.org/10.1097/OLQ.0000000000000054.
 
[5] Evans, A. L., Scally, A. J., Wellard, S. J., & Wilson, J. D. (2007). Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sexually transmitted infections, 83(6), 470–475. https://doi.org/10.1136/sti.2006.022277.
 
[6] “STD Facts – Bacterial Vaginosis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2020, www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm.
 
[7] Mirmonsef, P., Krass, L., Landay, A., & Spear, G. T. (2012). The role of bacterial vaginosis and trichomonas in HIV transmission across the female genital tract. Current HIV research, 10(3), 202–210. https://doi.org/10.2174/15701621280061816.
 
[8] Wiesenfield, Harold C., et al. “Bacterial Vaginosis Is a Strong Predictor of Neisseria Gonorrhoeae and Chlamydia Trachomatis Infection.” Oxford Academic, Clinical Infectious Diseases, Volume 36, Issue 5, 1 March 2003, Pages 663–668, 1 Mar. 2003, academic.oup.com/cid/article/36/5/663/456379.
 
[9] Allahna, Esber, et al. “Risk of Bacterial Vaginosis Among Women With Herpes Simplex Virus Type 2 Infection: A Systematic Review and Meta-Analysis .” Oxford Academic, The Journal of Infectious Diseases, Volume 212, Issue 1, 1 July 2015, Pages 8–17, 14 Jan. 2015, academic.oup.com/jid/article/212/1/8/1844919.
 
[10] Guo, Y-L, et al. “Bacterial Vaginosis Is Conducive to the Persistence of HPV Infection.” ResearchGate, International Journal of HIV & AIDS 23(8):581-4, Aug. 2012, www.researchgate.net/publication/230756337_Bacterial_vaginosis_is_ conducive_to_the_persistence_of_HPV_infection.
 
[11] “Pelvic Inflammatory Disease – CDC Fact Sheet.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Nov. 2020, www.cdc.gov/std/pid/stdfact-pid.htm.
 
[12] Money D. (2005). The laboratory diagnosis of bacterial vaginosis. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 16(2), 77–79. https://doi.org/10.1155/2005/230319.
 
[13] Publish date: February 26, 2017, and M. Alexander Otto. “Oral PrEP Works despite Bacterial Vaginosis.” MDedge, 18 Jan. 2019, www.mdedge.com/obgyn/article/132186/hiv/oral-prep-works-despite-bacterial-vaginosis.
 
 

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C-Sections vs. Vaginal Delivery: What’s Better for an Infant’s Health?

The belief that C-sections destroy a baby’s chance at a healthy microbiome has become a popular one. This common narrative may not be as clear as we once thought, though. Science about microorganisms and C-sections have come a long way. The incoming (or outgoing?) baby may still get some exposure to protective microbes even through this almost-routine procedure. Let’s discuss bacterial communities in the vaginal microbiome and the exposure to healthy bacteria for children through vaginal delivery and C-section.

 

Vaginal Delivery vs. C-Section: What’s Better for Baby Health?

 
When the baby passes through the vaginal microbiome, your incoming bundle of joy gets exposed to a plethora of bacteria [1]. The common idea is that this initial exposure of the baby to the vaginal microbiota is pivotal in setting the trajectory for the baby’s health.
 
This belief system is part of the hygiene hypothesis. While there is some credibility regarding delivery type within the hygiene hypothesis, it doesn’t mean a baby born via C-section is doomed.
 
Numerous health-conscious mothers want the immune-boosting support of a vaginal delivery. However, many women prefer the comfort of a C-section. Others must choose this delivery method for health reasons.
 
No matter what, it’s a woman’s choice. They shouldn’t feel pressured to sway either way. However, these decision-makers should have all the facts.
 
Thankfully, our knowledge about C-sections is broadening. Not all C-sections are created equal. In fact, some C-sections still expose your baby to healthy gut bacteria!

 

Health Risks Associated with C-Sections

 
There are a lot of health risks for babies associated with getting a C-section.
 
In fact, babies who are products of C-sections have been linked to:
Autoimmune Diseases [2]
Asthma [3]
Type 1 Diabetes [4]
Celiac Disease [5]
Obesity [6]

While these statistics may be alarming, each situation is unique. Mothers have their own set of DNA, bacteria, and immune cells that they transfer to their children. These traits have essential implications for all factors of our health. These very influencers can also be the reason why a C-section might be necessary. 

 

The Uniqueness of the Vaginal Microbiome 

 
That’s what makes microbiology so interesting! The human vagina has hundreds of bacterial species that make each situation unique.
 
For the most part, these microbes are pretty helpful. These flora regulate vaginal pH to ensure pathogens don’t take over and help regulate immune responses in the area. 
However, different bacteria can cause infertility issues, preterm delivery, bacterial vaginosis (BV), or a vaginal infection that requires medical intervention. 
 
That’s why decisions about your baby’s health and vaginal health are so personal and need to be made with as much information presented as possible. 

 

What Are the Differences in Microbiomes Between the Babies Born Through C-section and Those Born Through the Vagina?

 

Babies do not live in a sterile environment like we once thought. Bacteria are found throughout the womb. Not to mention, there are gut bacteria in a baby’s first bowel movement. Yeah, those sometimes occur inside the uterus!
 
An analysis of the vaginal microbiome found,
 

“Human amniotic fluid and placenta harbour unique microbial communities, which may provide the initial inoculum for gut colonisation, the single most important determinant of host-microbe interaction modulating the risk of non-communicable disease [7] .”

Nature

 
These findings show that a baby’s exposure to bacteria through vaginal microbial communities happens before the child is even born. Additionally, after the amniotic sac (which is the sac of water the fetus is held in) breaks, the baby begins to be exposed to bacteria in the vaginal microbiome.
 
One meta-analysis compared the anaerobic bacteria of infant children. Some were born via C-section, while others were delivered vaginally.
 
Results found,
 

“Caesarean section is characterized by lower numbers of strict anaerobes such as Bacteroides fragilis and bifidobacteria compared to vaginally delivered infants [8].”

Clin Med Pediatr

 
Research suggests that babies whose mother’s water broke prior to a C-section being performed had more microbial biodiversity than children born of a C-section whose mother’s water didn’t break [9].
 
Even if the result of the birth is a C-section, the broken amniotic sac allows some bacterial exposure from vaginal flora. This partial greeting between the fetus and microbes affects the baby’s microbiome. In particular, the vaginal microbiome is teeming with many species of Lactobacillus. 
 
Vaginal lactobacilli are essential for keeping yeast infections to a minimum and protecting against pathogens. They are among the first in the vaginal ecosystem to greet your little one. If you choose to breastfeed, you will continue to pass on various Lactobacillus species to your child that will help keep their immune system and digestive system healthy. 

 

Vaginal Microbiome and Labor

 

labor and vaginal microbiome

 
Labor is when a woman’s body begins to prepare for childbirth. In a nutshell, The labor process includes massive hormonal shifts [10].
 
When these changes happen, it causes:
Contractions of the Uterus
Dilation of the Cervix
Amniotic Sac Rupturing (Water Breaking)
 
All of these changes don’t just affect mom. As the process continues, the fetus is exposed to hormones that boost immunity and decrease inflammation [11].
 
Also, as mentioned above, after the water breaks, exposure to vaginal flora begins. One study found that babies born from a C-section tended to have lower levels of Escherichia-Shigella and Bacteroides species compared to those born through labor. 
 
The study noted these differences were more apparent in women who elected for a C-section rather than a woman who started going into labor and had to get an emergency procedure [12]. These findings further prove that the labor process already introduces vaginal flora to the baby.

 

Are Antibiotics More Harmful Than C-Sections?

 

 
In many cases, antibiotics are a lifesaving necessity during birth, but that does not mean they don’t have their drawbacks. It is already common knowledge that antibiotics can harm your gut microbiome [13]. Even scarier, studies show that they can have negative implications for babies before they are even born. 
 
One analysis published through the National Institutes of Health found,
 

“Our results indicate an effect of IAP (intrapartum antimicrobial prophylaxis) on the establishing early microbiota during the first months of life, which represent a key moment for the development of the microbiota-induced host homeostasis [14].”

Microbiome

 
Some studies show that it may not be the actual C-section that causes the differences in microbiome and disease development in children, but the antibiotics are to blame [15]. 

 

Antibiotics During C-Sections

 
When C-sections are performed, antibiotics are given during or after surgery to prevent infection. The problem is, different antibiotic protocols are used during C-section deliveries. Sometimes they are administered during or after the surgery. 
 
Also, sometimes antibiotics are administered during vaginal deliveries, such as when a woman has Group B strep [16].
 
Not shockingly, babies born vaginally that are exposed to antibiotics show similar microbial results to babies born via C-section who were exposed to antibiotics [17]. 
 
Their gut microbiome is more susceptible to pathogens, which can cause immune responses more frequently. That’s because antibiotics wipe out all bacteria.
 
If your doctor ever recommends you take antibiotics during the birthing process, you need to take them. Often antibiotics can be a lifesaving tool for both mom and baby. 
 
This lifesaving measure does not mean they don’t come with drawbacks, though. It is good to talk to your doctor about minimizing unnecessary antibiotic use before the birthing process begins.

 

Breastfeeding for Baby Health

 

 
Research suggests babies that are breastfed are generally healthier later in life. It is rich in protein that promotes growth, colostrum that supports a healthy immune system, and lactic acid that improves digestion. That’s why the American Academy of Pediatrics highly recommends this act.
 
They state,
 

“The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant [17].”

American Academy of Pediatrics

 
Another critical component of microbiome development is whether or not a baby was breastfed. Recent scientific discoveries found that breast milk contains many probiotic bacteria and prebiotics that help to develop a healthy microbiome [18].

 

Breast Milk Probiotics and Baby Growth

 
Often babies born via C-section have a more challenging time breastfeeding and do not breastfeed as frequently or as long [19]. This difference is another factor that could account for the correlations between C-section delivery and disease development later on. 
 
When you breastfeed, it’s essential to keep with a regular schedule. As your baby gets older, the breast milk changes in composition to continually meet the baby’s nutritional needs [20]. 

 

Vaginal Seeding for Newborns

 
Seeding is when a baby born by C-section is exposed to vaginal fluids immediately after birth. This practice is done by swabbing the baby in gauze with vaginal fluids from the mother to “seed” the baby’s microbiome [21]. 
 
The rationale behind seeding is that all of the negative correlations associated with C-sections are because the baby is not exposed to the bacteria-rich vaginal fluids. While a thoughtful theory, there are some concerns and further research is needed. We need a better understanding before we can endorse such a process. 
 
Additionally, the American College of Obstetrics and Gynecologists does not recommend this practice since it can introduce pathogens and harmful bacteria into the baby’s environment. 
 
There are instances where babies can become ill due to pathogenic bacteria in the vagina. Therefore, the risks do not outweigh the costs with the current research [22]. 

 

Are C-Sections Dangerous for Baby Gut Health?

 

 
There is a correlation between a multitude of diseases later in life and C-section delivery. Right now, we don’t know exactly how much of that is due to microbial changes due to the type of childbirth.
 
Even if you need to have a C-section, all hope is not lost; you can still give your baby the best shot at having a healthy microbiome. Being educated on all the different ways your baby’s microbiome can be affected is essential. It’s good to realize the story is not entirely so black and white, and sometimes those shades of gray are okay!
 
If you’re considering getting pregnant, you might want to consider taking a vaginal health test. That way, you can be more prepared for important procedural decisions down the road. 
 
With the Thryve Vaginal Health Kit, we send you vaginal swabs to safely collect a sample and discreetly ship back to our laboratories.

 

Are C-Sections Dangerous for Baby Gut Health?

 
There is a correlation between a multitude of diseases later in life and C-section delivery. Right now, we don’t know exactly how much of that is due to microbial changes due to the type of childbirth.
 
Even if you need to have a C-section, all hope is not lost; you can still give your baby the best shot at having a healthy microbiome. Being educated on all the different ways your baby’s microbiome can be affected is essential. It’s good to realize the story is not entirely so black and white, and sometimes those shades of gray are okay!
 
If you’re considering getting pregnant, you might want to consider taking a vaginal health test. That way, you can be more prepared for important procedural decisions down the road. 
 
With the Thryve Vaginal Health Kit, we send you vaginal swabs to safely collect a sample and discreetly ship back to our laboratories.
 
Our diagnostics can inform you of which bacteria have grown problematic. This information can help prevent the spread of infectious diseases, the frequency of yeast infections, or issues with infertility. 

 

Click Here To View Resources

Resources

 
[1] Luxembourg, University of. “Altered Microbiome after Caesarean Section Impacts Baby’s Immune System.” ScienceDaily, ScienceDaily, 30 Nov. 2018, www.sciencedaily.com/releases/2018/11/181130094328.htm.
 
[2] Neu, J., & Rushing, J. (2011). Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clinics in perinatology, 38(2), 321–331. doi:10.1016/j.clp.2011.03.008
 
[3] Kero, Jukka, et al. “Mode of Delivery and Asthma — Is There a Connection?” Pediatric Research, U.S. National Library of Medicine, July 2002, www.ncbi.nlm.nih.gov/pubmed/12084840.
 
[4] Algert, C S, et al. “Perinatal Risk Factors for Early Onset of Type 1 Diabetes in a 2000-2005 Birth Cohort.” Diabetic Medicine : a Journal of the British Diabetic Association, Blackwell Publishing Ltd, Dec. 2009, www.ncbi.nlm.nih.gov/pubmed/20002469.
 
[5] Decker, Evalotte, et al. “Cesarean Delivery Is Associated with Celiac Disease but Not Inflammatory Bowel Disease in Children.” Pediatrics, U.S. National Library of Medicine, June 2010, www.ncbi.nlm.nih.gov/pubmed/20478942.
 
[6] Ajslev, T A, et al. “Childhood Overweight after Establishment of the Gut Microbiota: the Role of Delivery Mode, Pre-Pregnancy Weight and Early Administration of Antibiotics.” International Journal of Obesity (2005), U.S. National Library of Medicine, Apr. 2011, www.ncbi.nlm.nih.gov/pubmed/21386800.
 
[7] Collado, Maria Carmen, et al. “Human Gut Colonisation May Be Initiated in Utero by Distinct Microbial Communities in the Placenta and Amniotic Fluid.” Nature News, Nature Publishing Group, 22 Mar. 2016, www.nature.com/articles/srep23129.
 
[8] Wall, R., Ross, R. P., Ryan, C. A., Hussey, S., Murphy, B., Fitzgerald, G. F., & Stanton, C. (2009). Role of gut microbiota in early infant development. Clinical medicine. Pediatrics, 3, 45–54. https://doi.org/10.4137/cmped.s2008.
 
[9] Stinson, Lisa F., et al. “A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome.” Frontiers, Frontiers, 20 Apr. 2018, www.frontiersin.org/articles/10.3389/fmed.2018.00135/full.
 
[10] “Labor and Childbirth: What To Expect & Complications.” WebMD, WebMD, www.webmd.com/baby/guide/normal-labor-and-delivery-process.
 
[11] Malamitsi-Puchner, Ariadne, et al. “The Influence of the Mode of Delivery on Circulating Cytokine Concentrations in the Perinatal Period.” Early Human Development, U.S. National Library of Medicine, Apr. 2005, www.ncbi.nlm.nih.gov/pubmed/15814224.
 
[12] Azad, Meghan B, et al. “Gut Microbiota of Healthy Canadian Infants: Profiles by Mode of Delivery and Infant Diet at 4 Months.” CMAJ : Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, Canadian Medical Association, 19 Mar. 2013, www.ncbi.nlm.nih.gov/pubmed/23401405.
 
[13] Langdon, A., Crook, N., & Dantas, G. (2016). The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome medicine, 8(1), 39. doi:10.1186/s13073-016-0294-z
 
[14] Nogacka, Alicja, et al. “Impact of Intrapartum Antimicrobial Prophylaxis upon the Intestinal Microbiota and the Prevalence of Antibiotic Resistance Genes in Vaginally Delivered Full-Term Neonates.” Microbiome, BioMed Central, 8 Aug. 2017, www.ncbi.nlm.nih.gov/pubmed/28789705.
 
[15] Azad, MB, et al. “OBGYN.” Obstetrics and Gynecology, John Wiley & Sons, Ltd (10.1111), 28 Sept. 2015, obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13601.
 
[16] Aloisio, Irene, et al. “Influence of Intrapartum Antibiotic Prophylaxis against Group B Streptococcus on the Early Newborn Gut Composition and Evaluation of the Anti- Streptococcus Activity of Bifidobacterium Strains.” SpringerLink, Springer Berlin Heidelberg, 1 Apr. 2014, link.springer.com/article/10.1007%2Fs00253-014-5712-9.
 
[17] Breastfeeding, Section On. “Breastfeeding and the Use of Human Milk.” Pediatrics, American Academy of Pediatrics, 1 Mar. 2012, pediatrics.aappublications.org/content/129/3/e827.
 
[18] Rautava, S. “Early Microbial Contact, the Breast Milk Microbiome and Child Health.” Journal of Developmental Origins of Health and Disease, U.S. National Library of Medicine, Feb. 2016, www.ncbi.nlm.nih.gov/pubmed/26051698.
 
[19] Bai, Dorothy Li, et al. “Association between Intrapartum Interventions and Breastfeeding Duration.” Journal of Midwifery & Women’s Health, U.S. National Library of Medicine, 2013, www.ncbi.nlm.nih.gov/pubmed/23317341.
 
[20] Ballard, O., & Morrow, A. L. (2013). Human milk composition: nutrients and bioactive factors. Pediatric clinics of North America, 60(1), 49–74. doi:10.1016/j.pcl.2012.10.002
 
[21] “Women’s Health Care Physicians.” ACOG, www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Vaginal-Seeding?IsMobileSet=false.
 
[22] Embleton, Nick, et al. “Mortality from Early Onset Group B Streptococcal Infection in the United Kingdom.” ADC Fetal & Neonatal Edition, BMJ Publishing Group, 1 Mar. 1999, fn.bmj.com/content/80/2/F139.
 


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