Once again, we are here talking about vaginal health and some rather important points. This is not my own work but taken from a professional article and the reference to the full article (which you may find even more helpful, if rather technical) is shown at the end of the article. Italics are mine. I have left in the references, which will take you to the original article.
The term ‘feminine hygiene habits’ encompasses a wide variety of practices used to cleanse in and/or around the female genital area. The most well-studied vaginal hygiene practice, douching, involves the introduction of water and/or cleansing products into the vagina. Douching has been associated with increased risks of BV, preterm birth, and pelvic inflammatory disease (PID), which can lead to infertility [5,6]. It has been hypothesised that douching alters the microbial community within the vagina, causing inflammation and providing an opportunity for pathogenic bacteria to invade and colonise the area [7]. Aside from vaginal douching, little is known of the effect that other feminine hygiene products such as gels, sprays and wipes have on the vaginal microbiome.
The vagina is a self-cleansing organ [8]. Vaginal discharge consists of desquamated vaginal epithelial cells, bacteria, and glandular secretions and helps to protect against vulvovaginal infections [7]. Discharge is normally white or clear in colour and possesses a slight, non-offensive odour. The quality of discharge changes throughout the menstrual cycle: discharge is thick, sticky, and hostile to sperm early in the cycle, and becomes thin and watery during ovulation due to rising estrogen levels [7]. For some women, discharge is unpleasant, and this leads to the use of feminine hygiene products and practices to remove discharge and odour from their genital area.
Feminine hygiene products such as douches, wipes, sprays, washes, and powders are part of a fast-growing industry worth USD 2 billion in the US [11]. These products are marketed to women with the idea of maintaining a ‘clean and fresh’ vagina. Products such as ‘Femfresh’ and ‘Vagisil’ are scented to block vaginal odour which in most cases is completely normal and healthy. These marketing ploys capitalise on cultural messages that women’s bodies are problematic, unclean, and require cosmetic products to maintain a healthy state [10].
Research suggests that the use of feminine hygiene products may be the result of a ‘harmful cycle’ whereby women wash to reduce perceived itching, odour, and discharge, only to develop more significant or additional symptoms resulting from increased washing and the associated disturbance of the normal microbiome [9,12].
The vaginal microbiome is a dynamic ecosystem that varies between women, depending on several factors. A seminal study by Ravel et al. [4] introduced the idea of community state types (CST) after discovering that the microbiomes of women of varying ethnicities could be clustered into five core community groups. Four of these groups were dominated by Lactobacillus spp., (L. crispatus, CST I; L. gasseri, CST II; L. iners, CST III; L. jensenii, CST V) while the final group (CST IV) was characterised by a low relative abundance of Lactobacillus spp. with higher proportions of anaerobic bacteria [4]. In 2012, Gajer et al. divided CST IV into two sub-states, with CST IV-A dominated by anaerobes of the genera Anaerococcus sp., Prevotella sp. and Streptococcus sp., and CST IV-B by higher proportions of the genera Atopobium sp. and Megasphaera sp., amongst others [13].
A ‘normal’ vaginal microbiome is difficult, if not impossible, to define. CST I, II, III and V have all been considered ‘healthy’ for their dominance of Lactobacillus species (L. crispatus, L. gasseri, L. iners, L. jensenii). However, as living microcosms, microbiomes are subject to change in response to intrinsic factors such as menstrual cycling and pregnancy but also external factors such as diet, exposure to smoke and other airborne pollutants, antibiotic treatment, exercise, and stress.
Research on the gut microbiome has revealed the effect of diet on gut bacterial composition, which impacts the well-being of individuals and their susceptibility to diseases such as obesity, inflammatory bowel disease and metabolic disorders [23,24,25]. In the context of the vaginal microbiome, research has shown that an insufficient intake of micronutrients such as vitamins A, C, D, E, β-carotene, folate, and calcium may increase the risk of BV [26,27,28,29]. There is also evidence to suggest that an increased carbohydrate intake may fuel Lactobacillus spp. growth within the vagina by increasing the free glycogen levels [26,30]. Glycogen is metabolised to lactic acid by Lactobacilli, which promotes an acidic vaginal pH [30]. However, carbohydrates with a high glycaemic index have also been demonstrated to increase the risk of BV in women, a condition generally associated with a low abundance of Lactobacillus spp. [26].
Chronic stress stimulates the hypothalamic-pituitary-adrenal (HPA) axis, promoting the release of cortisol from the adrenal cortex. Stress-related vaginal dysbiosis is hypothesised to be caused by increased cortisol levels which suppress immune activity leading to the loss of Lactobacillus sp. dominance [39]. Stress in pregnancy is an established risk factor for preterm birth [40,41,42]. Psychosocial stress also increases the risk of BV [39,43,44]. Culhane et al. [43] reported in 454 pregnant women that chronic stress was a significant and independent risk factor for BV status, even after multivariable analysis. Specifically, women in the moderate- and high-stress groups (as determined by the Cohen Perceived Stress Scale) were 2.3 and 2.2 times more likely to have BV than women in the low-stress group, respectively.
Research on the impacts of cigarette smoking on the vaginal microbiome has revealed an increased prevalence of bacterial vaginosis in smokers, as well as a greater risk of preterm birth [2,46,47,48,49,50,51]. Payne et al. [52] analysed the vaginal microbiomes of pregnant women for the presence of three target organisms (Ureaplasma, Mycoplasma, and Candida spp.) previously associated with preterm birth and found that smoking significantly increased the odds of detection of all three. Cigarette smoking is also known to have anti-estrogenic effects, which may negatively impact the growth of Lactobacillus spp. in the vagina [53]. Westhoff et al. [53] measured the mid-cycle and luteal phase concentrations of estrogens and progestins of 175 reproductive-aged women and observed that smoking was associated with decreased estrogen levels in both phases.
Hormonal contraceptives such as the combined oral contraceptive pill (COCP), and the hormonal intrauterine device (IUD) release sustained amounts of estrogen and progestin throughout the menstrual cycle, preventing ovulation and rendering cervical mucus impenetrable by sperm [67]. Barrier contraceptives such as condoms prevent genital contact as well as the transfer of sperm into the vagina, which helps to maintain a healthy vaginal microbiota. In fact, studies have found that condom users have a higher prevalence of H2O2-producing Lactobacilli [68], and are less likely to exhibit a non-optimal CST III (L. iners) microbiome [69]. There is also consistent evidence that hormonal contraceptive use prevents BV [70,71,72,73].
This is part 1 of the article as it is rather long and covers a very wide range of conditions. I will offer part 2 in due course, though you can read the full article now, of course at the reference shown below:
NOT MY OWN WORK. Taken from: Holdcroft AM, Ireland DJ, Payne MS. The Vaginal Microbiome in Health and Disease-What Role Do Common Intimate Hygiene Practices Play? Microorganisms. 2023 Jan 23;11(2):298. doi: 10.3390/microorganisms11020298. PMID: 36838262; PMCID: PMC9959050.
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