The Vaginal Microbiome — What Every Woman Needs to Know About UTIs, Fertility & Intimate Health

takeaways

1. The vaginal microbiome is unique in that health is marked by a dominance of acid-producing Lactobacillus (not diversity, as in the gut), which keeps the vagina at an acidic pH of roughly 3.5–4.2.

2. A healthy, Lactobacillus-dominant vaginal microbiome has been linked in research to shorter time to conceive, reduced recurrent miscarriage and support for IVF cycles, though it is described as one piece of the fertility puzzle.

3. The vagina and bladder are closely linked, and dysbiosis in the vagina can act as a reservoir of uropathogens that drives recurrent UTIs.

4. Women often experience dismissal from clinicians, and the pairing of taboo and a historic lack of women's health research has slowed progress in this area.

5. Lifestyle and product choices were discussed, including avoiding douching and harsh soaps, using pH-matched washes and lubricants, wearing cotton or bamboo underwear, and considering partner testing for recurrent BV.

6. At menopause, falling estrogen reduces glycogen fuel for Lactobacillus and can trigger genitourinary syndrome of menopause (GSM), which unlike hot flushes is progressive and lifelong.

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