Meet the different types of vaginal lactobacilli

Unlike the GIT microbiome, where we want as many species and as much diversity as possible, in the vagina, it is the opposite. A healthy vagina is dominated by lactobacilli species- ideally aiming for over 75-90% lactobacilli dominance.

High levels of Lactobacilli can protect against opportunistic infections, yeast infections, bacterial vaginosis and urinary tract infections. Having low levels of Lactobacillus, or none at all, is associated with having disruptive microbes and their related conditions.

Not all Lactobacilli are quite equal though, and there are 4 main types that may be found vaginally:

Lactobacillus crispatus:

dominance of this species has strong body of research supporting its association with vaginal health. The main reason is that Lactobacillus crispatus produces chemicals called lactic acid and hydrogen peroxide, which keep the pH in an optimal acidic range, making it difficult for opportunistic bacteria, pathogens and fungal species to grow.

Lactobacillus gasseri:

this is also a key component of a healthy vaginal microbiome, which helps to protect against infections and maintain a healthy vaginal environment. It contributes to vaginal health by producing antimicrobial compounds, lowering vaginal pH, and potentially interfering with the growth of other bacteria.\

Lactobacillus jensenii:

like other Lactobacilli, produces lactic acid, which helps to lower the vaginal pH- however, it does not produce lactic acid as efficiently as L. crispatus

Lactobacillus iners:

the role of this species in vaginal health is unclear, since it can be detected in normal conditions as well as during vaginal dysbiosis, such as bacterial vaginosis. Some studies suggest it be a transitional species that colonises after the vaginal environment is disturbed. It is not a great contributor to lactic acid production. An overabundance of L. iners may contribute negatively to fertility outcomes, unlike the previously mentioned species.

Some others include: Lactobacillus vaginalis, Lactobacillus salivarius

Now it’s important to realise when you do a general culture/swab with your GP- lactobacilli will be vaguely defined as “not seen” or “some” or “numerous”.

Some labs do go as far as grading with “+” up to “+++” but none of them will tell you which type of lactobacilli you have specifically.

Examples:

For us to know this, more comprehensive testing needs to be done with either PCR testing or even better, Next-Generation Sequencing testing (NGS) which can sequence for a wide range of bacterial and fungal species with specificity down to the species level.

Examples:

A qualified and vaginal microbiome-trained naturopath can assist with requesting and interpreting these incredible tests. At Peppermint & Sage, we are specialists in this area and use them all the time to help our patients with ongoing recurrent symptomatic issues, as well as in a fertility context.

For anyone struggling with the following issues, more comprehensive vaginal microbiome testing is key to understanding and addressing the issue:

• Recurrent Vulvovaginal Candidiasis (RVVC) (thrush/candida)

• Bacterial Vaginosis

• Frequent Urinary Tract Infections (UTIs)

• Recurrent HPV carriage

• Recurrent miscarriage or implantation failure

• Unexplained vaginal symptoms