Summer is bathing suit season—which unfortunately means it’s UTI season. While we’re all about lazy afternoons at the pool, brisk ocean dips and evening lake swims, romping around in a wet swimsuit for hours on end can lead to a higher risk of urinary tract infections (UTI) or bacterial vaginosis (BV), both of which are decidedly less fun.
That said, there is a way to ward off those itchy conditions—outside of simply changing into dry clothes immediately. Microbiome-focused company Seed Health recently launched its first vaginal prebiotic and probiotic (known as a synbiotic), VS-01, a three-strain suppository which is designed to maintain a protective and stable vaginal microbiome—helpful if you tend to be more prone to UTIs or BV. And if that’s you, you’re not alone: Clinical data shows that a whopping 9 out of 10 women are prone to vaginal complications like infections, malodor, discharge and inflammation. At the root of those issues? Disruptions in the vaginal microbiome, Seed CEO and co-founder Ara Katz tells Motherly.
The Seed team set their sights on a vaginal health probiotic years ago, and began working with renowned vaginal microbiome researcher, Dr. Jacques Ravel. Connecting with Dr. Ravel and his groundbreaking research led Katz and team to understand the crucial role of the vaginal microbiome in gynecological, urogenital and reproductive health—and the bacteria supporting it. A landmark move, especially given how under-researched women’s health conditions are.
“We now know that the most stable and optimal vaginal microbiome is dominated by one bacterium: Lactobacillus crispatus. But everyday factors—like menstruation, sexual activity, exercise, contraceptives, cleansers, or even stress—can disrupt the vaginal microbiome and deplete the abundance of this protective L. crispatus,” Katz says.
But oral probiotics are generally ineffective when it comes to vaginal health. Seed’s VS-01 is a vaginal suppository designed to deliver three key strains exactly where they need to go, establishing and sustaining a balanced vaginal microbiome amidst those everyday disruptors Katz describes. And it works: “In a double-blind, randomized, placebo-controlled clinical trial, VS-01 established an optimal vaginal microbiome dominated by L. crispatus in 90% of participants with a non-optimal vaginal microbiome within one menstrual cycle, and 100% of participants maintained regulated vaginal pH,” Katz shares. “This work is personal to me, and I am profoundly proud of what we have achieved.”
Here, Katz answers our biggest questions about the vaginal microbiome—and how to prevent pesky UTIs and BV infections before they start. Responses have been lightly edited and condensed for clarity.
Q. What is the vaginal microbiome?
Ara Katz: The vaginal microbiome is the community of microorganisms, primarily bacteria, that live in the vagina.
Think of it like your vagina’s personal immune system. A healthy vaginal microbiome is predominantly made up of Lactobacillus species. These lactobacilli produce lactic acid, helping the vagina maintain a low, acidic pH that inhibits the growth of harmful bacteria, yeast, and viruses. Beyond maintaining this healthy acidity, lactobacilli also help reduce inflammation and keep the protective vaginal mucus barrier intact. One standout species, Lactobacillus crispatus, even produces natural antibiotic-like substances that fend off pathogenic invaders. Research shows that L. crispatus is the most protective against pathogens and is key to a stable, healthy vaginal environment.
But the vaginal microbiome is a living, ever-changing ecosystem. Everyday factors can throw it off balance. When this happens, the number of protective Lactobacillus can drop, leaving the vagina vulnerable to infections and other issues. Disruptions in the vaginal microbiome have been associated with increased risk of UTIs, bacterial vaginosis (BV), yeast infections, and even obstetric challenges such as infertility, preterm birth, and low birth weight.
Q. How does the vaginal microbiome change throughout different life stages?
Throughout your life, the microbes in your vagina will shift. These changes are common and normal. Everything from your menstrual cycle and pregnancy status to the types of period and personal care products you use can temporarily alter your vaginal microbiome. The good news is that you can take control and restore your vaginal microbiome to a healthy state with a few daily practices.
Puberty: Before puberty, the vaginal microbiome is pretty quiet. When puberty starts, hormones kick in, and things get lively. Lactobacillus bacteria start to flourish, thanks to increased glycogen (a form of sugar) that these bacteria love. By the end of puberty, Lactobacillus is usually in charge, keeping things balanced.
Menstrual cycles: Your period can shake things up. Menstrual blood is slightly alkaline, which can temporarily change your vaginal pH. Hormonal ups and downs during your menstrual cycle also impact your vaginal microbiome. Estrogen helps Lactobacillus thrive, but when estrogen dips during your period, there’s more bacterial diversity and fewer Lactobacillus. This can sometimes lead to yeast infections right before your period.
Pregnancy: Pregnancy brings major changes. Early on, your vaginal microbiome supports the embryo’s development. As you progress, Lactobacillus, especially Lactobacillus crispatus, takes over, maintaining an acidic environment that protects you and your baby from infections. These changes also help set up your baby’s microbiome and immune system. By the third trimester, your vaginal microbiome is helping to prepare for labor and your baby’s first exposure to beneficial bacteria.
Menopause: During perimenopause and menopause, lower estrogen levels change your vaginal microbiome again. Lactobacillus levels drop, and other bacteria can take over, increasing the risk of infections. Without hormone replacement therapy (HRT), the vaginal microbiome can resemble that of someone with bacterial vaginosis, with higher pH levels and vaginal discomfort. But maintaining a healthy diet, staying active and making informed choices can help keep your vaginal microbiome balanced during this time.
Q. What are some tips for preventing UTIs and maintaining a healthy vaginal microbiome?
Fluctuations in the vaginal microbiome throughout life can sometimes lead to a microbial imbalance or decrease your ability to fight off infections—like UTIs.
UTIs are bacterial infections that usually occur in the lower urinary tract and are caused by Escherichia coli (E. coli) bacteria. E. coli are common in the gut and generally harmless there, but when they spread to the urinary tract, they can cause inflammation and infection.
Here are some preventive measures to keep your vaginal and urinary environments healthy:
Use physical barriers during sex
Having sex can introduce new bacteria into the vagina, increasing the risk of UTIs. Using protection during sex, like condoms and dental dams, can help minimize disruptions to the vaginal microbiome while also reducing the risk of sexually transmitted infections (STIs). To help flush out any harmful bacteria, it’s a good idea to urinate after sex.
Know that diet seems to play a role
Some studies have shown that eating lots of sugary, processed foods could lead to harmful bacteria and yeast growth. Excess sugar can also impair immune function and contribute to inflammation, both of which can negatively affect the vaginal microbiome. Meanwhile, a low-fat diet rich in fiber, fruits, vegetables, and nuts and seeds (which are rich in phytoestrogens) could promote a more balanced microbiome—these foods contain estrogen-mimicking compounds that gut microbes can modify, promoting the growth of beneficial lactobacilli in the vagina.
Consider taking a D-mannose supplement
This simple sugar, found naturally in fruits, shows promise as an alternative UTI treatment. Research suggests D-mannose can help prevent UTIs by stopping bacteria from sticking to the walls of the urinary tract, lowering the chance of another infection.
Skip douching and scented pads and tampons
It’s also important to avoid vaginal douching, as it can disrupt the natural pH of the vagina and increase the risk of infections. Remember, your vagina is a self-cleaning organ, so there’s no need to douche. Alongside this, avoiding harsh or scented products in the vaginal area can help maintain the balance of your vaginal microbiome. Limiting antibiotic use is another key factor—only use antibiotics when necessary and as prescribed by your healthcare provider to minimize disruption to the beneficial bacteria throughout your body.
Avoid hanging out in damp clothing
Wearing tight, non-breathable clothing for long periods can create a warm, moist environment where bacteria thrive. Choose breathable, cotton underwear and avoid tight-fitting pants when you can, and after exercise or swimming, change out of sweaty, wet clothes quickly.
Stay hydrated
Improper hydration can increase the risk of UTIs by allowing bacteria to grow unchecked. Drinking plenty of water helps flush out harmful bacteria and supports a healthy balance in your urinary and vaginal environments.
Try a vaginal suppository probiotic
It’s important to note that not all probiotics for vaginal health are created equal. Many probiotics marketed for vaginal health are taken orally, despite there being no direct path from the GI tract to the vagina, and many use strains found in the gut rather than those native to the vagina. If you want a vaginal probiotic to have a meaningful impact on the vaginal microbiome, you’ll need a product that directly interacts with the vaginal wall (AKA, a vaginal suppository—not an oral capsule), and contains native vaginal strains associated with optimal vaginal health. This is why we designed our VS-01 tablets to be inserted directly into the vagina, with three live strains of L. crispatus that are clinically validated to promote optimal vaginal health.
Q. What are some common myths or misconceptions about the vaginal microbiome that need debunking?
There are certainly a lot, so I’ll share just 5 here:
- MYTH: Boric acid is a safe and long-term solution for managing vaginal health issues.
FACT: Though boric acid can eliminate harmful pathogens, it also indiscriminately kills beneficial vaginal bacteria. This can disrupt the vaginal microbiome and lead to further imbalances and complications.
- MYTH: Washing or douching is beneficial for maintaining vaginal cleanliness and health.
FACT: Douching or excessive washing can remove the beneficial bacteria that make up the vaginal microbiome, leading to increased risk of infections and irritation due to an imbalance.
- MYTH: You can treat yeast infections with yogurt or garlic.
FACT: Regardless of what you may have heard, there’s little evidence that alternative, homeopathic solutions can effectively treat vaginal discomfort. As convenient as it would be to have the solution sitting in your kitchen pantry, the reality is that there’s little good quality clinical research to show that placing yogurt, kefir, garlic, tea tree oil, or anything of the sort into your vagina will clear up an infection.
- MYTH: Oral probiotics can improve the health of the vaginal microbiome.
FACT: Oral probiotics are generally designed for gut health and do not directly affect the vaginal microbiome. There is no direct pathway from the gastrointestinal tract to the vagina, so these probiotics often do not reach or influence the vaginal environment. Targeted treatments that are specifically formulated for vaginal health are more effective.
- MYTH: Removing pubic hair is more hygienic.
FACT: Women are socialized to believe that their body hair is not only undesirable but also gross, and that removing it can enhance feelings of cleanliness and femininity. In fact, pubic hair, like everything else on your body, has evolved to be there for a reason: It keeps your vulva warm and moisturized, protects your skin from friction during sex, and traps germs.
Removing pubic hair is known to cause genital itching, pain, rash or burning. Sometimes, these side effects are harmless and go away on their own. But in some cases, grooming can cause microtears on the skin that may increase one’s susceptibility to infection. Some studies have also found that regular grooming may lead to changes in the vaginal microbiome and a higher risk of recurrent UTIs.
Q. Do you see the role of the vaginal microbiome becoming more prominent in the future?
Yes, absolutely. The vaginal microbiome is critical to the future of women’s health, and interest, understanding, and research in this space are only growing.
Still, it’s important to be mindful as we navigate these advancements. The fact remains that many products marketed for vaginal health and care often lack rigorous, scientifically validated testing.
In our development of VS-01, our first innovation for the vaginal microbiome, it was essential for us to not just meet the current standard in vaginal care, but set an entirely new one. We extensively test for safety, contaminants (including chemical residues and heavy metals), impurities and all classes of allergens. It is also formulated with gentle, non-irritating ingredients and tested for vaginal biocompatibility using an FDA-recognized tissue model. And we’ve continued our commitment to gold-standard clinical testing for all of our products, as seen with our first randomized, double-blind, placebo-controlled clinical trial for VS-01.
As interest in the vaginal microbiome grows, it’s crucial that the industry applies the level of scientific rigor that this field deserves. This way, the excitement about new possibilities will translate into real benefits for women’s health, rather than getting lost in the noise of unregulated and ineffective solutions. By taking a careful, informed approach, we can truly harness the potential of microbiome science to improve and revolutionize women’s health care.
