Last year, the UK-based sustainable tampon brand Daye made headlines for raising nearly $12 million in funding for their latest invention: a tampon that doubles as a vaginal microbiome testing kit. Wildly innovative, yes, but the news also raised a more important question: what is our vaginal microbiome anyway, and do we really need to think about it, let alone test it and treat it?
The gut has, for years, dominated the microbiome spotlight (and related social media hashtags; see #guttok), but it is really one of many that live in the body. A community of organisms, including bacteria, fungi, and viruses coexisting in a particular environment, there are microbiomes not just in the gastrointestinal tract, but also the skin, the mouth, and, yes the vagina too. “Microbes make up about 50% of our cell counts, which is extraordinary if you think that over 38 trillion cells in our bodies are not human,” says Ara Katz, co-founder of Seed Health. As scientists have gained sequencing technologies that have allowed these non-human cells to be studied more closely, says Katz, we have in turn, developed an understanding of their broader impact. “For centuries in medicine and science, we were looking at the human body with only half the picture, and the same goes for the vagina,” she adds.
While the vagina may have a microbiome like the oft-mentioned gut, their environments have evolved to be radically different. Katz compares it to the dissimilarities between natural ecosystems like a rainforest versus a desert, swamp, or lake: all of them play host to their own singular species. The same is true of the body. “When you look at the markers of health of the gut microbiome, you want it to not just be diverse, but have a high biomass,” says Katz. But an optimal vaginal microbiome is characterized by the opposite. “The vagina is an incredibly special and highly unique microbiome in that it is by design meant to have low bacterial diversity and is only dominated by lactobacillus,” Katz explains. Aka, good bacteria. According to Alyssa Dweck, MD, a board-ceritifed obgyn and chief medical officer at Bonafide, those lactobacilli promote lactic acid production and keep the vaginal pH in a normal acidic range (that’s 3.8-4.5).
“Keeping the vaginal microbiome in balance serves to preserve the structure and function of the vagina and prevent disease,” says New York dermatologist Macrene Alexiades, MD. Because it plays such a crucial role in our urogenital, vaginal, and reproductive health, being out of balance (or dysbiotic) can lead to a host of pathologies and conditions. “Certain patterns of bacteria are linked to higher risk for preterm birth, acquisition of sexually transmitted diseases, and persistence of infections like HPV,” says Caroline Mitchell, MD, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and the director of the vulvovaginal disorders program at Boston’s Mass General Hospital.
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