Caring For Your Reproductive Microbiome: Why and How?
Research in the area of the reproductive microbiome has exploded in the past 5 years. First, we now recognize that our gynaecological tissues actually have microbiomes! Until the completion of the Human Microbiome Project in 2016, we had erroneously believed that gynaecological tissues such as the uterus and fallopian tubes were sterile. We now know that (estimates vary) between 56-98% of the human body is actually non-human (mostly bacterial) cells, and the reproductive tissues are no exception. Second, we are starting to categorize the makeup of these microbiomes, and research is identifying patterns that are conducive to important clinical outcomes - like whether an embryo will implant after an IVF transfer, or whether a patient will be diagnosed with premature ovarian failure. For someone who works with patients every day who are trying to fall pregnant, and many (many!) couples diagnosed with unexplained infertility where their microbiomes and resultant immune system effects are often playing a role, this stuff is simply fascinating,
We are starting to understand from this research that the microbiomes of the reproductive tissues in both men and women play a role in nearly every single step of the reproductive process. There are healthy, commensal bacterial populations in follicular fluid, which impact egg quality and ovulatory function, in the fallopian tubes, the uterus, the cervix and the vagina, and in the testes and seminal fluid too. These healthy bacteria not only help facilitate reproductive functions, but they interact with the gametes throughout their lifespans in those tissues. The exact makeup of bacterial species in each of these reproductive tissues differs by site - so the bacteria that inhabit your ovaries are not the same species as in your vagina, for example. And further, these microbiomes change in relation to your age, ethnicity, and even where you’re at in your menstrual cycle.
More intriguing, perhaps, is that research is starting to show that the interaction between a couple’s microbiomes (seminal fluid and vaginal, for example, in heterosexual couples) determines which sperm is allowed to fertilize the egg, and microbiome compatibility likely plays a large role in couples experiencing unexplained infertility. Both heterosexual and same-sex couples influence each others’ microbiomes, as do environmental factors such as the type of underwear and clothing we choose to wear on our bodies, the soaps we select, our hygiene practices and our diets, etc.
Supporting your vaginal microbiome is an important consideration when you’re trying to conceive. The microbiome of the vagina is meant to be fairly simple - predominated by Lactobacillus species that produce lactic acid, making the vagina an acidic environment to help ward off opportunistic pathogens. In many cases, however, other species can predominate - especially when the cellular environment is shifted due to hygiene practices.
How can you best support a healthy reproductive microbiome? Depending on your individual makeup, we may need to do a protocol involving things like oral and vaginal/topical probiotics and washes, but to start - know that the following practices are generally considered microbiome supportive:
How to support a healthy reproductive microbiome
1. Stop smoking: we know from research that components from cigarette smoke can be detected in vaginal secretions and seminal fluid. These components reduce populations of healthy bacteria.
2. Don’t use douches, genital washes, or soaps unless strictly directed by your physician: this is especially important for those with vaginas. Soaps, washes, and even just water used intra-vaginally can have a major influence on the microbiome. They change the pH of the vagina, which may result in an unfavorable shift. Unless you’re doing a specific short term protocol to change your vaginal microbiome - use water on the external tissues (labia) only, and nothing at all in the vagina. Just remember - your vagina is self-cleaning! If there is an unfavourable odour, bring it up with your physician as it might be sign of dysbiosis or an infection that needs to be addressed. For those with penises, choose a gentle unscented cleanser for external hygiene (I like Dr Bronner’s unscented baby castille soap).
3. Consider sources of exogenous bugs: do you use sex toys? A menstrual cup? Bleached tampons? Anything that touches the reproductive tissues, especially anything inserted into the vagina, is a potential source of microbes. Make sure you boil your sex toys and menstrual cup regularly - having 2 menstrual cups that you rotate throughout your cycle is a good practice. Consider switching from conventional to organic tampons, or use my favourite menstrual product - OEKO-TEX® certified period underwear - of course, being sure to practice good hygiene while using them.
4. Rethink your underwear: for both men and women, the fabric we’re wearing as undergarments can influence the growth of microbes on (and in) our genitals. While research is yet to suggest the best type of gitch for you, I recommend organic cotton and, ideally, full brief underwear (not thongs - particularly for certain vaginal infections or microbiome patterns). Thong/‘g-string’ underwear have been accused of facilitating bacterial transfer from the anus to the vagina, increasing the likelihood of pathogenic growth of species like E. coli and Enterococcus faecalis - both of which can cause a disruption to the microbiome (at least) and possible infections and inflammation (at worst). While not everyone who wears a thong will negatively impact the vaginal microbiome, taking this variable out of the picture is the safest approach.
5. Feed the healthy bacteria: we know from research that the microbiome of the gut directly influences the reproductive microbiomes. Thus, feeding your gut microbes with a high fiber diet encourages healthy reproductive microbial populations everywhere. Fruits and veggies, legumes, whole grains and lentils are rich in prebiotic fibers. Fermented foods like sauerkraut and kimchi are teeming with lactobacillus species. Polyphenol rich red and purple fruits and veg, in particular, support healthy gut microbiota.
6. Consider hormonal influences: hormones like estrogen and insulin have significant impacts on the microbial populations in the body. Women who are post-menopausal, for example, have different vaginal microbiomes than those who are still cycling, and people who have diabetes have different microbiomes to those without. Keeping your blood sugar stable is one healthy microbiome strategy that I recommend for a number of different reasons. Similarly, knowing what’s happening with your hormones, and balancing the endocrine system, can positively affect your reproductive microbiome.
I have so much more to say about your reproductive microbiome! If you’re curious to learn more about how to support your reproductive microbiome while you’re trying to conceive, throughout your pregnancy, or in your postpartum, I encourage you to book an appointment with myself or Dr Ashley Damm ND to discuss testing and individual strategies.
Your reproductive microbes are more important than we’ve ever known. Take care of them! And they will, in turn, help you reach your reproductive goals.
Dr Kali MacIsaac, Naturopathic Doctor in Vancouver BC.