As many of you know, one of my most important research areas at the Center for Translational Microbiome Research at the Karolinska Institute is the vaginal flora and its role in women’s health. Today I thought we would cover a slighly embarrassing subject – smelly fluids, which usually get worse during menstruation and after sex.

The most common cause of these disorders is bacterial vaginosis, which is caused by an imbalance of the vaginal normal bacterial flora. It is very common, in Sweden, it is estimated that 10-30% of all women of childbearing age suffer. The risk factors include excessive hygiene habits such as intimate soaps, or multiple sex partners, the use of spirals and antibiotics.

As I described in previous posts, a healthy vaginal flora is dominated by lactobacilli that produce lactic acid which contributes to an acidic environment in the vagina with a pH value below 4.5. In addition, lactobacilli produce hydrogen peroxide that protects against disease-causing bacteria, viruses and fungal infections. When the balance is disturbed, the pH increases in the vagina and other anaerobic bacteria can grow, among other things which produce smelly amines. The diagnosis is made on the basis of symptoms such as odor and discomfort, an abnormally high pH value and an increased number of bacteria. However there are many women who have this imbalance in their vaginal flora without feeling any symptoms. Women with bacterial vaginosis are at greater risk of being infected by sexually transmitted infections. In addition, there are studies showing that women with bacterial vaginosis are more likely to become pregnant and are at greater risk of giving birth prematurely. The disease also leads to increased stress and reduced quality of life.

Treatment of bacterial vaginosis consists of antibiotics such as vaginal cream or tablets that cure 70-80% of patients. Unfortunately, the healthy part of the vaginal flora is also damaged and a large portion of women contract the infection again which will again be treated with antibiotics. It’s easy to understand why this is not particularly wise and how the evil spiral continues. Many women use home remedies for their troubles, such as yogurt, tampons with lactobacilli, sour creams and intimate flushes. However, these cures have limited effect and vaginal douching has even been shown to increase the risk of bacterial vaginosis.

A group of researchers from Israel asked if one could transmit a healthy vaginal flora to women with bacterial vaginosis in a similar way that one can restore the gut flora by stool transplantation. (Stool transplants are used successfully in the care of treating severe diarrhea following an infection with Clostridium difficile.) The study testing vaginal flora transmission was conducted on 5 patients with bacterial vaginosis who had at least 5 relapses during one year despite repeated antibiotic treatments. With the help of transmission of healthy vaginal flora, the problems for 4 of the women disappeared completely and they remained healthy for almost two years. The fifth woman got better but was not completely cured. The donors were carefully selected and tested for various infections. No adverse reactions were reported. Although it is a very small study, it feels important and opens up a whole new way to treat bacterial vaginosis by restoring the entire vaginal flora instead of using antibiotics.

Today, we have very little knowledge of how many women are affected by bacterial vaginosis, although it is so common and has far-reaching consequences for women’s health. Our research group is finding out more through several current large studies. 

Watercolor: Ina Schuppe Koistinen

This is a guest post. The opinions expressed are the writer’s own.