Probiotics, bacteria that are naturally occurring in the body, are often recommended as a treatment for vaginal flora imbalance. Probiotics can help to restore a healthy level of lactobacilli both in the gut and in the vulval-vaginal area particularly after a course of antibiotics. The vaginal flora of healthy premenopausal woman is generally dominated by a number of Lactobacillus species.

Because vaginal lactobacillus species produce lactic and hydrogen peroxide, maintaining the vaginal pH around 4.5 or less and hampering growth of pathogenic bacteria and fungi, they are thus considered protective against vulval vaginal candidiasis (VVC) and bacterial vaginosis (BV). This has increased the interest in the beneficial effect of Lactobacillus species-containing probiotics in restoring and maintaining the vaginal microbiome.

Are probiotics effective for long term vaginal health?

The effectiveness of probiotics for the treatment of VVC in non-pregnant women was evaluated in 2017 in a Cochrane systematic review. A total of 10 RCTs (1656 participants) investigating the effect of probiotics used by the oral and vaginal route as a complementary therapy to conventional antifungal drugs were included. Probiotics slightly improved the short-term clinical cure rate and reduced the 1-month relapse rate. However, no important impact of probiotic use was observed on long-term clinical cure rate (3-month post-treatment evaluation). Given the low- or very low-quality of the considered studies, the authors emphasized the need for further and better designed RCTs with larger sample size, standardized methodology for probiotic preparation, and longer follow-up. More studies are needed to conclude that taking probiotics orally or vaginally alone will inhibit vaginal candida overgrowth and successfully treat any fungal infections.

The use of probiotics in people who have a health condition of the bowel should always be discussed with their GP or consultant.

There are also particular risks associated with supplements that are meant to be taken vaginally. There is the risk of introducing other bacteria with insertion – for instance, because of dirty hands or if the tablet wasn’t clean at insertion – as well as the risk of small cuts in the vagina if it’s not inserted correctly and the risk of increased vaginal discharge and change in odour.

There is also the question of cost – both vaginal and oral probiotic supplementation can be expensive. Your gynaecologist, genito urinary medicine doctor or women’s health doctor should advise as to whether their usage is necessary.

If the vaginal PH is too alkaline, lactic acid pessaries are also available.

More about oral probiotics

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