Additionally, the following can alter the vaginal microbiome:

• medications such as antibiotics or steroids
• menstruation as the vaginal PH becomes more alkaline in the 10 days up to and including menstruation. Periods in the peri and menopausal years become irregular leading to sometimes shorter gaps between menstruation.
• bacteria from the gut which transfers to the vagina from the nearby rectum
• bath creams and products used for feminine hygiene
• vaginal douching
• tampons and sanitary towels
• sexual intercourse and oral sex
• use of contraceptives