Intimate and intestinal flora

A microbiome, in general terms, is a collection of bacteria — beneficial and harmful, transient and permanent — that cohabit and live in synergy with one another. They are often accompanied by fungi and other organisms. What matters, as in any ecosystem, is the balance between these different populations.

All our microbiomes are made up of the same broad families of bacteria. However, their proportions and quantities vary considerably. The richest in terms of quantity and diversity is the gut microbiome, which is often described as a reservoir for the other microbiomes.

The bacteria in our microbiomes play a protective role. Taking the vaginal flora as an example, the bacteria that make it up produce lactic acid. This substance lowers the pH of the vagina, making the area acidic and therefore hostile to external bacteria, viruses, and parasites.

They also protect us by producing biofilms that prevent external organisms from entering the body or adhering to our mucous membranes.

The distinctive feature of the vaginal microbiome is that it is highly dependent on hormone levels, and in particular oestrogen levels. Oestrogen thickens the vaginal lining and stimulates the production of glycogen, which attracts lactobacilli — the most prevalent bacteria in the vagina — thereby contributing to good vaginal health and protection.

The vaginal microbiome also has the distinctive feature of evolving throughout a woman's life (childhood, puberty, pregnancy, menopause) as well as in line with the phases of the menstrual cycle. During menstruation, for example, bacteria produce less lactic acid, causing the pH to rise and therefore reducing its protective effect.

A less protective microbiome can allow infections and fungi to develop. This is what happens in cases of thrush, vulvitis, vaginitis, or cystitis, for example.

The most obvious link, even if indirect, occurs at the moment of birth: during a vaginal delivery, the mother passes on her vaginal microbiome to her baby. These bacteria form the foundation for the development of the baby's gut microbiome.

The vaginal flora, much like the gut flora, is therefore unique and specific to each woman. It depends on her birth, her age, her environment and place of life, her habits and hygiene, her contraception, and so on.

Links are then established between the gut microbiome and the vaginal microbiome due to the anatomical proximity of the colon — particularly its terminal section, the rectum — and the urogenital tract. This is why there are many similarities between these two microbiomes: exchanges are constant, whether via the internal route, through contact between organs, or externally via the biofilm formed by bacteria on the perineum, between the anus and the vulva, or as a result of inappropriate habits (see below).

In this way, bacteria migrate from one to the other — for better, offering protection, and for worse: cystitis, vulvitis, papillomavirus, thrush, and so on, along with the associated discomforts, irritations, pain, discharge, odours, and more.

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Their difference therefore lies in their active agent: the copper IUD releases copper into the uterus, while the other releases a synthetic progestogen (levonorgestrel), similar to what one might find in a progestogen-only pill (rather than a combined oestrogen-progestogen pill). Their common feature is their mechanical inflammatory action, which, broadly speaking, accounts for the remaining 50% of their effect.

Their common feature is their mechanical inflammatory action, which, broadly speaking, accounts for the remaining 50% of their effect.

To look after your vaginal flora, whether as a preventive measure or following an infection, here are a few simple steps:

• Take care of your gut microbiome

As we have just seen, the two are closely linked. To do this, consume plenty of fibre (if your digestive system tolerates it), as well as probiotic and prebiotic foods (artichokes, asparagus, chicory, lacto-fermented foods, leeks, bananas, onions...). Limit refined sugar and stress. Eat organic. Take time to chew properly -- this also helps reduce constipation.

• Maintain appropriate hygiene

Not too much, not too little! A healthy vagina is "self-cleaning". So no products inside -- not even water alone. Simply cleanse the vulva with a gentle product at a suitable pH, no more than once or twice a day.

• Choose your underwear wisely

Opt for natural fabrics, changed every day, and avoid wearing them at night. Avoid staying in damp swimwear for too long either.

• Adopt protective habits

Wipe from front to back when using the toilet, with unscented and uncoloured paper. Urinate after sexual intercourse. Full intimate waxing is also best avoided: pubic hair helps maintain a protective warmth and moisture for the beneficial bacteria.

• Avoid certain enemies

Such as tobacco and, where possible, antibiotics.

• Take oral or vaginal probiotics and prebiotics

Particularly from the menopause onwards, to compensate for the loss caused by the decline in oestrogen, and regularly when prone to thrush and recurrent cystitis. Preference should be given to the strains mentioned above and, ideally, to formulas that combine these strains with their food source, namely prebiotics.

• Reduce recurrences with the help of plants

Certain plants have also been shown to have proven effects in reducing urogenital infections. This is the case for cranberry in particular, with study data suggesting it may help limit the adhesion of certain harmful bacteria of intestinal origin to the wall of the bladder. It therefore has a preventive action against cystitis.

When suffering from recurrent cystitis or thrush, it is beneficial, beyond treatments, to address the root cause and restore and maintain intimate balance. It is this balance that will protect against recurrences. Microbiomes, whatever they may be, remain largely unexplored. Research is only just beginning. While we wait for them to reveal all their secrets, let us take care of them.

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