How do probiotic strains care for intimate and intestinal flora ?

Probiotics for intimate and intestinal flora

The vaginal and intestinal flora are made up of a group of bacteria and fungi that contribute to the well-being and balance of the intimate and digestive systems. As these flora are linked, the balance of one reflects the general state of the other. However, periods of hormonal change (menstruation, pregnancy, menopause) can disrupt our flora, making them vulnerable and encouraging discomfort, both intimate and intestinal.

Taking probiotics will help rebalance our flora. Numerous studies have already demonstrated the beneficial effect of probiotics on intestinal flora. More recently, it has been shown that taking probiotics canimprove intimate comfort.

In this article, we look at the role of the intimate and intestinal microbiota , and the importance of probiotics in maintaining their balance.

What is the microbiota ?

The microbiota, or flora, refers to thecommunities of micro-organisms that colonize the human body. These are non-pathogenic bacteria, viruses, parasites and fungi hosted by the human body. There are several microbiota in the skin, mouth, vagina, lungs, etc. The largest microbiota is that of the intestine, which contains the most micro-organisms in terms of number and species. The microbiota is involved in the proper functioning of the body. It is involved in major essential functions such as nutrition, development, immunity and well-being.

The intestinal microbiota

Our digestive tract is home to no fewer than¹⁰¹³ micro-organisms. This collection of non-pathogenic bacteria, viruses, parasites and fungi makes up our intestinal microbiota (or intestinal flora). The intestinal microbiota ensures its own functioning by drawing on our food. It is unique to each individual. However, there is a common base of 15 to 20 species present in all human beings, responsible for the essential functions of the microbiota. This flora is formed from birth and builds up gradually. It evolves with age, in response to changes in diet, ingested medications or disease-carrying pathogens. Changes in lifestyle and fluctuating sex hormones (testosterone and estrogen) can also lead to changes in the intestinal microbiota.

The intestinal flora plays a number of essential roles in the proper functioning of our body, including promoting digestion, immunity and well-being. The intestinal microbiota synthesizes essential compounds and vitamins, and breaks down complex molecules. It also has a protective function against foreign bacteria. It acts as a physical and chemical barrier, as the bacterial layer is difficult for foreign bodies to penetrate. Some intestinal bacteria also produce molecules that kill invasive pathogenic bacteria. The intestinal microbiota thus acts as a protective barrier against ingested pathogens.

Vaginal microbiota

In 1892, Doderlein published the first in-depth study of the human vaginal microbiota. The vaginal microbiota, also known as intimate flora or Döderlein’s flora, consists of 90% lactic acid bacteria (lactobacilli), which colonize the vagina throughout a woman’s life. Many other species are also present in the vaginal microbiota, such as viruses, fungi, yeasts, etc. After puberty, the vaginal microbiota is mainly made up of four species of lactobacilli , but there are many variations between populations. Lactobacilli are a commensal bacterial genus of the digestive tract and genital tract. The species present in the genital tract are mainly L. crispatus, L. gasseri, L. iners and L. jensenii.

The vaginal microbiota evolves with time and with sex hormones over the course of a woman’s life. It is not present from birth, and requires the presence of estrogen to become established. During puberty and the female reproductive period, the microbiota changes radically. During menstruation, the environment may be more favorable to the proliferation of certain bacteria in the vaginal cavity. This change in vaginal microbiota depends on the individual woman, and can be more or less marked. At menopause, estrogen levels fall, making the environment less favorable to the development of lactobacilli.

The bacterial flora forms a protective biofilm on the vaginal mucosa, preventing the proliferation of pathogenic germs by inhibiting their growth, adhesion and development. It protects the deep genitalia by creating a hostile environment for most other bacteria.

The link between intestinal and intimate flora

The vaginal microbiota inherits a number of bacteria from the intestinal microbiota due to the anatomical proximity of the colon and urogenital tract. There are therefore considerable similarities between these two flora. Exchanges are permanent, either internally, via 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 gestures.

In this way, bacteria migrate from one to the other, for the better, protection, as well as for the worse: cystitis, vulvitis, papillomavirus, mycosis… and the associated discomforts, discomfort, pain, discharge and odours.

For example, the Candida albicans bacteria involved in candida infections are present in the intestinal and vaginal microbiota. Similarly, in the case of urinary tract infections or cystitis, it is most often found that a germ from the intestinal microbiota manages to colonize the urinary tract via the ascending route, causing the infection.

That’s why it’s important not only to restore balance in the vaginal microbiota, but also in the intestinal microbiota, as the two are closely linked.

Dysbiosis

The bacterial balance can be altered and have an impact on well-being. An alteration in the microbiota is called dysbiosis. In the case of the intestinal microbiota, dysbiosis can be caused by stress, an unbalanced diet or other factors that can lead to intestinal transit disorders, bloating or digestive discomfort.

As for the vaginal microbiota, its alteration can be caused by the presence of a multitude of anaerobic bacteria during a dysbiosis, vaginosis. Vaginosis is defined as an imbalance in the vaginal flora, leading to a reduction in useful, protective micro-organisms and an increase in more harmful ones. Symptoms of vaginosis may vary from woman to woman, but can include unusual vaginal discharge (white, grey or yellowish) with an unpleasant odour, as well as vaginal itching and burning.

Predisposing factors such as menstruation, pregnancy, sexual practice, uncontrolled use of antibiotics and vaginal pain can alter the microbial community. An altered intimate flora is associated with various pathologies, such as an increased risk of sexually transmitted infections and urinary tract infections. According to a study on the role of the vagina and vaginal microbiota in urinary tract infection, the vagina can harbor uropathogenic bacteria such as Escherichia coli, the most common cause of urinary tract infection. Vaginosis also increases the risk of developing cancer, particularly cervical cancer. Finally, it is associated with a greater risk of gyneco-obstetrical complications.

The vaginal microbiota therefore plays an important role not only in women’s sexual health, but also in reproduction and the risk of developing cancer. The major role played by bacterial vaginosis in the pathologies associated with it clearly demonstrates the importance of effectively combating this dysbiosis.

How can you take care of your microbiota ?

There are a number of ways to restore healthy intestinal and intimate flora:

• Use of plants: Licorice and alchemilla help reduce vaginal and intestinal mycoses.
• Follow a healthy lifestyle: The WHO (World Health Organization) recommends avoiding vaginal douches, using intimate cleansing products that are too scouring and wearing synthetic or tight-fitting underwear.
• Taking probiotics: These are living micro-organisms that can temporarily colonize our microbiota.

What are probiotics?

Probiotics are living micro-organisms that have a positive effect on host health when administered in sufficient quantities. Probiotics can be bacteria (bifidobacteria, lactobacilli, etc.) or yeasts (saccharomyces). They play a preventive and curative role by colonizing the intestine and vagina, thereby altering the balance of the flora. The environment is then acidified, which may help relieve various intestinal and vaginal disorders. To be effective, probiotics must be administered live, be able to withstand the acidity of the stomach and vagina, and be able to adhere to their walls. These properties depend on the strain used, the nature of the food containing them and, above all, the dose ingested. To be beneficial, probiotics should be taken several times a week. In fact, they only colonize flora temporarily.

The recommended dose of probiotics is 109 to 1010 bacteria per day, to ensure that 108 to 109 live bacteria have access to the intestine and are able to exert their effects. Probiotics must be taken regularly, as studies have shown that they disappear from the tract after one or two weeks. Probiotics can be taken in the diet , particularly with foods traditionally rich in probiotics (fermented dairy products and certain cold meats). However, the quantity of probiotics naturally present in foods is highly variable and often low. Today, there are products enriched with probiotics, such as yoghurts, fermented milk and cheeses, as well as dietary supplements. The latter provide a reliable, controlled and consistent source of essential probiotics.

The main strains recognized as probiotics in humans are bacteria belonging to the genera Lactobacillus, Bifidobacterium, Enteroccocus, Streptoccocus and yeasts of the genus Saccharomyces. These species are widely used in fermented and unfermented food products, as well as in dietary supplements. At urogenital level, probiotic action is most often based on the antimicrobial capacities of lactobacilli.

The benefits of lactobacilli

Lactobacilli are beneficial bacteria found in various parts of the body, including the digestive tract and vagina. They play a role in lactic acid fermentation, the process by which sugars are converted into lactic acid. This ability to metabolize sugars is a characteristic feature of lactobacilli. By producing lactic acid, they lower the pH of their environment, creating an acidic environment that inhibits the growth of many pathogenic bacteria.

Lactobacilli generally predominate in normal vaginal flora and play an essential role in maintaining vaginal health. According to a study on the role played by lactobacilli in controlling the vaginal pathogen population, lactobacilli are of considerable interest. These organisms contribute to the control of the vaginal microbiota through two mechanisms:

• Adherence to mucus: they form a barrier that prevents colonization by pathogens.
• Production of antimicrobial compounds: Lactic acid, hydrogen peroxide…

Lactobacilli help maintain an acid pH, preventing the proliferation of pathogens and the development of vaginal infections. As such, lactobacilli have strong antimicrobial activity, which may present these strains as probiotic candidates.

In the 1930s, Mohler and Brown were the first to propose treatment of vaginitis and vaginosis with a culture of Doderleïn bacilli. Since then, various studies have demonstrated the efficacy of applying lactobacillus strains vaginally to combat urinary tract infections and bacterial vaginosis:

• In 1992, Bruce et al. administered one lactobacillus capsule per week for one year to ten patients suffering from recurrent urinary tract infections. Following this treatment, half of these women reported no further recurrences.
• In 1992, Hallen et al. treated 28 women with bacterial vaginosis with capsules containing a strain of lactobacillus acidophilus, twice a day for six days. Following this treatment, more than 50% of treated women saw their vaginal swabs normalized with the elimination of the bacteria causing vaginosis , whereas this was not the case for any of the women in the placebo group.
• In 2020, a study on the roles of the vagina and vaginal microbiota in urinary tract infection showed that women with bacterial vaginosis had a higher risk of urinary tract infection than women with a vaginal microbiota dominated by lactobacilli. Clinical trials suggest that vaginal interventions that affect the microbiota (vaginal probiotics and estrogen treatments) may protect against further episodes of recurrent UTI.

probiotics for intimate flora

The use of probiotics has been studied to space out or even prevent recurrences of bacterial vaginosis. Several strains are of interest in limiting intimate infections by inhibiting pathogen growth and reconstituting healthy intimate flora. These are summarized in the table below:

Italian probiotics specialist Roelmi has developed a blend of several lactobacilli and bifidobacteria, patented SynBalance®: Lactobacillus rhamnosus LRH020, Lactobacillus plantarum PBS067, Bifidobacterium animalis lactis BL050.

• Lactobacillus rhamnosus LRH020: This strain has a strong capacity to fight pathogens, particularly Candida albicans, a yeast that can cause candidiasis in cases of hormonal imbalance. L.rhamnosus helps restore a healthy balance to the vaginal flora.
• Lactobacillus plantarum PBS067: This strain helps break down dietary fibers, thus promoting healthy digestion. This strain is therefore particularly effective in reducing digestive disorders such as bloating and abdominal pain. It also contributes to the balance of intimate flora, as its presence in the vaginal tract has been shown to reduce the risk of bacterial vaginosis.
• Bifidobacterium animalis lactis BL050: This bifidobacterium is recognized for its potential to support intestinal health. It promotes the growth of good bacteria in the intestine, which can help improve digestion, strengthen the intestinal barrier and reduce gastrointestinal problems such as bloating and constipation.

This probiotic complex can be combined with a strain of Lactobacillus acidophilus PBS066, dominant in the vaginal ecosystem. It helps maintain an acid pH in the intimate area by producing lactic acid. Studies show that this strain helps prevent and treat bacterial vaginosis.

Several clinical studies have been carried out by Roelmi to demonstrate the action of these probiotics on intimate flora:

• A randomized controlled trial involving 20 women without urinary tract infections studied the effect of this probiotic blend on vaginal colonization, to prevent urogenital infections and promote a healthy balance of vaginal flora. Significant vaginal colonization for the strains administered and a reduction in symptoms (itching, burning, discharge, etc.) were observed.

• A prospective study highlighted the improvement of bacterial vaginosis using SynBalance® Femme complex. 75 women with bacterial vaginosis (BV) were treated with local metronidazole, then 50 of them began a supplementation program with SynBalance® Femme. The remaining 25 women formed the control group and received the same gynecological follow-up as the active group. A reduction in the rate of recurrence of bacterial vaginosis was observed in the supplemented women. Long-term recovery of lactobacilli was also observed, with resolution of symptoms.

• In 2023, a randomized clinical trial was conducted on 50 postmenopausal women aged 45 to 60. They were treated with lactobacilli for 4 weeks. Changes in vaginal microbiota were assessed using vaginal swabs while the product was being taken. Positive colonization and promotion of good bacteria were observed. An activation of the immune response and an increase in antioxidant potential were also noted.

These strains are able to colonize the vaginal epithelium even when introduced orally. This probiotic complex therefore acts as a preventive and complementary treatment for female infections and intimate disorders.

Conclusion

To sum up, vaginal and intestinal flora are the result of a natural balance of different bacteria living in harmony. It’s important to maintain this balance through a healthy lifestyle. However, disruption can occur, and that’s where probiotics come in. These living micro-organisms help to rebalance the flora. Numerous studies have already demonstrated the beneficial effect of vaginal probiotics in treating bacterial vaginosis and preventing its recurrence.

So, because of their generally recognized safe status, lactobacilli are widely used as one of the alternatives to conventional antimicrobial treatment against vaginal pathogens for the prevention of chronic vaginitis and the restoration of the vaginal ecosystem.

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