Have you heard about using vaginal probiotics for UTI prevention? Let’s explore why you would want to put probiotic products in your vagina and what to expect.

What Are Probiotics?

Probiotics are the tiny critters that live within us; in fact, we are made up of more bacterial cells than human ones. Probiotics are bacteria that “improve our health when taken in the right dose.” (Reid, 2004). For a quick review, look at what you need to know about probiotics.

Surprisingly, our vaginas are full of lactobacilli, a group of bacteria that keep the vagina acidic and make peroxide (Reid, 2004), the same stuff you use to disinfect skin wounds.

Unfortunately, we are not always protected.  For example, over our monthly cycles, only 22% of women (Schwebke, 2001) maintain a high number of lactobacilli, and this drops even further after menopause (Reid, 2004). This is exactly why you might want to start using vaginal probiotics for UTI prevention and to keep your vagina healthy.

In the past probiotic research focused on the gut. New research shows that probiotics prevent and treat vaginal infections and UTIs (Grin, 2013). Many people take a daily probiotic because the Standard American Diet (SAD) does not have any probiotics or prebiotics, the food that probiotics live on (Reid, 2004).

Of course, we can get some of these healthy bacteria from our food. Certain dairy and poultry naturally contain L. rhamnosus GR-1, a probiotic important in vaginal health (Reid, 1987). Furthermore, women who eat “fermented milk,” such as yogurt, sour milk, and cheese, as well as berries three or more times a week, are less likely to get UTIs. (Kontiokari, 2003).

Probiotics Are Very Important. Duh!

Bad bacteria must overcome many obstacles to get to our vaginas or bladders and wreak their havoc.

Pathogenic bacteria start life in our gut and move to the vagina and periurethral area by attaching to these organs’ walls. However, probiotics block this process by creating large biofilms, or sheets of good bacteria that form a barrier on the vaginal and bladder walls.

Lactobacilli make the vagina acidic and unwelcoming to infection-causing bacteria and make hydrogen peroxide, which kills bad bacteria.

Moreover, they also wake up the immune system, which brings in reinforcements to combat the bad bacteria and produce mucus, another barrier preventing bad bacteria from grabbing onto the vaginal walls. (Reid, 2004; Marelli, 2004). It is like an action movie in our vaginas!

Which Probiotics For Vaginal Health

With all their benefits, who wouldn’t want to try probiotics? Be cautious: there are many brands on the market, and you must learn which ones are effective. L. rhamnosus GR-1, L. fermentum B-54 & RC-14 and L. reuteri (Reid, 2001) are the most studied lactobacilli for healthy vaginal flora. Other useful ones are L. planatarium 57-B and L. gasseri 57-C (Tomusiak, 2015).

Remember to keep an eye on what you eat. Prebiotics make or break your healthy vagina aspirations. For example, yeast infections (whether in the vagina or elsewhere) thrive on sugar. This means staying away from excess sugar so that probiotics have the best chance of working.

Unfortunately, there are many probiotics on the market, with no governing body (like the FDA) ensuring quality. Don’t take the company’s word that their product does what they say, as the quality and quantity of individual probiotics may not live up to their claims. (Tomsuiak, 2015)

Once you decide to use probiotics, you will choose between two options:

• Taking them by mouth,
• Or placing them directly into the vagina. 

The good news, both methods are OK and beneficial.

It is important that you start with the right probiotics in the correct container so they can safely get to the vagina (if taken by mouth) or survive in the vagina (both oral and vaginal).

Vaginal Probiotics For UTI Prevention

The obvious, if more “squeamish” option, is to put the probiotics directly where they are needed- in the vagina and vulva.

This is nothing new; women have been using yogurt in their nether regions for decades to treat infections. This is still a natural way to bump up your lactobacilli population, and many alternative health practitioners recommend this.

If you go this route, stick to plain live active culture yogurt free of added sugars and flavoring. Generally, vaginal probiotics are used sporadically or for a short period to prevent or treat an infection.

More mainstream medical research is coming from investigating this topic. One study showed that weekly suppositories of L. rhamnosus GR-1 and B-54 decreased recurring UTIs from six per year to only 1.6 on average.

Prebiotics worked just as well; they decreased the number of 1 UTIs to only 1.3 per year. This means that feeding our bacterial guests will allow them to grow and thrive. (Reid, 1995). Other studies showed that vaginal suppositories containing lactobacilli repopulated women’s vaginas for several months after use. (Tomusiak, 2015; Bruce, 1988).

Importantly, these studies show that not only do probiotics effectively treat UTIs and vaginal infections, but they also have few, if any, side effects. (Reid, 1995). When women complained, these were no worse than the complaints of women using placebos. (Tomusiak, 2015) This means that probiotics are pretty safe!

This is a marked improvement compared to the side effects of antibiotics. In fact, suppositories help to revive your good bacteria after antibiotics destroy them. Generally, you can take vaginal suppositories for 3-7 days. (Reid, 2004; Tomsuiak, 2015) Of course, if you have a serious infection (or if you have fevers or body aches) or are unsure if it is a UTI, you should touch base with your doctor first.

Best Vaginal Probiotics for UTI Prevention

So, what vaginal probiotic should you get? Great question! Unfortunately, if you live in the US, this may be a tall order. Here are two options:

1. Purfem probiotic: This contains one billion colony-forming units (CFU) each of L. rhamnosus and L. gasseri. It helps to prevent and treat the vaginal infection as well as build up the vaginal flora after using antibiotics.
2. Zerotaboos: 15 billion CFUs of Lactobacillus Crispatus, Lactobacillus Reuteri, Lactobacillus Acidophilus, and Lactobacillus Rhamnosus directly where they most needed. Work twice faster than probiotics taken by mouth. The addition of lactoferrin helps both the native healthy flora and the probiotics. We’ve seen 20-30% shifts in vaginal flora towards beneficial in just five days. Perfect when you are taking oral antibiotics. Unlike probiotic pills designed for oral consumption (that you could, technically, use as a suppository as well) they are coated in hyaluronic acid and cocoa butter, making it less irritating for the vaginal lining.  

Here is a little trick; you can put most oral probiotics directly into the vagina. Yes, you read this correctly! If you go this route, make sure the probiotics are in powdered form in a capsule (either vegetarian or gelatin).

Insert about 2-3 inches inside the vagina after washing your hands or use a vaginal applicator. There may be some drainage, so it is best to insert the capsule at bedtime and wear a panty-liner. Studies show that if you use powdered lactobacilli in a capsule, the health-bringing critters are rehydrated in the vagina and get to work! (Reid, 2004).

Best Oral Probiotics For Vaginal Health

This is the most common option. Oral probiotics and their packaging must survive the very acidic environment of your stomach to make it safely to your vagina. You need at least one billion CFU of probiotics once or twice weekly (Reid, 2004), although many people take them daily. Commonly, you refrigerate probiotics and take them with food.

Also, oral probiotics help heal your gut flora, which vaginal capsules cannot do. Women taking L. rhamnosus GR-1 and L. fermentum RC-14 daily have less yeast and infection-causing bacteria in their vaginas. (Reid, 2004) This benefit persists in women with current or recent infections (Reid 2004, Reid 2001). Importantly, these women still had lactobacilli in the vagina up to 3 months later, after just 14 days of daily use (Reid, 2001).

So, which probiotics should you try? Great question:

1. FemEcology: This contains ten billion CFUs of L. acidophilus, L. planatarum, L. reuteri, L. rhamnosus and L. salivarius. This is a good choice for your gut health as well. Take once daily.
2. Jarrow Formulas Fem-Dophilus: This contains five billion CFU of L. rhamnosus GR-1 and L. reuteri RC-14 and should be taken once daily. This uses a gelatin capsule.
3. Pro-Flora Women’s Probiotic: This contains between one and five billion (some of the bacteria may die during transport) CFU of L. rhamnosus GR-1 and L. reuteri RC-14 and should be taken once daily. It can be taken with or without food. This uses a vegetarian capsule.
4. Zerotaboos: 15 billion CFUs of Lactobacillus Crispatus, Lactobacillus Reuteri, Lactobacillus Acidophilus, and Lactobacillus Rhamnosus directly where they most needed. Work twice faster than probiotics taken by mouth. The addition of lactoferrin helps both the native healthy flora and the probiotics. We’ve seen 20-30% shifts in vaginal flora towards beneficial in just five days.

All three of these “oral probiotics” can be used in the vagina!

Remember, probiotics are not a panacea; you must eat your prebiotics and choose wisely. Apart from diet, treat your perineal area with microbiome-friendly hygiene products, like this prebiotic Wash, to support beneficial bacteria and suppress organisms responsible for infections. Still, there is a lot of evidence that the right probiotics are a valuable tool in keeping the vagina healthy and preventing infections. You can take back your health!

References:

• Bruce AW, Reid G. Intravaginal instillation of lactobacilli for prevention of recurrent urinary tract infections. Can J Microbiol. 1988 Mar; 34(3):339-43.
• Grin PM, Kowalewska PM, Alhazzan W et. al.  Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis. Can J Urol. 2013 Feb;20(1):6607-14.
• Kontiokari T, Laitinen J, Jarvi L et. al. Dietary factors protecting women from urinary tract infections. Am J Clin Nutr. 2003 Mar;77(3):600-4.
• Marelli G, Papaleo E & Ferrari A. Lactobacilli for prevention of urogenital infections: a review. Eur Rev Med Pharmacol Sci. 2004 Mar-Apr;8(2):87-95.
• Reid G, Cook RL & Bruce AW. Examination of strains of lactobacilli for properties which may influence bacterial interference in the urinary tract. J Urol 1987; 138: 330-5.
• Reid G, Bruce AW, Taylor M. Instillation of lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. Microecol Ther. 1995; 23:32-45.
• Reid G, Bruce AW, Fraser N et. Al. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol 2001; 30: 49-52.
• Reid G, Burton J & Devillard E. The rationale for probiotics in female urogenital healthcare. Medscape General Medicine. 2004; 6(1): 3: 38.
• Schwebke Jr, Weiss H. Influence of the normal menstrual cycle on vaginal microflora. Clin infect Dis. 2001; 32: 325.
• Tomusiak A, Strus M, Heczko P et. al. Efficacy and safety of a vaginal medicinal product containing three strains of probiotic bacteria: a multicenter, randomized, double-blind, and placebo-controlled trial. Drug Des Devel Ther. 2015; 9: 5345-54.