In all seriousness it really is this cave of wonders. Our vaginal microbiome is unlike any other in the body. The vaginal niche is isolated with a unique function, where the gut microbiome has multiple niches. Complete with biofilms and all!

We have been taught that biofilms are bad but not when we are talking about our vagina. Biofilms are a community of organisms that adhere to some type of surface. In the case of the vagina it is the mucosal layer, which is attached to the epithelial layer of cells. The glycocalyx is the slime of the gut or the coating surrounding certain cells like a fence that protects certain organisms from coming in contact with cells that may have a pro inflammatory effect. The biofilm is a community of the microbiome created by glycocalyx.

A healthy- Asymptomatic woman will have a loose vaginal biofilm, richly dominated by lactobacilli or lactic acid producing bacteria.

An unhealthy woman, experiencing some sort of dysbiosis such as vaginal bacteriosis (BV), would have a thick/adherent biofilm that degrades the mucous therefore coming into more contact with the epithelial cells.

Another fun fact…Estrogen that is produced within the vaginal environment stimulates glucose. Vaginal cells produce their own amylase, seeing as lactobacilli can’t digest glycogen, they have to digest derivatives and metabolites of glycogen. Lactobacillus iners adhere very strongly to the epithelial cells of the vagaina, acting as a pathobiont only producing L-lactic acid. They are able to be in either high or low pH (same as candida albicans). They are the only lactobacillus species recorded (published) that encodes a poor forming cytolytic toxin. This means it can punch holes through the membranes of other cells, which is usually a pathogenic trait. Whether this is upregulated or downregulated really depends on the environment (welcome to epigenetics).

I realize this is a lot of heavy info but hang in there!

There are two species of lactobacillus, crispatus and iners – found in the vaginal cavity that are generally mutually exclusive. One or the other usually dominate, but never both. We still don’t have enough science to figure out exactly why this is, not even on a global scale. That’s the amazing thing about bacteria, we are continuously discovering new species, strains and new functions.

If your vaginal flora is dominated by iners it appears you will have less protection against bacterial vaginosis (BV), dysbiosis and sexually transmitted infections. It is a transitional microorganism that can be pathobiont, however it is still being studied.

The reason I mention this is that it may in fact be more beneficial to be using crispatus as a strain plus a good prebiotic when looking at vaginal health rather than iners as a strategy for fighting infections down there… I should note that crispatus has multiple strains in their species so finding the right one is important.

To determine which strain of crispatus has the correct characteristics or the correct ‘genes’ turned on (eveloved) to be the healthy option for each patient might be more challenging than originally thought. First we need to understand the mechanisms of action for the issue it is being used to treat. We know that lactobacillus in general dominates the vagina, what we need to determine is strain specificity.

We call this assessing mechanisms of action and function. Function is the ultimate goal. We want to have a patient be asymptomatic. We need to know if a patient is at risk of an STI due to the type of bacteria dominating her flora. This is where knowing the patients profile is important, unfortunately our diagnostics haven’t changed in 50 years and science has yet to catch up. We will get there…eventually.