When we hear the word 'microbiome,' we often think of the gut — but there’s another important ecosystem that deserves attention: the vaginal microbiome. This community of bacteria and fungi that lives inside the vagina plays a vital role in not just vaginal health, but overall well-being. Research shows that imbalances in this ecosystem are a leading cause of vaginal discomfort and recurrent infections —and have also been associated with infertility, pregnancy complications, and other health concerns.^{1, 2, 3}  

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While conventional treatments focus on relieving immediate symptoms, a functional medicine approach looks deeper — aiming to identify and address the root imbalances within the vaginal ecosystem that may be contributing to ongoing issues.

Your Vaginal Microbiome: A Protective Ecosystem

A healthy vaginal microbiome is typically dominated by bacteria from the Lactobacillus family. These “good” or “protective” bacteria produce lactic acid, which keeps the vaginal pH low — ideally between 3.8 and 4.5 — creating an acidic environment that helps prevent harmful microbes from growing.

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When protective bacteria like lactobacilli are low in your vaginal microbiome, it creates an imbalance that allows disruptive bacteria—such as Gardnerella, E. coli, or Mycoplasma—to grow and dominate. This imbalance, known as vaginal dysbiosis, may contribute to infections such as bacterial vaginosis (BV), yeast infections, and urinary tract infections (UTIs). These conditions often cause uncomfortable symptoms like itching, burning, irritation, unusual vaginal discharge and unpleasant odor.

Recurrent Infections? Your Microbiome May Be Out of Sync

If you’re dealing with frequent infections or persistent discomfort, the issue may not be from a single pathogen — but rather an imbalance in the overall ecosystem of your vaginal microbiome. 

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Roughly 1 in 3 women experience BV each year⁴. Yeast infections affect about 75% of women at least once in their lives⁵. And UTIs? Half of all women will experience one⁶. The problem? Many infections are treated without ever investigating the underlying imbalance — leading to high recurrence rates and frustration for patients.

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This is where microbiome testing can be helpful — not only to identify which microbes are present, but also to guide a more personalized treatment approach.

Your Vaginal Microbiome Is Connected to the Rest of Your Health

Like the gut, your vaginal microbiome influences more than just local symptoms. When the vaginal microbiome is in dysbiosis, the rest of the reproductive system is left compromised. Pathogens are able to make a home in the vagina, increasing inflammation and infection in the reproductive tract – and driving up the risk of adverse health outcomes. An imbalanced vaginal microbiome has been associated with:

• Higher risk of STIs (including HPV⁷, herpes⁸, and chlamydia⁹)
• Infertility¹⁰ and failed IVF cycles¹¹
• Pregnancy complications like miscarriage¹² or preterm birth¹³
• Pelvic inflammatory disease (PID)¹⁴
• Gynecological cancers such as ovarian,¹⁵ cervical¹⁶, or endometrial cancer¹⁷

Supporting a healthy vaginal microbiome isn’t just about comfort — it’s about building long-term reproductive and immune health from the inside out.

How to Support a Healthy Vaginal Microbiome

Your vaginal microbiome shifts with behaviors, hormones, and more. Here are a few ways to support your vaginal ecosystem:

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• Avoid products that disrupt your natural balance. Douches and scented feminine hygiene products can strip away protective bacteria and raise vaginal pH. ^{18, 19}
• Use antibiotics thoughtfully. Oral antibiotics prescribed for unrelated conditions can reduce protective vaginal flora, increasing the risk of yeast infections or BV.
• Be mindful of sugar intake. Early studies suggest links between high-sugar diets and increased risk for BV, UTIs and vaginal yeast infections.
• Avoid smoking. Studies suggest that women who smoke are significantly more likely to have a vaginal microbiota with lower levels of protective Lactobacillus species. ²⁰
• Manage chronic stress. Research shows that stress can reduce levels of Lactobacillus and may worsen the severity of vaginal infections. ²¹
• Pay attention to sexual patterns. Sex can shift the vaginal microbiome. Noticing symptoms after changes in activity can be informative.
• Consider vaginal microbiome testing: If you’re experiencing recurring symptoms or want deeper insight, testing can uncover imbalances and guide personalized care.

Understanding Your Vaginal Microbiome

Vaginal microbiome tests like the one offered by Evvy use metagenomic sequencing to screen for all bacteria and fungi in your vaginal ecosystem — with one swab. If you’re navigating ongoing symptoms, optimizing for fertility, or simply want to better understand your vaginal health, comprehensive testing can offer valuable insight.

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The results can help you and your healthcare provider to get to the root of recurring issues or explore ways to proactively support your microbiome over time. 

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Providers at Eleven Eleven Wellness Center have experience reviewing vaginal microbiome test results and developing treatment plans. Not in NY? Find a provider near you here. 

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Citations: 

¹ https://www.sciencedirect.com/science/article/abs/pii/S0025712516304965?via%3Dihub

²  https://pmc.ncbi.nlm.nih.gov/articles/PMC8745627/

³ https://www.ajog.org/article/S0002-9378(20)31193-5/fulltext

⁴ https://pubmed.ncbi.nlm.nih.gov/17621244/

⁵ https://fungalinfectiontrust.org/wp-content/uploads/2021/04/Global-burden-of-recurrent-vulvovaginal-candidiasis.pdf

 ⁶ https://pubmed.ncbi.nlm.nih.gov/12113866/

 ⁷ https://link.springer.com/article/10.1186/1471-2334-11-10

 ⁸ www.mdpi.com/1422-0067/20/2/266

⁹ https://pubmed.ncbi.nlm.nih.ghttp://www.mdpi.com/1422-0067/20/2/266ov/31409678/

¹⁰ https://academic.oup.com/humrep/article-abstract/28/7/1809/611205?redirectedFrom=fulltext&login=false

¹¹ https://pmc.ncbi.nlm.nih.gov/articles/PMC8001118/

¹² https://www.researchgate.net/publication/6560919_Leitich_H_Kiss_H_Asymptomatic_bacterial_vaginosis_and_intermediate_flora_as_risk_factors_for_adverse_pregnancy_outcome_Best_Pract_Res_Clin_Obstet_Gynaecol_21_375-390

¹³ https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2020.00476/full

¹⁴ https://pmc.ncbi.nlm.nih.gov/articles/PMC5013099/

¹⁵ https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30340-7/abstract

¹⁶ https://pmc.ncbi.nlm.nih.gov/articles/PMC5962305/

¹⁷ https://pubmed.ncbi.nlm.nih.gov/27884207/

¹⁸ https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0543-y#Abs1

¹⁹ https://pubmed.ncbi.nlm.nih.gov/20215951/

²⁰ https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-471#:~:text=The%20cross%2Dsectional%20study%20(Phase,low%20proportions%20of%20Lactobacillus%20spp.

²¹ https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2018.00568/full