Vaginal and Bladder Health Probiotics? What Are They and Why Do You Need Them?

October 13, 2025 Dr. Anna Cabeca

How to reduce your risk for bacterial infections, UTIs, vaginal discomfort and odors, reproductive issues, and bladder symptoms.

Women of all ages come to me with vaginal and bladder health problems. Certainly, vaginal dryness and itching, yeast infections, other bacterial infections, and urinary tract infections (UTIs) rank at the top of most women’s complaints, especially as they age and their hormone levels start to decline. Estrogen levels in particular are linked to a woman’s susceptibility to such infections. Did you know that estrogen promotes a healthy balance of bacteria in the vagina and urinary tract? It does. But aging, environmental factors, and just living our lives (including stress, sexual activity, contraceptives, menstrual products, lubes, antibiotic use, and more) all can impact the healthy balance of our vaginal and bladder bacteria.

So it’s important women pay attention to changes in their feminine health relating to body odor, urine odor, urine color, itching, and discharge, etc. Sometimes infections can be asymptomatic at the start, meaning only small signs of a brewing problem. When ignored, this can turn into a larger—often recurring—condition. One such example is a 50-year-old patient I had recently. She had an asymptomatic bladder infection. She didn’t know what was going on, but had noticed vaginal odor. Sure enough, upon testing, she had atrophy (vaginal drying and irritation) in the urethral area and dysbiosis (unhealthy bacteria levels) in the vagina. The bacteria were likely introduced during intercourse, causing the urinary tract infection. I ended up treating the UTI with an antibiotic, but an important piece to her longer-term symptom improvement (and to help prevent recurring symptoms) was also adding in a vaginal and bladder health probiotic (my new product, VB Probiotic) after the antibiotic treatment, in order to rebalance the bacteria.

Another example is a 67-year-old client who came to see me having significant vaginal atrophy, as well as discharge and odor. She was not sexually active and was undergoing stress in her marriage, and we know what stress does to our bodies. I worked with her to balance her hormones and had her use Julva® (my DHEA-based moisturizer addressing vulvar and vaginal dryness, intimacy and ooh la la as a woman’s hormones decline) regularly. Her symptoms improved dramatically within three months. She still, however, had occasional odor and discharge. So I added in my vaginal and bladder health probiotic, VB Probiotic, and her vaginal health significantly improved. No more odor. She likes to say that her vagina reverse-aged 20 years with this combination therapy. I think that's amazing!

Focusing on our feminine health should be on all women’s minds. It always strikes me as so unfortunate that many of us often spend more time on our teeth (daily brushing and flossing) than we do being proactive about our vaginal and urinary health. This is especially disturbing given the potential misery and significant health impacts that can come from neglecting this area of our bodies. As an OB/GYN, I can attest to the fact that women often don’t prioritize our lady parts, and we tend to be reactive—because that’s when things hurt down there, or make us feel less than the sexy mamas we are—versus preventative in our actions. Being reactive, however, often allows conditions to worsen. So, today I want to introduce an easy-to-take, vaginal and bladder health probiotic, designed to optimize our vaginal and bladder health at all of a woman’s ages and stages.

This article will discuss the science and research behind why a vaginal and bladder health probiotic is a beneficial—and necessary—part of every woman’s intimate health-care regimen. It will also provide tips on other essential vaginal health care and preventive strategies.

The Vaginal and Bladder Microbiome: What You Need to Know

It’s All About Having the Right Microbial Makeup

Most of you have heard of the “gut microbiome,” which consists of trillions of bacteria, fungi, and viruses living in our gastrointestinal tract. These are a diverse set of both “good and bad” microbes, and as long as the good guys stay in charge, the microbial community works in harmony to ensure healthy digestion, keep our bodies in an anti-inflammatory state, and support important metabolic processes that keep us healthy. A balanced gut microbiome also helps maintain the intestinal barrier, keeping harmful bacteria and bacterial toxins from leaking into the bloodstream and triggering systemic immune responses (referred to as leaky gut). Many of you likely take a daily gut probiotic to help support healthy gut-specific functions, and that probiotic will contain microbes particularly suited to create balance in the intestinal microbiome.

But the female body has many microbiomes beyond the gut, just a few examples being the vagina, the urinary tract, and even breast tissue. Each of these has a distinct microbial makeup that addresses that region of the body’s varying environmental factors and functions. Whether a particular organ needs to support an acidic or alkaline environment—to accomplish its key functions—is very important. This is measured as pH, with acidic being a lower number on the pH scale and alkaline environments having a higher pH measure. In the gut microbiome, the gut traverses different organs and functions: the stomach needs to be very acidic (with a low pH) to digest food and kill harmful bacteria, but the intestines need to be alkaline (higher pH) to prevent damage to the intestinal lining and to promote proper enzyme function to break down foods for optimal nutrient absorption. These differing pH requirements are one reason why a healthy gut microbiome needs a diverse microbial makeup, some supportive of an acidic pH, others thriving in an alkaline environment. In the gut microbiome, reduced diversity is linked to disease, including obesity, type 2 diabetes, IBD, cardiovascular diseases and certain cancers. (1)

But in the vagina, the pH singularly needs to remain acidic as an acidic environment is not hospitable to external pathogens. Most worrisome bacteria in the vagina grow best at an alkaline pH. (2) Additionally, your vagina is near the rectum and bacteria between these microbiomes do get exchanged—and are the basis for many infections including Bacterial vaginosis (BV). Sexual activity and semen can introduce bacteria—as well as change the vagina’s pH—as semen is alkaline, causing an imbalance in the microbial community. A healthy acidic pH in the vagina is one reason it takes millions of sperm to fertilize a single egg… the vagina is very protective of outsiders! (3) Tampons, lubes, soaps and more can all cause the vagina to become more alkaline as well.

So, to reduce the risk of infections and maintain optimal feminine (“V”) health requires a dominance of bacteria that thrive in an acidic environment. (4) This is where Lactobacilli species come in—and why they are found to make up about 70-90 percent of a healthy vaginal microbiome. (5,6) The main bacteria found in the vagina are L. iners, L. crispatus, L. gasseri, L. jenesenii, followed by L. acidophilus, L. fermentum, L. plantarum, L. brevis, L. casei, L. vaginalis, L. delbrueckii, L. salivarius, L. reuteri, and L. rhamnosus. These bacteria colonize in the vagina and maintain an acidic environment. The remaining microbes include anaerobic bacteria like Gardnerella, Prevotella, and many others, along with fungi like Candida species (that can cause the much dreaded—and very common—vaginal yeast infection), and viruses. In small numbers these microbes can be friendly but can become pathogens if Lactobacillibecome depleted and less dominant. (7)

In the vaginal microbiome, lower levels of Lactobacilli(resulting in a more alkaline environment) are not only shown to result in greater risk of infections (Bacterial vaginosis and urinary tract infections/UTIs, yeast infections, discharge and odor, sexually transmitted infections such as HIV and HPV, and other inflammatory states), but have been linked to an increased risk of infertility, adverse pregnancy outcomes, preterm birth, pelvic inflammatory disease, vaginal atrophy (vaginal dryness, itching, irritation from thinning of the vaginal walls), along with sexual discomfort and decreased libido. (8,9)

While a healthy vagina is usually acidic and between 3.5 and 4.5 in terms of pH, the pH will fluctuate depending on a woman’s age, hormone status, and many other lifestyle/environmental factors. Some of those factors include things like stress, smoking, menstruation, sexual activity and hygiene, contraceptives, lubricants (which is why I developed my pH-balancing lubricant, Velvé), antibiotic usage, diet, health status (diabetes), douching (don’t do it!), exposure to chemicals in tampons/sanitary products, etc.

As a woman ages, sexual hormone decline affects her vaginal pH. Changing levels of DHEA, progesterone, estrogen and testosterone have all been shown to influence vaginal pH levels. Estrogen levels in particular influence the makeup of the vaginal microbiome and its health.

The Urinary Tract Microbiome (urobiome)

The urobiome includes the bladder. Many pathogens found in the urinary tract (E. coli being one) spread from the final section of the digestive tract and the vagina, so those bacterial communities greatly influence the risk of urinary tract infection (UTI) development. (10) The healthy urobiome of women contains several Lactobacillus spp. which inhibit or impede E. coli growth in the urinary tract. Studies have repeatedly shown that women with low levels of Lactobacilliare more commonly colonized with vaginal E. coli than those with lactobacilli-dominated microbiomes, one reason UTIs are seen in greater numbers in postmenopausal women having lower levels of estrogen. (11-13) A healthy, balanced vaginal microbiome will support a healthier urobiome.

How Estrogen Levels Affect Vaginal Bacteria

What You Need To Know About Vaginal Health at Every Age

Infant girls begin life with an alkaline vaginal pH (an average of 7). Then, in puberty, and as women age, increasing levels of estrogen result in greater levels of Lactobacillus colonizing the vaginal microbiome. Estrogen increases the glycogen content in cells, supporting greater numbers of Lactobacilli, which metabolize (consume) the glycogen. Lactobacillus bacteria produce lactic acid and hydrogen peroxide, maintaining an acidic pH and furthering greater Lactobacilli colonization. This environment inhibits the growth of nonbeneficial bacteria and supports a balanced microbial environment. (14) Lactobacilli also produce antimicrobial peptides (AMPs) such as bacteriocins, which can prevent other opportunistic microbes from attaching to and infecting vaginal epithelium cells. They can promote autophagy (degradation) of potentially pathogenic microbes and can downregulate proinflammatory markers (cytokines). (15,16) A reduction in Lactobacillus abundance can result in a dysbiotic (out-of-balance) vaginal microbiome and influences the urinary tract microbiome as well.

Given estrogen’s particular impact on vaginal pH we can see how a woman’s feminine health (including fertility and pregnancy outcome) can be protected—or put at risk—over the course of her life. And as mentioned, everyday environmental and lifestyle impacts further influence a woman’s vaginal microbiome makeup. So, let’s talk about all of that. It’s fascinating to see how the vaginal microbiota change over a woman’s life, and how those changes can result in problems if women don’t take preventive steps.

Visual courtesy: https://pmc.ncbi.nlm.nih.gov/articles/PMC9977513/

How Lifestyle Decisions Affect Premenopausal Vaginal Health

It has been estimated that some 83 percent of premenopausal American women have a Lactobacillus-predominant vaginal microbiome, so that’s good! But there are many things that can impact this, even in younger women. Sadly, this statistic dramatically shifts downward after menopause, and there are many twists and turns in our vaginal health throughout a woman’s life. (17)

Contraceptives, lubricants, and hygiene products can all affect microbial balance in the vaginal microbiome. The most common form of spermicide, Nonoxynol-9, significantly reduces Lactobacillus,and spermicides have been linked to an increase in vaginal dysbiosis. (18,19)

Unprotected sex—even with a single partner—can lead to an unbalanced vaginal pH. As mentioned, semen is alkaline and can alter the vaginal pH (for as much as 14 hours), triggering the growth of bacteria. (20)

Antibiotics can inhibit bacterial growth but kill both harmful and good bacteria, rapidly altering the vaginal microbiome within just a few hours. (21) Even many conventional doctors will now recommend gut-probiotics to their patients when prescribing antibiotics. Taking intestinal probiotics may help provide some support to the vaginal microbiome, even though most feature bacteria from non-Lactobacillus strains such Bifidobacterium, Saccharomyces, Enterococcus, Streptococcus, Escherichia, and Bacillus. A balanced, healthy gut will help support the entire body (including the vagina) and overall immune system; the different microbiomes do overlap (sometimes referred to as the gut-vagina axis), interconnecting and influencing each other. But having said that, each microbiome still has a particular set of, “the bacteria you want to be dominant for optimal function and health.” For the vagina, that’s singularly Lactobacillus.

The gut can also influence circulating estrogen levels. Via the gut-vagina axis, gut microbes can alter the estrobolome, which is the population of microorganisms (and their genes) in the gut capable of metabolizing estrogen. (22)

Endocrine disruptor exposure (skincare products, cleaning products, lubes, food, etc.) throughout one’s daily life can change the microbial makeup of the gut, reducing Lactobacillus spp. (23) If you’ve never gone onto the Environmental Working Group’s website, you should (to review the many exposures that you can easily remove). You’ll be horrified enough that the next time you go to the grocery store, you’ll seek out an organic meal that hasn’t been sprayed with pesticides and herbicides, or injected with antibiotics.

Menstrual products in particular have been studied as a concern as they contain a wide variety of endocrine-disrupting chemicals, including phthalates, parabens, volatile organic compounds, phenols, fragrance chemicals, dioxins, and dioxin-like compounds. (24) Vaginal and vulvar tissue is highly permeable, and chemicals can be easily absorbed. Research has found that the average menstruator will use over 11,000 tampons or sanitary pads! Nowadays, there are “cleaner” options such as non-toxic and organic period products. (25) Even the commonly used lubricant, K-Y™ Jelly, has been found to contain chlorhexidine gluconate (CHG), a chemical that significantly inhibited Lactobacillus species growth in studies. (26,27)

Millennials and Generation Z may be faced with new stresses, given career, financial, and relationship concerns, perhaps finding themselves in a sandwiched multigenerational household, perhaps even caregiving for parents or grandparents. The stress hormone cortisol results in a dysregulated immune system and can inhibit the accumulation of glycogen in the vagina, reducing Lactobacilli and the levels of lactic acid, and increasing the vaginal pH. All of this increases proinflammatory response. Research still needs to determine if it is the immune system’s inflammatory response or vaginal dysbiosis, or a combination of both, that may be involved in the increased susceptibility to infections in the body (including the vagina and urinary tract) when someone is undergoing physiological stress, but we know stress can be a factor. (28,29)

Infections: In the United States, bacterial vaginosis (BV) affects approximately 30 percent of women of reproductive age. (30) As earlier mentioned, BV also increases the risk for urinary tract infections (UTIs), and has been associated with an increased risk of infertility, fallopian tube (uterine tube) inflammation, adverse pregnancy outcomes, and preterm birth (PTB). Studies have found decreased conception rates and high rates of early pregnancy loss due to reduced concentration of Lactobacilli and BV infection. (31-33)

Antibiotics and antifungal medications for vaginal and urinary tract infections are not always optimal, as bacteria such as BV and candidiasis (yeast) are sometimes able to resist these treatments by forming biofilms. Antibiotics can also disrupt Lactobacilli, actually promoting BV and candidiasis recurrence. (34) Another reason women need to take a more active role in their “V” health by addressing environment and lifestyle factors that may make them more susceptible to these infections, given imbalances in the vaginal microbiota.

Libido-killers! While there isn’t specific research tying the status of one’s vaginal microbiome with “libido”, how can it NOT be linked? When a woman has itching, odor, abnormal discharge, or infections… it can impact her wanting to initiate sex, or it can certainly make sex uncomfortable. There has been research (and let me just add, I’ve worked with women for decades, so have my own data to support this) suggesting that probiotics, either in combination with other treatments or alone, can significantly enhance “sexual function” in women by regulating the gut microbiome (remember the gut-vagina axis), immune system, and even the central nervous system. (35)

Some women will be found to have a more diverse vaginal microbiome. Lower levels of vaginal lactobacilli are reported more frequently in women of African and Latin American descent, perhaps due to sociocultural factors or genetics. (36)

Why Vaginal and Bladder Infections Are Common During Pregnancy

There are increased levels of estrogen throughout pregnancy, so healthy pregnant women have an increased abundance of Lactobacillus species in the vagina in comparison with non-pregnant women. This helps prevent vaginal infection, although vaginal infections (BV, yeast infections, and Trichomoniasis) are still quite common during pregnancy. There are hormone swings, physical changes (vaginal secretion changes can increase the risk for yeast infections, in particular), and just so many environmental and lifestyle impacts that can influence the balance of the vaginal microbiome. (37,38) Pregnancy infection(s) can result in adverse pregnancy outcomes such as miscarriages, spontaneous abortion, and premature delivery. (39)

Urinary tract infections (UTIs) plague many women during pregnancy, diagnosed in as many as 50–60 percent of all pregnant women. (40) Changes in bladder dynamics (making it easier for bacteria to ascend from the urethra to the bladder), hormonal changes, and immune system changes may make a pregnant woman more subject to infection as well as impair her body’s ability to combat such infections effectively. (41)

Studies have shown a significant reduction in Lactobacillus abundance after delivery, increasing the chance of infections.

Beyond Dryness, Menopause Can Cause Yeast Infections, Bacterial Vaginosis, and UTIs

As a woman transitions to—and thru—menopause, there is a decline in estrogen levels, and thus a decline in the abundance of Lactobacilli. Only 54 percent of post-menopausal American women are estimated to have a Lactobacillus-predominant vaginal microbiome. (42) With less estrogen and lactobacilli, a higher pH becomes the new “normal” for menopausal women, at around 5.3 for many. A woman’s vaginal pH can be measured and an elevated pH in the 5.0 to 6.5 range will suggest either a diagnosis of menopause (in the absence of an infection) or of a bacterial infection itself! (43) I’ll talk later about how we can measure our own pH levels as well as ascertain the microbe makeup of our vaginas (all from the comfort of home).

The many environmental and lifestyle factors that I’ve already discussed continue to be true during this time, including the impact of endocrine disruptors (lubes, personal care products, etc.), antibiotics, diet, and stress. Boomers may find themselves in the midst of struggling with caregiving stress during and after menopause, in particular.

Due to vaginal dysbiosis, menopausal women become more prone to vaginal infections such as yeast infections and bacterial vaginosis (BV) from the growth of harmful microbes. Multiple studies have shown a reduction of glycogen after menopause, which correlates with lower levels of Lactobacillusin the vagina. Along with a reduced abundance of Lactobacillus, many studies found a greater diversity of bacteria, including an increase in the abundance of anaerobes in postmenopausal women (e.g., Bacteroides, Mobiluncus), along with vaginosis-associated bacteria like Gardnerella vaginalis. (44)

The decline in estrogen is also associated with changes in the vaginal lining. Vaginal atrophy affects 25-50 percent of postmenopausal women, causing symptoms such as dryness, difficulties in intercourse, itching, bleeding, discharge and burning sensations. These symptoms affect a woman’s sexual health but also decrease her quality of life, thus my development of my restorative vulvar cream, Julva. The incidence of urinary tract infections (UTIs) begins to rise during menopause as well, as women with low levels of lactobacilli are more commonly colonized with vaginal E. coli, which increases the risk of UTI development. (45-47)

Estrogen After Menopause Can Improve Bladder Health and Reduce UTIs

While Lactobacilli dominance decreases as estrogen levels decline following menopause, it has been shown to increase with vaginal estrogen replacement therapy. Postmenopausal women taking hormone replacement therapy (HRT),increasing circulating estrogen levels, are more likely to have dominant vaginal Lactobacilli like women of reproductive age. In one study, postmenopausal women who were not on HRT displayed around 10-fold lesser Lactobacilli bacterial count than both premenopausal and postmenopausal women on HRT. (48-51)

The colonization of E. coli is more frequent in women who have not received estrogen replacement therapy, and treatment with local estrogen preparations can reduce the incidence of recurrent urinary tract infection in most women. (52) But not every woman wants to—or should—take estrogen when there are other natural ways to increase healthy levels of vaginal bacteria.

DHEA and Progesterone Also Support a Healthy Vaginal Microbiome

Progesterone: While estrogen primarily drives glycogen production in the vaginal lining, progesterone helps regulate the release of this glycogen, indirectly supporting the acidic environment created by Lactobacilli. Progesterone has many other hormone-balancing benefits as well. (53)

DHEA: Plays an important role in female reproductive health as an indirect precursor for estrogen. Its levels begin to decline in a woman’s mid-20’s and progressively decline. Administration of DHEA has been shown to decrease the vaginal pH in cases of vaginal atrophy in menopausal women (while maintaining normal postmenopausal serum estrogen levels), one of many reasons I used it in my Julva DHEA-based cream for vulvar rejuvenation. (54,55)

The Best Probiotic for Vaginal and Bladder Health

Introducing a Targeted Approach for a Healthy Vaginal Microbiome: VB Probiotic

VB Probiotic is a multi-strain probiotic formula containing five specifically chosen Lactobacillus probiotic strains, all commonly found in healthy vaginas and clinically found to result in a more balanced, pro-health vaginal microbiome.

Four of these strains are provided by the proprietary probiotic blend, Astarte™, and include the most dominant vaginal Lactobacillus species found in healthy pregnant women: Lactobacillus crispatus (LBV 88™), Lactobacillus gasseri (LBV 150N™),Lactobacillus jensenii (LBV 116™), and Lactobacillus rhamnosus (LBV 96™). VB Probiotic also includes an important and well-researched gut-supportive bacteria, Lactobacillus acidophilus (LA-5®), offering digestive and immune support. The inclusion of cranberry powder supplies additional urinary support.

L. crispatus in particular is associated with vaginal microbiome stability and health. (56) It is a high producer of lactic acid and produces antimicrobial peptides called bacteriocins, which help prevent BV-associated bacteria.

VB Probiotics Vaginal + Bladder Probiotic

VB Probiotic contains probiotic strains chosen for their proven abilities in supporting a healthy vaginal and urinary tract microbiome, as well as providing digestive and immune health support.

A probiotic designed for the colonization, survival, and growth of the key microbes needed for the greatest vaginal and urinary tract support.

Increases colonization of the vaginal microbiome with preferred Lactobacillus species and promotes microbiome balance.
- Has a pH-lowering effect.
- Produces anti-microbial compounds that prevent undesirable microbes.
- Grow abundantly and stick to vaginal surfaces, inhibiting the growth and attachment of pathogenic bacteria to vaginal epithelial cells. May directly adhere to these bacteria, killing them and/or preventing their spread.
- Inhibits inflammatory response cytokines.
Supports successful transit from the mouth to the vaginal microbiome: the lactobacillus strains in VB Probiotic have developed mechanisms (bile salt resistance) to survive the acidic environment of the digestive tract, ensuring successful transit through the gut-vagina axis.
Screened for glycogen consumption effects, optimizing healthy growth.

A probiotic clinically shown to provide pro-health effects on vaginal microbiome balance and health.

Specific research details below.

Found to significantly improve vaginal microbiota balance and reduce symptoms of bacterial vaginosis.**
Found to maintain healthy yeast levels.**
Reduced pathogenic and opportunistic pathogens (including Candida/yeast and Gardnerellas/BV) in pregnant women having herpesvirus infection, improved vaginal comfort and increased lactobacilli abundance. Improved pregnancy wellness.**
Shown to reduce vaginal discharge and odor.**
Supported healthy vaginal microbiome balance and symptom relief in a study that compared the probiotic to the antifungal treatment Fluconazole in the treatment of recurrent vulvovaginal candidiasis infection.**

A probiotic designed to promote urinary tract health.

Cranberry powder has been shown to reduce the risk of UTI infections. (57)

Cranberry Powder (500 mg) has been added to the key bacterial strains of VB Probiotic. Cranberries contain proanthocyanidins (PACs) having anti-adhesion properties that inhibit the adhesion of certain harmful bacteria, including E. coli (associated with urinary tract discomfort and infections), onto urothelial cells lining the bladder. (58,59) The amount of cranberry in VB Probiotic provides the correct level of PACs for UTI prevention.
Multiple clinical studies suggest a woman’s vaginal microbiota affects her susceptibility to urinary tract infections (UTIs). A more balanced vaginal microbiome as well as a predominance of Lactobacillus crispatus in the vaginahave both been associated with lower risk of UTIs. (60-64)
- Ensures an acidic environment due to the production of lactic acid, hydrogen peroxide and anti-microbial bacteriocins.
- Inhibits pathogens from binding to urethral and/or vaginal epithelial cells.
- Inhibits bacterial biofilm formation (which can result in pathogens developing resistance to antibiotics and antifungal medications).
- Downregulates inflammatory response cytokines (↓ TNF, IL-56, IL-8, IL-10).
May reduce the risk of recurrent UTI infections in some women. ‡
- Clinical trials suggest that vaginal interventions (e.g., vaginal probiotics and estrogen treatments) that create a healthier vaginal microbiome balance may protect against additional episodes of recurrent UTIs. (65)
- The FDA has stated that, “Limited scientific evidence shows that by consuming 500 mg each day of a cranberry dietary supplement, healthy women who have had a urinary tract infection (UTI) may reduce their risk of recurrent UTI.” Some 50 studies with 8857 participants support the use of cranberry products to reduce the risk of UTIs in women with recurrent UTIs, although in some studies, the reduced risk for recurrent UTIs has not been shown for the elderly, those with bladder emptying problems, and pregnant women. (66-68)
May reduce the risk of vaginal discomfort in women with a history of ongoing concerns. **
May reduce urinary urgency and urinary frequency. **
- Cranberry powder: One study found that a daily intake of cranberry powder reduced urgency episodes by 57.3 percent, patient perception of bladder condition by 39.7 percent, and daily micturition (urination level) by 16.4 percent. (69)
- Vaginal microbiome balance: Research tied to estrogen replacement therapy has shown that increased levels of Lactobacillus in the bladder were associated with modest improvement in urgency (Overactive Bladder) and incontinence symptoms. (70) Due in part to their anatomical proximity, there is an interconnected axis between the microbiomes of the vaginal and urinary microbiomes, and although the healthy female urinary microbiome is more diverse than that of the vagina, it contains Lactobacilli along with other microbes. (71)

A probiotic designed to provide digestive and immune system support.

Lactobacillus acidophilus,the 5 ^th Lactobacillus strain contained in VB Probiotic, is an important intestinal probiotic. It is commonly found in gut probiotics and intended to help regulate intestinal microbe balance, as well as support one of the gut’s primary functions, overall immune system health. Through this immune support function, gut probiotics have been found to help support systems throughout the body, including in the vagina and urinary tract. Studies have found that when L. acidophilus is precultured with urinary and vaginal epithelial cells, and subsequently exposed to urinary tract pathogens, that it competitively excludes these pathogens and suppressed urinary tract and vaginal infections. (72)

VB Probiotic is designed to contain the ingredients you want, but also excludes many we don’t want in our bodies. It is non-GMO, vegan, and free from 9 major allergens including wheat, gluten, milk (including lactose), nuts, peanuts, eggs, soybeans, sesame seeds, and crustacean shellfish.

A probiotic designed to be taken orally.

I take my probiotics along with my vitamins each day. Frankly, it’s just easier to take a pill versus insert it vaginally, and it’s easier to make it a habit (just like brushing your teeth). VB Probiotic is designed to be taken orally, typically: for younger women, or women who have optimized levels of estrogen, 2 capsules per day for two - three months, and then repeat on a quarterly basis for healthy maintenance. For menopausal and postmenopausal women the recommended dosage is for 2 capsules per day ongoing. Studies have shown that bacterial strains in orally administered probiotics do reach the vaginal tract as well as vaginal applications do. (73) The strains selected for VB Probiotic were chosen for many reasons, one being a high survival rate. Astarte strains have bile salt resistance, which is important, as that ensures that microbes can navigate the acidic gastric juices of the stomach without being degraded.

Orally administered probiotics may actually provide additional beneficial effects to vaginal health—over vaginally applied probiotic—due to the “gut-vagina axis” by balancing gut microbiota and inhibiting/preventing ascension of urogenital pathogens (yeast, pathogenic bacteria) from the rectum to vaginal tract as well as stimulating the gut and systemic immune system, potentially lowering the risk of infection. (74,75)

Clinical Research on the Effectiveness of VB Probiotic

There is increasing evidence that specific combinations of vaginal probiotic strains promote the colonization of vaginal Lactobacillipopulations in healthy women or women having bacterial vaginosis (BV) or vulvovaginal candidiasis infections, as well as support during/after recovery from antibiotics/antifungal treatments. (76) Each probiotic consists of different strains, however, so it is difficult to compare apples to apples when seeking research information online. Rather than include all of the more generic research findings, here are the studies specific to the microorganisms found in VB Probiotic.

Effect of a yoghurt drink containing Lactobacillus strains on bacterial vaginosis in women - a double-blind, randomised, controlled clinical pilot trial: 2018. Probiotic Yogurt (L. crispatus, L. gasseri, L. jensenii, L. rhamnosus), 125g twice daily for 4 weeks. Double-blind, randomized controlled trial assessing the effect of probiotic yogurt on vaginal microbiota balance in women. Results: Probiotic group showed significantly improved support for vaginal microbiota balance and reduced recovery rate and symptoms of bacterial vaginosis compared to the placebo (P < 0.05). https://pubmed.ncbi.nlm.nih.gov/29065710 (77)

Ingestion of Yogurt Containing Lactobacillus acidophilus as Prophylaxis for Candidal Vaginitis: 1992. Probiotic (Lactobacillus acidophilus). LA-5® probiotic strain from Novonesis is associated with gut health benefits in randomized, double-blinded, controlled human studies. Crossover trial with 33 women (13 completed the study) having recurrent candidal vaginitis.Results: A threefold decrease in candidal colonization and infections was seen when patients consumed 8 ounces (daily, for 6 months) of yogurt containing Lactobacillus acidophilus(>10 ¹⁰/d). https://www.acpjournals.org/doi/10.7326/0003-4819-116-5-353 (78)

Role of microbiota correction in complex treatment of pregnant women with herpesvirus infection. Randomized study 2016. Probiotic blend (L. crispatus, L. gasseri, L. jensenii, L. rhamnosus) provided in a patented food supplement (Florium) in the form of capsules. 60 pregnant women with herpes. Results. Reduced opportunistic pathogens (including Gardnerellas/BV and Candida), increased Lactobacillus. Improved microbiota balance of the vagina. Decreased complaints (excessive vaginal discharge, itching, swelling and redness of the mucosa) by 2-3 times. Improved conditions in the gestational process (reduced incidence of placental insufficiency and pre-eclampsia) supporting overall pregnancy wellness. https://pmc.ncbi.nlm.nih.gov/articles/PMC8491456/#prp2787-bib-0168 (79)

Effect of a yoghurt drink containing Lactobacillus strains on bacterial vaginosis (BV) in women - a double-blind, randomised, controlled clinical pilot trial: 2018. Probiotic Yogurt (L. crispatus, L. gasseri, L. jensenii, L. rhamnosus), 125g twice daily for 4 weeks. Double-blind, randomized controlled trial assessing the effect of probiotic yogurt on vaginal microbiota balance in women being treated for BV with the standard treatment, oral metronidazole, for 7 days. Results: BV-associated symptoms, including discharge and odo,r decreased in the probiotic group. Vaginal pH reduced in the probiotic group but remained on average above the normal range for the control group. The vaginal microbial pattern was improved compared to the control group. Results suggest that the use of these probiotic strains could be an important adjuvant therapy with antibiotics to resolve BV symptoms. https://pubmed.ncbi.nlm.nih.gov/29065710 (80)

Comparing the Effect of Probiotic and Fluconazole on Treatment and Recurrence of Vulvovaginal Candidiasis: a Triple-Blinded Randomized Controlled Trial. 2022. Probiotic (Lactobacillus acidophilus). LA-5® probiotic strain from Novonesis associated with gut health benefits. Triple-blinded randomized controlled trial with 80 married women, aged 18-49 years, having vulvovaginal candidiasis (VVC). The probiotic-treated group received 30 probiotic capsules containing 1 × 10 ⁹ CFU/g LA-5, daily for 60-65 days, and 1 fluconazole placebo capsule. The Fluconazole group received 30 placebo probiotic capsules, 1 daily, and 1 Fluconazole capsule. Results: The probiotic, used alone, had an effect similar to that of the antifungal treatment Fluconazole in treating most symptoms of VVC (discharge, burning, itching and dysuria) and healthy microbiota balance, but it was less effective than Fluconazole in preventing recurrence. https://pubmed.ncbi.nlm.nih.gov/36198994/ (81) Dysuria is pain and discomfort while urinating and is often associated with urinary tract infections (UTIs) and bacterial vaginal infections. The authors concluded that given the emergence of drug resistance species and the chemical side effects of antibiotics/anti-fungals, that more clinical trials should be undertaken to evaluate the anti-Candida properties of the probiotic.

Should you have questions about the research or this article, please feel free to message my team at: team@drannacabeca.com. This is detailed information, I know. But, so important.

Finally, I also have some additional recommendations relating to our being preventative with our feminine health.

Essential Vaginal Healthcare and Preventive Strategies from Dr. Anna

My first recommendation is to simply prioritize your feminine health, including vagina and bladder, alongside your usual preventive healthcare activities.

And recognize there are broader repercussions associated with neglecting vaginal and bladder health, beyond simple feminine comfort and sexual well-being. Infertility and pregnancy outcomes can be affected, as mentioned. Additionally, frequent UTIs, urinary frequency and incontinence all lead to inflammation and have been associated with cognitive decline. Often, the reason a woman falls is her getting up in the middle of the night to use the restroom. Falls break her hip and she becomes further limited. One of the top reasons an older woman moves into a nursing home is due to incontinence. Maintaining urogenital health is important for overall health and comfort across a woman’s life span.

There are a number of action items I suggest.

Screening and Prevention for Optimal Vaginal Health:

Regular pelvic exams and Pap smears are vital, especially after menopause, regardless of what your insurance company or doctor may say. Pelvic exams can detect asymptomatic conditions early (e.g., cervical or ovarian cancer). I’ve had patients in their 70s who have developed late-stage cervical cancer due to the lack of such exams. Women are often told they don’t need such care after menopause. That is not true.

Annual pelvic exams are strongly recommended, regardless of your age and hormone status.

Pap smears are also strongly recommended, regardless of your age and hormone status. Even women under the age of 21 should have a pap smear if sexually active. And women having had a hysterectomy should also get one. For all others, I recommend women have a pap smear every 2-3 years (especially if health history/risk factors are present, or when having a new partner, this is important), even if menopausal or postmenopausal. Maybe 3 years with low risk and monogamy (even if this means you have to self-pay, which can be the case after menopause).

A Pap smear can detect potential precancerous cervical changes before cancer even develops. And because the timeline from a precancerous stage to cancer is slow, routine screening can make cervical cancer a preventable disease. Not having a Pap smear in the last 3 years has been found to significantly increase a woman’s risk for cervical cancer. In fact, not having that screening is actually the highest risk factor (82.4 percent) there is. (82)

This concern about pap smears is so important, I’ve recorded a podcast discussing the topic. You can find that recording, “Why Would I Need a Pap Smear” here.

Active hormone monitoring may seem like something that goes without saying, but I’ve had new patients come to me that were prescribed hormones years before, and were not ever tested again. That is criminal! If you have been prescribed hormones, you should be routinely tested for your hormone levels. Hormones are not prescribed as a “one prescription good for the rest of your life” kind of thing. Actually, no prescriptions should be.

Testing for Vaginal pH and Vaginal Microbiome Makeup

We can test our vaginal pH as well as our vaginal microbiota makeup. I always say, “Test, don’t guess.”

Vaginal pH testing:

In my Women’s Restorative Health programs and as a key principle of my Keto-Green® Diet, we test our urine pH using easy-to-use test strips. With our urine, we’re measuring whether our body is in ketosis and in an overall alkaline state. Both of these measures are designed into my Keto-pH Urine Test Strips. You can use these same test strips to test your vaginal pH if you are already using them to test for ketones, or there are many other vaginal pH testing strips available (or you can purchase pH hydrion paper). Just insert a test strip into the mouth of the vagina. It is a quick, inexpensive initial screening to determine whether you might have something going on. Values greater than 4.5 (if you are nonpregnant and premenopausal) may be pointing towards your having bacterial vaginosis (the sensitivity for this is quite high, ranging from 84 to 97 percent.) (83) There are not always symptoms.

It's a little trickier if you are menopausal or postmenopausal, as your vaginal pH may normally be a bit higher than 4.5 (often around 5.3). But a higher pH, with symptoms, would confirm a problem.

Note that vaginal pH testing does not help identify other types of infections, such as HIV, chlamydia, gonorrhea, herpes, syphilis, or group B streptococcus. So, along with pH testing you really want to focus on what symptoms you have, and always discuss with your doctor.

Vaginal microbiome testing:

Women can purchase at-home test kits which report on the specific microbe makeup present in the vagina. One example I’m familiar with is the Microbiome Labs BiomeFX Vaginal Health Kit. This test provides a deep dive into your vaginal microbial makeup with results measuring: levels of the four dominant vaginal Lactobacillus species (those associated with greatest vaginal microbial balance, the same ones found in VB Probiotic), levels of 26 opportunistic bacteria, and candida counts. Along with the detailed report there is evidence-based nutrition, lifestyle, and supplement recommendations to help restore and maintain a healthy vaginal ecosystem. It can be interesting to see how various interventions you take (use of a vaginal probiotic, improved diet, reduction of endocrine-disrupting personal care products/lubes/etc.) may improve your microbiome makeup. Just always consult with your doctor should you have symptoms or health concerns.

Integrative & Targeted Therapies:

Use of topical formulas such as Julva (with DHEA, emu oil, and plant stem cells) can help restore glandular secretions and moisture, as well as improve tissue health. When I initially developed Julva, there weren’t targeted vaginal and bladder health probiotics like VB Probiotic. I always recommended gut-specific probiotics such as Lactobacillus acidophilus and Bibidobacterium lactis, like found in my Gut Thrive formula, and had women use that along with Julva therapy, clitoris to the anus. This helped so many women with resolving bladder infections as well as improving odor, discharge, and dryness.

Now I view Julva and Gut Thrive as great companion products to VB Probiotic.

Educate Yourself and Be the Champion of Your Feminine Health!

The fact that you are reading about vaginal health and the importance of vaginal probiotics is a very positive thing; it means you are investing time in your health. Continue to educate yourself on topics relating to your feminine health. Learn how to identify signs of when your vagina is out of balance, so you can be preventive in regards to vaginal and urinary tract infections and uncomfortable symptoms. Your vagina and bladder are important at every age, and regardless of your level of sexual activity.

This is your vaginal and bladder health checklist:

Don’t neglect regular gynecological exams, even if postmenopausal or on hormone therapy.
Be alert to body changes and seek evaluation for new symptoms.
Learn what is “normal” for your body. Know that pain is never normal.
Be brave, not shy, about talking to your doctor when you suspect things are out of balance.
Consider incorporating a vaginal and bladder health probiotic such as VP Probiotic into your regular healthcare routine (and a gut-specific probiotic as well, helpful for daily use but in particular after antibiotics use).

And finally, think about the many environmental and lifestyle impacts that affect our feminine health each and every day of our lives, many were mentioned in this article. The good news is that most of these are under our control and relatively easy to address. Reduce your use of endocrine disrupting products in your home and within your body (check out the EWG site), clean-up your diet with gut-supportive foods (I recommend Keto-Green®), be cautious with feminine health products you use such as menstrual products, contraceptives and lubes, find ways to better manage your stress.

Every change, even little ones, can help your body maintain its healthiest microbe balance, and keep you a healthier, happier you.