We sat down with Jessica Lloyd, a qualified, experienced vulvovaginal specialist naturopath, and founder of My Vagina. The purpose of My Vagina is to revolutionise the way vaginas are treated, using tools from conventional medicine, robust scientific research and sound naturopathic principles. My Vagina brings more options to the treatment table via comprehensive, quality information, and treatment or management strategies for both practitioners and patients, demystifying science and medicine.

Q: Why do women generally come and see you?

A: The majority of my clients have bacterial problems - a disruption to the vaginal microbiome that causes a variety of uncomfortable symptoms. I tend to see people who have been through the traps with their doctor, but nothing is working. Like many naturopaths, I’m usually the practitioner of last resort!

Q: What are some common patterns that you see in women’s microbiome tests?

A: One thing we know from research, and I see a lot, is that bugs tend to hang out in cliques, often actively taking care of each other - you scratch my back, I’ll scratch yours.

Some bugs are besties, and you’ll often find them together, causing trouble, and forming the pillars of a diagnosis like bacterial vaginosis (BV). These ‘friendships’ also apply to the bacteria that make up a protective microbiome.

When I look at a report, I’m usually looking for groups of bugs and who the ringleader is.

Q: Which at-home microbiome test would you recommend and why?

A: At the moment, there is only one comprehensive microbiome test available to the public globally, and that’s Juno.

The Juno test doesn’t miss much, particularly when compared to other available tests such as PCR or culture. So many people have been told there was ‘nothing found’ in a culture, only to find out later that, well, there was plenty there, the culture just didn’t pick upon it.

PCR tests check for the DNA of a dozen or so microbes (present or not present), and they’re still a very good option. Conversely, a culture uses a food source in a petri dish to overgrow the most dominant species in your sample, missing sometimes problematic - but low-level or unculturable - microbes.

Q: You treat women all over the world, do you notice any differences in infection or microbiome tests depending on geography?

A: There are geographic trends in what the most common vaginal microbiome profiles are, and these are down maternal lines - which makes sense. We inherit microbiomes.

But, our microbiome can and does change depending on who we’re around and what sort of environment we live in. If someone you have sex with has a lot of unfriendly bugs in and on their genitals, and you don’t use a barrier during sex (like a dental dam or condom), you’ll inherit them too. Or, if you spend a lot of time in hospital, you can pick up hospital-related pathogens. Whether your body fights them off or not is a matter of individual biology.

Countries that have the worst sex ed and slackest use of condoms (America, here’s looking at you) have, in my experience, overall worse vaginal microbiomes, with more frequent and severe infections, compared with the more sexually savvy and safe countries (Europe, high five).

Q: Why don’t antibiotics or antifungal treatments always work?

A: The reasons for a lack of response to treatments really do vary. A couple of good examples are biofilms and hormonal imbalances.  

Many bacteria and yeasts - even protective varieties - build treatment-resistant biofilms to cover themselves. Bacterial biofilms are like a jelly cup with berries, the bugs being the fruit, the jelly being the biofilm.  

Antibiotics can’t penetrate the biofilm, so any bug unlucky enough to be on the outside of the jelly dies. Bugs inside the jelly are unaffected. Sometimes adding in targeted biofilm treatments can break the chain of recurrence and allow treatments to work.

Having a lack of or abundance of certain hormones like oestrogen can also create imbalances in vaginal flora.

If you’re breastfeeding, on oestrogen-blocking drugs, or in menopause, you’re likely to have low oestrogen levels. Oestrogen stimulates a special sugar in vaginal cells that feeds protective bacteria, so if you’re low in oestrogen, you may not be able to support a protective microbiome. This makes restoring a protective microbiome difficult, if not impossible, as there isn’t enough of the right kinds of food to support a healthy colony.

If you have an abundance of oestrogen, conversely, you may be prone to an overgrowth of lactobacilli or yeast, and that can make diagnosis and treatment tricky if you don’t look at these contributing factors.

Q: For women experiencing the first onset of symptoms for a possible vaginal infection, are there any at-home treatments that you would recommend as your first point of call?

A: Initially, I’d be looking at a vaginal probiotic, for sure. When it works, it works quickly and effectively. Get in quick and go hard, but just for 2-3 days and then just leave it be and see if it helped.

Q: You tend to see women for more complex or recurring vaginal conditions. If women are experiencing symptoms, and don’t have an STI, BV or a yeast infection, what else could it be?    

A: I’d be looking at genetic variations, a messed-up gut microbiome, incompatible diet choices, partner reinfection, heavy metal overload, a struggling immune system and chronic stress.

While it can be complex, don’t ignore the simple things too. One of my favourite examples is a woman with BV who decided to start brushing her teeth regularly. I know, gross, but she wasn’t brushing her teeth for days on end, and as soon as she started, her BV cleared up completely and never came back.

Q: What options are out there for women who’ve ‘tried everything’?

A: Try different. Find a practitioner who can bring a fresh perspective, perhaps an acupuncturist, osteopath, naturopath, herbalist, nutritionist or reflexologist.  

Also, this must be said - clean up your sh*t! If you party all weekend and eat like trash, don’t expect your body to cooperate.

Q: What piece of advice would leave women with?

A: One of the most common reasons people seek my advice for vaginal symptoms is after having unprotected sex with a new partner who had nasties on their genitals and passed the gift on. Use a condom!