For generations women’s pain and discomfort has been downplayed. Now, the spotlight is finally being shone on vaginal health with exciting developments supporting reproduction, general comfort and health.
Evolution of vaginal health treatments
Vaginal health products have come a long way:
- from sitting in a bucket filled with herbal tea, to nanomaterials and genetic sequencing of vaginal microbiome
- from oral route of administration to vaginal bio-adhesive delivery systems
- from general “good for you” random probiotics to specific vaginally active and clinically proven strains
- from yogurt-dipped tampon to quality-controlled products that offer consistent and accurate dosage delivery.
Importance of innovation in vaginal healthcare
Due to the structure and position of the vagina, all vaginal healthcare products face the same problem – they disappear quickly due to gravity and self-cleansing action of the vagina. Some, before they have a chance to act. Some dosage forms present more challenges than others. For example aerosols, lotions, gels and creams for vaginal delivery are not just uncomfortable due to the product leaking but do not possess the dosage accuracy. Conventional tablets, suppositories and ovules may be removed from the vaginal canal before being thoroughly dissolved, which makes them less effective. Therefore, the need for innovation and more advanced vaginal delivery systems is clear. In scientific research, there has been a lot of studies investigating the dosage forms that express attributes such as:
- prolonged dwelling time in vagina
- quick dissolution of active ingredients from a dosage form
- simple application, reduced leaking and increased practicality
- vaginal microbiome friendly ingredients
- biocompatibility and safety of ingredients
- safety of application procedure.
Advances in vaginal health
1. Vaginally active probiotic species
In the last 10 years, there has been a lot of scientific break-throughs in the field of vaginal microbiome sequencing. Lactobacillus crispatus has been confirmed as the most beneficial, the most protective and the most stable vaginal species.
Through scientific research it was confirmed that L. crispatus was the species with the highest adherence properties to vaginal epithelial cells. A systemic review analysis concluded that L. crispatus vaginal microbiome dominance is not easily shifted toward dysbiosis. Decreased L. crispatus presence was related to increased bacterial diversity. Increased bacterial diversity in vaginal microbiome carries a risk of vaginal infections. A study conducted in Australia, followed 298 women over 2 years and concluded that L. crispatus is an essential part of healthy vaginal microbiome and its abundance is related to vaginal health.
Amelia’s v-spot probiotic features L. crispatus organisms in dose 2 billion CFU (colony forming units) per dose.
2. Innovation in vaginally active postbiotics
As an addition to probiotics and prebiotics, recent research is delving into the advantages of postbiotics, examining their potential impact on vaginal health. Postbiotics relevant to vaginal health represent bioactive compounds that are derived from the metabolic processes of Lactobacillus bacteria. They include a variety of molecules such as different types of proteins, bacteriocins, and organic acids (especially lactic acid and hydrogen peroxide). Sometimes, postbiotics are referred to as “ghost probiotics’ or ‘paraprobiotics”.
A clinical trial examined the effect of one week’s application of postbiotic gel on vaginal microbiome in 50 patients. The postbiotic gel increased the relative abundance of vaginal lactobacilli and shifted the vaginal microbiome toward healthy species. It was concluded that postbiotics represent an exciting area of research with promising applications for vaginal health.
3. Vaginal delivery system formulations and technologies
The main focus of the vaginal delivery formulation research has been in the area of creating a vaginal product that will remain in situ for longer and be able to release active ingredients to the vaginal environment before being removed.
Amelia’s v-spot probiotic advantages include:
- Time of application – once per day, before bed time, minimizing the potential of pessary leaving vagina before releasing active probiotic species.
- Rapid dissolution – the plant-based capsule dissolves on body temperature, without need of dissolution medium, which is ideal for vaginal environment, with low discharge volume.
- Supporting survival of probiotic strains – food packed pessary, enables probiotic organisms to be revived and nourished, ready for colonization and multiplication in the vagina.
- Biocompatible and safe ingredients – all ingredients are safe to use in vagina.
- Simple and safe application – no applicators, complete control of position of the pessary in your vagina, minimizing risk of hurting yourself
4. Vaginal health therapeutic approaches
Innovation in vaginal health was not only in active ingredients and delivery systems. Therapeutic approaches also need a new perspective.
For example, an experimental trial created a bifunctional suppository which contained an antifungal drug and lactobacilli organisms together.
Vaginal microbiota transplant (VMT) is a new field that has been explored in a recent scientific paper. It is recommended as a promising intervention for women with recurrent bacterial vaginosis (BV). The process involves identifying a suitable vaginal microbiome donor, with healthy and Lactobacillus dominated microbiome. The donor then provides vaginal secretions, which are screened for various STIs and further processed. The processed secretions are introduced into a recipient’s vagina. This concept was tested in a clinical trial which included 5 women with recurrent BV. VMT procedure achieved the long-term remission for 4 out of 5 women, which makes this procedure a promising method for treating intractable BV. However, the efficacy of VMT is still being explored as a donor’s sample requires extensive testing and provides relatively small bacterial load. It was also noted that nonintentional transfer of sperm in vaginal secretion can lead to unintended pregnancy. The long-term consequences of VMT procedure are still unknown.
Interestingly, another scientific review even suggests that Fecal Microbiota Transplantation (FMT) could have beneficial effect on vaginal microbiome and health. The proposed gut-vagina cross-talk is based on the fact that live bacterial organisms implanted through FMT procedure induce both a local and systemic immune response, which may also induce stimulation at the vaginal level. Together with the application of vaginal probiotics, FMT could contribute toward enhancing multiple vaginal health conditions. Therefore, more research is needed to understand the connections between gut and vaginal microbiome, which can be an interesting therapeutic approach for addressing vaginal health issues and disorders (such as endometriosis and polycystic ovary syndrome – PCOS).
References
- Mane et al., 2020. Characterisation of colonisation properties of vaginal lactobacilli from healthy Indian women: Implications for identification of potential probiotic candidates. https://doi.org/10.4103/ijmm.IJMM_20_108
- van de Wijgert et al., 2014. The vaginal microbiota: what have we learned after a decade of molecular characterization? https://doi.org/10.1371/journal.pone.0105998
- Plummer et al., 2019. Sexual practices have a significant impact on the vaginal microbiota of women who have sex with women. https://doi.org/10.1038/s41598-019-55929-7
- Shen et al., 2023. Postbiotic gel relieves clinical symptoms of bacterial vaginitis by regulating the vaginal microbiota. https://doi.org/10.3389/fcimb.2023.1114364
- Pashayan & Hovhannisyan, 2021. Development of bifunctional vaginal suppositories by joint use terconazole and probiotic for treatment and prophylaxis of vulvovaginal candidiasis. https://doi.org/10.1080/03639045.2021.2001485
- France et al., 2022. Towards a deeper understanding of the vaginal microbiota. https://doi.org/10.1038/s41564-022-01083-2
- Lev-Sagie et al., 2019. Vaginal microbiome transplantation in women with intractable bacterial vaginosis. https://doi.org/10.1038/s41591-019-0600-6
- Quaranta et al., 2019. Fecal Microbiota Transplantation: A Potential Tool for Treatment of Human Female Reproductive Tract Diseases. https://doi.org/10.3389/fimmu.2019.02653