The Vaginal Microbiome: What It Is, and Why It Matters More Than You Think
When we talk about gut health, most people now understand the idea of a microbiome — a complex ecosystem of bacteria that plays a huge role in digestion, immunity, mood, and inflammation.
But far fewer people realise that the vagina has its own microbiome too — and that it’s just as important.
Research over the past two decades has shown that the vaginal microbiome plays a key role in infection risk, reproductive health, fertility outcomes, pelvic comfort, and overall wellbeing (Ravel et al., 2011). I see this allll the time in clinic too! And when this ecosystem is balanced, it works quietly in the background. But when it’s disrupted, symptoms can be persistent, confusing, and deeply frustrating.
Importantly (of course! You’re on a Chinese medicine page!), this modern understanding aligns closely with Traditional Chinese Medicine (TCM), which has long viewed vaginal health as a reflection of immune strength, hormonal sufficiency, digestion, and nervous system balance — not simply the presence or absence of infection.
What Is the Vaginal Microbiome?
The vaginal microbiome refers to the community of microorganisms that live within the vaginal environment. In most healthy, premenopausal women, this ecosystem is dominated by Lactobacillus species, particularly L. crispatus, L. jensenii, L. gasseri, and L. iners (Ravel et al., 2011).
These bacteria aren’t just ‘nice to have.’ They actively protect vaginal health by producing lactic acid, which maintains an acidic vaginal pH — typically between 3.8 and 4.5. This acidic environment inhibits the growth of potentially harmful bacteria, yeast, and pathogens, acting as a frontline immune defence (Borges et al., 2014).
Rather than being sterile, the vagina is healthiest when this microbial balance is intact and stable — a concept that closely mirrors the TCM principle of supporting the body’s internal environment rather than attempting to eradicate all microbes. And in this case, healthy really is happy.
Why Balance Matters
When Lactobacillus populations decline and other bacteria overgrow, the vaginal environment becomes less acidic. This imbalance, often referred to as vaginal dysbiosis, has been strongly associated with a wide range of symptoms and health outcomes.
Dysbiosis is linked to higher rates of bacterial vaginosis (BV), recurrent vulvovaginal candidiasis, vaginal irritation, altered discharge, and increased susceptibility to sexually transmitted infections (Brotman, 2011). And this bit is really key: it’s also associated with reproductive consequences, including reduced implantation rates and poorer outcomes in IVF cycles (Moragianni et al., 2019; Koedooder et al., 2019).
From a TCM perspective, these presentations are commonly understood as Dampness or Damp-Heat in the lower burner — patterns that arise when the body’s regulatory systems are overwhelmed or weakened. Rather than focusing on a single organism, TCM asks why the vaginal environment has become vulnerable in the first place.
What Disrupts the Vaginal Microbiome?
A number of common, everyday factors can disrupt microbial balance. Some of the most significant include:
Antibiotic use, which reduces beneficial Lactobacillus along with harmful bacteria
Hormonal fluctuations, particularly changes in oestrogen
Chronic stress, which alters immune regulation and inflammatory pathways
Sexual activity, as semen temporarily raises vaginal pH
Over-cleansing, including douching or scented ‘feminine hygiene’ products
Studies consistently show that practices aimed at ‘cleaning’ the vagina actually increase the risk of dysbiosis and BV, rather than preventing it (Fethers et al., 2008).
In TCM terms, repeated antibiotic use and digestive disruption may weaken Spleen Qi, impairing the body’s ability to regulate fluids and immune defence. Chronic stress contributes to Liver Qi stagnation, which can generate heat and further destabilise the vaginal environment.
The Vaginal Microbiome & Hormones
Oestrogen plays a central role in shaping the vaginal microbiome. It stimulates vaginal epithelial cells to produce glycogen, which Lactobacillus species use as fuel. When oestrogen levels are robust, Lactobacillus tends to thrive.
When oestrogen declines — as it does during perimenopause, menopause, breastfeeding, postpartum, or under chronic stress — glycogen availability drops. As a result, Lactobacillus populations often fall, vaginal pH rises, and susceptibility to irritation and infection increases (Mirmonsef et al., 2014).
This helps explain why many women notice new or worsening vaginal symptoms during hormonal transitions, even when routine swabs return as ‘normal.’ The issue isn’t always the presence of a pathogen — it’s a loss of protective balance (you can read the journal post here about ‘normal’ vs ‘optimal’ lab results, very fitting!).
In TCM, these transitions are often associated with Kidney Yin deficiency — a decline in the body’s ability to nourish tissues, regulate reproductive fluids, and maintain resilience. Symptoms such as dryness, burning, recurrent infections, or irritation without obvious discharge closely mirror this pattern.
Chronic stress and nervous system overload further compound the issue. From both biomedical and TCM perspectives, stress alters immune signalling, inflammatory pathways, and hormonal communication — making balance harder to maintain.
The Gut–Vagina Connection
Emerging research increasingly highlights the relationship between gut health and vaginal health. Disruptions in the gut microbiome can influence immune function and microbial balance elsewhere in the body.
This connection has been recognised in TCM for centuries: The Spleen system, responsible for digestion and the transformation of food into Qi and Blood, plays a central role in gynaecological health. When digestive function is compromised (through diet, stress, or illness) Dampness can accumulate and descend to the lower burner, affecting vaginal health.
Supporting digestion, therefore, becomes a key part of restoring vaginal microbial balance.
Supporting a Healthy Vaginal Microbiome
Supporting vaginal health is less about eradication and more about restoration and stability.
Helpful strategies may include:
Avoiding douching and fragranced vaginal products
Using antibiotics judiciously
Supporting gut health
Managing stress and nervous system load
Addressing hormonal insufficiency where appropriate
There is growing evidence that targeted probiotic therapy — particularly strains containing Lactobacillus crispatus — may help restore vaginal microbial balance and reduce recurrence of BV in some women (Happel et al., 2020).
From a TCM perspective, acupuncture and herbal medicine may support immune regulation, reduce inflammation, improve digestive function, and nourish Yin and Blood — particularly during perimenopause, postpartum recovery, or fertility treatment.
Rather than repeatedly suppressing symptoms, this integrative approach aims to strengthen the body’s internal environment so balance can be maintained long term. Sounds good, doesn’t it?
When to Look Deeper
For women experiencing recurrent symptoms despite standard treatment, it may be necessary to look beyond basic testing. Traditional vaginal swabs don’t always capture microbial diversity or functional imbalance, and symptoms can persist even in the absence of a clearly identifiable pathogen.
Persistent irritation, recurrent infections, or a sense that something isn’t quite right are signals worth listening to, and not dismissing.
The Takeaway
The vaginal microbiome is a quietly hardworking ecosystem — not something we should try to sterilise or micromanage.
When it’s supported, it does its job in the background: protecting against infection, supporting fertility, and keeping you comfortable. When it’s out of balance, the ripple effects can show up in hormones, reproductive health, and just how you feel day to day.
Like so much in women’s health, it’s about whole-body care, not quick fixes — blending modern science with approaches that respect how connected our hormones, immunity, digestion, and nervous system really are.
References & Further Reading:
Borges, S., Silva, J., & Teixeira, P. (2014). The role of lactobacilli and probiotics in maintaining vaginal health. Archives of Gynecology and Obstetrics, 289(3), 479–489.
Brotman, R. M. (2011). Vaginal microbiome and sexually transmitted infections: An epidemiologic perspective. Journal of Clinical Investigation, 121(12), 4610–4617.
Fethers, K. A., et al. (2008). Sexual risk factors and bacterial vaginosis: A systematic review. Sexually Transmitted Infections, 84(1), 59–64.
Koedooder, R., et al. (2019). The vaginal microbiome as a predictor for IVF success. Human Reproduction, 34(6), 1042–1054.
Maciocia, G. (2011). Gynecology in Chinese Medicine (2nd ed.). Churchill Livingstone.
Mirmonsef, P., et al. (2014). The effects of estrogen on the vaginal microbiome. American Journal of Reproductive Immunology, 71(6), 550–560.
Moragianni, V. A., et al. (2019). Vaginal microbiota and assisted reproductive outcomes. Fertility and Sterility, 111(3), 564–571.
Ravel, J., et al. (2011). Vaginal microbiome of reproductive-age women. Proceedings of the National Academy of Sciences, 108(Suppl 1), 4680–4687.