When we think about fertility, we often focus on hormones, egg quality, and sperm health. But one key factor that is often overlooked is the vaginal microbiome - the unique community of bacteria and other microorganisms that live in the vagina.
A well-balanced vaginal microbiome plays a crucial role in protecting against infections, supporting implantation, and even helping sperm survive the journey to the egg. But when the balance is disrupted, it may contribute to conditions like bacterial vaginosis (BV), thrush, inflammation, and even unexplained fertility struggles.
In this article, we’ll cover:
What a healthy vaginal microbiome looks like
Signs of imbalance
How to test your microbiome
Ways to support balance naturally
Why your partner’s microbiome might matter too
What’s Normal and What’s Not?
A healthy vaginal microbiome is dominated by Lactobacillus bacteria, which help maintain a slightly acidic environment (pH between 3.8 and 4.5). This acidity prevents harmful bacteria and pathogens from thriving, reducing the risk of infections and inflammation.
Everyone’s ‘Normal’ is Different
While there are general characteristics of a healthy vaginal microbiome, your own ‘normal’ might be slightly different. Some people naturally produce more discharge, have a different baseline odour, or experience mild fluctuations throughout their cycle. What’s most important is recognising when something changes for YOU.
Signs of a healthy microbiome:
✔ No unusual odour
✔ Clear or white discharge without discomfort
✔ No itching, burning, or irritation
✔ Balanced vaginal pH
Signs of an imbalance:
❌ Strong or fishy odour (may indicate bacterial vaginosis)
❌ Thick, white, cottage cheese-like discharge (often associated with thrush)
❌ Burning, itching, discomfort
❌ Chronic or recurrent infections
❌ Pain during intercourse or urination
❌ Any new or persistent changes that feel unusual for YOU
When the microbiome is imbalanced, it may create a less hospitable environment for sperm, affect implantation, and even contribute to pregnancy complications. Research has linked vaginal dysbiosis (imbalance) to recurrent miscarriage and reduced IVF success rates.
How Can You Test Your Vaginal Microbiome?
If you’re experiencing recurrent infections, unexplained fertility issues, or just want to understand your microbiome better, testing can provide valuable insights.
Types of vaginal microbiome testing:
PCR-based tests – Identify specific bacterial species, including both beneficial and harmful microbes, helping to detect imbalances like bacterial vaginosis or a lack of Lactobacillus.
NGS (Next-Generation Sequencing) screening – The most comprehensive form of microbiome testing available. This advanced method analyses the entire microbial community, detecting a wide range of bacteria, fungi, and other microbes that could be influencing your vaginal health and fertility.
pH testing – Measures vaginal acidity, which can indicate overall balance but doesn’t give details about specific bacteria. This is therefore a much more basic approach, often used to just measure pH changes throughout the cycle, rather than to identify any imbalance.
Testing can be particularly useful for those undergoing fertility treatment, experiencing recurrent implantation failure, or struggling with vaginal discomfort. If you feel that this may be helpful for you I recommend speaking with a qualified fertility specialist to discuss the most appropriate option.
How to Support a Healthy Vaginal Microbiome
1. Diet and Nutrition
What you eat directly impacts your microbiome, including the vaginal flora.
✔ Increase prebiotic-rich foods (garlic, onions, asparagus) to feed good bacteria.
✔ Consume probiotic foods (fermented foods like kefir, yoghurt, sauerkraut) to introduce beneficial bacteria.
✔ Reduce sugar and processed foods, which can feed harmful bacteria and yeast.
2. Lifestyle Practices
✔ Avoid douching and harsh soaps, as they disrupt the natural balance.
✔ Wear breathable cotton underwear and avoid synthetic fabrics.
✔ Use condoms if experiencing recurrent infections, as semen can temporarily raise vaginal pH, potentially antagonising the situation. You also don't want to be passing any infection between partners.
✔ Manage stress, as high cortisol levels can impact bacterial diversity.
3. Probiotics and Supplements
✔ Certain Lactobacilli strains are particularly beneficial for vaginal health, and research has shown that taking oral probiotics can influence the vaginal environment.
✔ Some vaginal probiotic pessaries can help restore balance directly.
NB. Use of probiotics and supplements is best guided by a trained practitioner.
4. Medical Support When Needed
If imbalances persist, it may be worth exploring targeted treatment options such as antibiotics (for BV) or antifungals (for recurrent thrush), sometimes combined with probiotics for long-term balance. Certain imbalances, such as with the bacterium ureaplasma, may require an antibiotic approach as natural antimicrobials and probiotics are not as effective in this case.
Should You Consider Your Partner’s Microbiome?
We often think of vaginal health as separate from male reproductive health, but the male partner’s microbiome can play a role too.
✔ Semen contains its own microbiome, which can introduce new bacteria into the vaginal environment.
✔ Men with an imbalanced microbiome (e.g., high levels of certain bacteria) may unknowingly contribute to recurrent infections in their partner.
✔ Male partners experiencing chronic inflammation or infections (like prostatitis) should consider microbiome testing and support.
If one partner keeps experiencing recurring infections, it may be worth investigating both microbiomes to break the cycle of imbalance.
To Sum Up...
Your vaginal microbiome is a key player in fertility, potentially influencing everything from conception to pregnancy outcomes. If you’ve been struggling with infections, discomfort, or unexplained fertility challenges, looking into your microbiome could be a missing piece of the puzzle.
If you’d like to learn my Top Ten Tips for how to support your vaginal microbiome, I’ve created a free resource that you can download. Grab it here.
📩 Feel free to reach out if you have any questions—I’d love to help!
Yours, Sarah
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