A few months ago, I had a 57-year-old executive who'd been going through what felt like an endless cycle of recurring infections and unexplained pelvic discomfort.
Women everywhere need this valuable resource for their reproductive health and general wellbeing.
Just a question or two:
Do feminine products like tampons and pads disrupt lactobacillus health? Are there correlations with athletes who use these products (tampons) when competing? With adrenaline rising during athletic competitions, does that increase the risk?
I read you said estrogen feeds lactobacillus but does progesterone starve it?
Thank you for this valuable insight and education in women’s health
Nice systems health thinking behind these questions.
Tampons/Pads:
The latest research is reassuring here. A 2023 randomized clinical trial of 89 women found that tampons don't significantly disrupt Lactobacilli populations for most users. While I still prefer organic cotton products to minimize chemical exposure, I would avoid those with added chemical scents.
Athletes & Competition Stress:
There is no direct evidence linking tampon use during athletic competition to increased microbiome disruption. Acute adrenaline surges during competition don't appear to directly disrupt Lactobacillus either, though intense exercise may influence the microbiome through broader immune and hormonal changes. If stress induces chronic cortisol release, that will suppress the immune system.
Progesterone vs. Estrogen:
Estrogen clearly supports Lactobacillus abundance and microbiome stability. Progesterone, however, may actually reduce Lactobacillus populations and appears negatively associated with vaginal glycogen levels, and that glycogen is food for Lactobaillus.
Chlorine has antimicrobial properties that can disrupt beneficial Lactobacilli.
Chlorine doesn't distinguish between harmful pathogens and protective Lactobacilli and pool chemicals alter local pH when they come in contact with vaginal tissues. Not to mention the mix of other bacterial contaminants from other swimmers.
When I was a young man, I went down on a woman, and the smell made me change my mind so we went straight to intercourse. After she had experienced powerful orgasms and the final superpowerful one, I smelled something wonderful between her legs. So I think regular orgasms are essential too.
I "liked" the article based on the title alone. Now I'm going to read it in-depth, slowly. This is the first article I have ever seen on this topic. I'm 62 years old and my gyno is the first doctor who brought this topic up for me this spring at my annual after discussing some issues I've been having. She's the first who ever tested my vaginal microbiome and the results showed that I have an imbalance of bad to good. I have had a few episodes of SIBO which is also a condition of imbalance. Luckily I have an excellent gastro doctor who didn't downplay my symptoms and actually treated it. I haven't done anything to rebalance my vaginal imbalance yet due to eldercare issues that cropped up about the time I got my own health results. Now I've got some time to get back to taking care of my own health. I'm quite sure your article is going to have me actually address it now.
Thank you so much for sharing your experience and for your openness. It means a lot to hear that this article resonated with you and may help you take the next steps for your health. You’re not alone, many women only learn about the vaginal microbiome later in life, and it’s encouraging to see more doctors addressing it.
Having fully read the article now, I can see that extreme stress is most likely what was causing my issues at the time. I was too busy to even notice that my body self-corrected as my stress levels declined. I never did get the probiotics recommended by my doctor for vaginal health but I’ll look into it for maintenance.
I’m on BHRT. Have been for a couple of years. Mainstream doctors don’t seem to think women should use BHRT or even standard hormones unless it’s for hot flashes and other perimenopause symptoms. My doctor is using it to ward off some of the potential health downsides of menopause like osteoporosis and heart disease. What is your view of when and how long one should be on BHRT? I’m in excellent health but have a family history of osteoporosis, heart disease, and dementia.
There is no convincing evidence that women should universally stop bioidentical hormone replacement therapy (BHRT) after 10 years. The decision to continue or discontinue BHRT should be individualized, based on a woman’s symptoms, health status, risk factors, and personal preferences.
Thank you for the article, very informative and educational. I’ve never had an OB/GYN mention or discuss this at any depth with me. I’ve shared this with my 25 year old daughter and a friend with girls of the same generation.
I do have a couple questions, what is the connection between vaginal microbiome and UTIs? Daughter developed UTI on honeymoon in Italy (treated there), but has had recurrences in the 14 months since then. She is diligent to urinate after sex, but hasn’t totally avoided reoccurrence. An article on suggested treatment and biome management would be greatly appreciated. Also have female family member who has urinary interstitial cystitis any insight, guidance orarticle on that condition would be greatly appreciated.
I'm grateful you found the article valuable. Unfortunately, no OB/GYN has discussed this with you, reflecting the massive gap in conventional medical reductionism and the treat the symptom mentality.
Your daughter's situation is a perfect, albeit frustrating, example. Here's what likely happened:
When your daughter developed that initial UTI and received antibiotic treatment, those antibiotics didn't just kill the harmful bacteria causing the infection - they decimated her protective Lactobacilli. This created the perfect setup for recurrent infections.
The protective barrier was destroyed, and the pH became more alkaline. The ecosystem never fully recovered, and eac subsequent antibiotic treatment further disrupts the microbiome.
Urinating after sex helps, but doesn't address the root causes.
My protocol with my clients in this situation
• Microbiome testing (like Evvy) to see what’s colonizing her ecosystem
• Probiotic restoration with vaginal-specific strains
• Maybe boric acid suppositories to help restore pH balance and mannose supplementation, which can prevent E. coli adherence to bladder walls
The interstitial cystitis is an entire post of its own and will address it in the near future.
Many thanks for your response and original article; it was very informative and well written i.e., was not dumbed down, or written at the medical research publication level which is beyond most of us that are not medically trained.
Look forward to the interstitial cystitis article…relative has suffered with illness and various medical treatments for years, with no long term improvement and certainly not a cure.
This article is fantastic
Women everywhere need this valuable resource for their reproductive health and general wellbeing.
Just a question or two:
Do feminine products like tampons and pads disrupt lactobacillus health? Are there correlations with athletes who use these products (tampons) when competing? With adrenaline rising during athletic competitions, does that increase the risk?
I read you said estrogen feeds lactobacillus but does progesterone starve it?
Thank you for this valuable insight and education in women’s health
Nice systems health thinking behind these questions.
Tampons/Pads:
The latest research is reassuring here. A 2023 randomized clinical trial of 89 women found that tampons don't significantly disrupt Lactobacilli populations for most users. While I still prefer organic cotton products to minimize chemical exposure, I would avoid those with added chemical scents.
Athletes & Competition Stress:
There is no direct evidence linking tampon use during athletic competition to increased microbiome disruption. Acute adrenaline surges during competition don't appear to directly disrupt Lactobacillus either, though intense exercise may influence the microbiome through broader immune and hormonal changes. If stress induces chronic cortisol release, that will suppress the immune system.
Progesterone vs. Estrogen:
Estrogen clearly supports Lactobacillus abundance and microbiome stability. Progesterone, however, may actually reduce Lactobacillus populations and appears negatively associated with vaginal glycogen levels, and that glycogen is food for Lactobaillus.
Thank you!
Background, college athlete many years ago. Had some friends with issues such as vaginitis.
Another background-swimming and diving athletics.
Wondering about pool effects chlorine, and other contaminats in the pool.
Chlorine has antimicrobial properties that can disrupt beneficial Lactobacilli.
Chlorine doesn't distinguish between harmful pathogens and protective Lactobacilli and pool chemicals alter local pH when they come in contact with vaginal tissues. Not to mention the mix of other bacterial contaminants from other swimmers.
Thanks Dr. Stickler. Your in-depth report is very helpful. I'm wondering where i can find more information on berberine & vaginal balance?
Here is an article that has some info on that https://aliveda.com/en/the-antimicrobial-properties-of-berberine-and-its-role-in-urogenital-health/
Thank you!
When I was a young man, I went down on a woman, and the smell made me change my mind so we went straight to intercourse. After she had experienced powerful orgasms and the final superpowerful one, I smelled something wonderful between her legs. So I think regular orgasms are essential too.
I "liked" the article based on the title alone. Now I'm going to read it in-depth, slowly. This is the first article I have ever seen on this topic. I'm 62 years old and my gyno is the first doctor who brought this topic up for me this spring at my annual after discussing some issues I've been having. She's the first who ever tested my vaginal microbiome and the results showed that I have an imbalance of bad to good. I have had a few episodes of SIBO which is also a condition of imbalance. Luckily I have an excellent gastro doctor who didn't downplay my symptoms and actually treated it. I haven't done anything to rebalance my vaginal imbalance yet due to eldercare issues that cropped up about the time I got my own health results. Now I've got some time to get back to taking care of my own health. I'm quite sure your article is going to have me actually address it now.
Beth,
Thank you so much for sharing your experience and for your openness. It means a lot to hear that this article resonated with you and may help you take the next steps for your health. You’re not alone, many women only learn about the vaginal microbiome later in life, and it’s encouraging to see more doctors addressing it.
Having fully read the article now, I can see that extreme stress is most likely what was causing my issues at the time. I was too busy to even notice that my body self-corrected as my stress levels declined. I never did get the probiotics recommended by my doctor for vaginal health but I’ll look into it for maintenance.
I’m on BHRT. Have been for a couple of years. Mainstream doctors don’t seem to think women should use BHRT or even standard hormones unless it’s for hot flashes and other perimenopause symptoms. My doctor is using it to ward off some of the potential health downsides of menopause like osteoporosis and heart disease. What is your view of when and how long one should be on BHRT? I’m in excellent health but have a family history of osteoporosis, heart disease, and dementia.
There is no convincing evidence that women should universally stop bioidentical hormone replacement therapy (BHRT) after 10 years. The decision to continue or discontinue BHRT should be individualized, based on a woman’s symptoms, health status, risk factors, and personal preferences.
Thank you for the article, very informative and educational. I’ve never had an OB/GYN mention or discuss this at any depth with me. I’ve shared this with my 25 year old daughter and a friend with girls of the same generation.
I do have a couple questions, what is the connection between vaginal microbiome and UTIs? Daughter developed UTI on honeymoon in Italy (treated there), but has had recurrences in the 14 months since then. She is diligent to urinate after sex, but hasn’t totally avoided reoccurrence. An article on suggested treatment and biome management would be greatly appreciated. Also have female family member who has urinary interstitial cystitis any insight, guidance orarticle on that condition would be greatly appreciated.
I'm grateful you found the article valuable. Unfortunately, no OB/GYN has discussed this with you, reflecting the massive gap in conventional medical reductionism and the treat the symptom mentality.
Your daughter's situation is a perfect, albeit frustrating, example. Here's what likely happened:
When your daughter developed that initial UTI and received antibiotic treatment, those antibiotics didn't just kill the harmful bacteria causing the infection - they decimated her protective Lactobacilli. This created the perfect setup for recurrent infections.
The protective barrier was destroyed, and the pH became more alkaline. The ecosystem never fully recovered, and eac subsequent antibiotic treatment further disrupts the microbiome.
Urinating after sex helps, but doesn't address the root causes.
My protocol with my clients in this situation
• Microbiome testing (like Evvy) to see what’s colonizing her ecosystem
• Probiotic restoration with vaginal-specific strains
• Maybe boric acid suppositories to help restore pH balance and mannose supplementation, which can prevent E. coli adherence to bladder walls
The interstitial cystitis is an entire post of its own and will address it in the near future.
Dr. Stickler,
Many thanks for your response and original article; it was very informative and well written i.e., was not dumbed down, or written at the medical research publication level which is beyond most of us that are not medically trained.
Look forward to the interstitial cystitis article…relative has suffered with illness and various medical treatments for years, with no long term improvement and certainly not a cure.
God bless You!!
Sincerely,
Laura Coleman
Good article Dan.