When it comes to gynaecological symptoms we don’t feel comfortable talking about openly, the strong fishy smell associated with bacterial vaginosis is definitely up there. Bacterial vaginosis – or BV – is the most common vaginal infection, with symptoms including a greyish-white, watery discharge and unpleasant fishy odour. It’s not sexually transmitted and half of those affected don’t have any symptoms, but it can cause complications in pregnancy. And despite the fact that as many as one in three of us will get BV at some point in our lives, it’s still badly understood and notoriously difficult to treat.
Research published last week could be a game-changer though. Scientists at Johns Hopkins University in the US have taken the first step towards using vaginal fluid transplants as a potential new treatment option for BV. Inspired by the successful use of faecal microbiota transplants (FMT – or poo transplants, to you and me) to treat gut problems, the idea behind vaginal microbiota transplants (VMT) is effectively to ‘reset’ the balance of bacteria inside the vagina, using ‘good’ bacteria from donors’ vaginal fluid (or mucus).
Balancing vaginal bacteria
What exactly is the scientific explanation behind this? “The vaginal microbiome is fascinating. Bacteria reside within the mucus that’s secreted by the vaginal tract and, in the healthy state, you essentially have a monoculture of [protective] lactobacillus bacteria,” explains researcher Dr Laura Ensign, who is also co-author of the paper. “That’s completely unique compared to [the microbiomes of] your gut and your skin, where the community of bacteria is very diverse. In the vagina, the dominance of these lactobacillus bacteria keeps the vaginal pH acidic, and that’s how you keep other [bad] bacteria out.”
I have a very understanding partner, who tries to reassure me, but I’m extremely aware of my symptoms, which can put me off having sex as it really affects my self-esteem. I’m so embarrassed by it.Vicky*, Support Worker
Bacterial vaginosis, she explains, is a blanket term for that vaginal microbiome being out of whack – instead of being dominated by ‘good’ lactobacillus bacteria, it’s made up of any other combination of bacteria.
Currently BV is treated using antibiotics – either taken orally or applied to the vagina in a gel or cream. The problem, as the Johns Hopkins researchers point out, is that existing BV treatment isn’t “curative or restorative” – while antibiotics may treat the harmful bacteria, they don’t create a protective environment to prevent them from coming back. As a result, Dr Ensign says, up to 70% of women experience a recurrence of BV. Oh, and the antibiotics used to treat BV can also cause thrush, just in case that recurrent cycle of infection wasn’t frustrating enough already.
Vaginal fluid transplants, on the other hand, would work by introducing ‘good bacteria’ from a healthy woman’s vaginal mucus. Those bacteria should then take over and become dominant in the recipient’s microbiome, suppressing the other, harmful bacteria.
Healthy vaginal fluid would be self-collected by donors using a flexible plastic disc, similar to a menstrual cup or contraceptive diaphragm, and the recipient could then insert it herself using an applicator, similar to putting in a tampon. What researchers now need is funding and approval to trial the technique.
“I’ve resigned myself to life with BV”
If clinical trials are successful, vaginal fluid transplants could prove to be an absolute godsend for women like 28-year-old support worker Vicky*, who’s lived with recurrent BV for more than two years. “Having BV makes me very self-conscious, not only during sex – especially when my partner performs oral sex – but also during everyday activities. At work I’m required to be on the move quite a lot, or work long hours, which aggravates the condition,” Vicky says.
“I’m very aware that my underwear can become quite damp. I have to wear panty liners, which need to be changed regularly, but this doesn’t help to tackle the unpleasant odour, which I’m constantly aware of. I’m worried people will think I have poor hygiene, or that I have a sexually transmitted infection,” she adds. “I have a very understanding partner, who tries to reassure me, but I’m extremely aware of my symptoms, which can put me off having sex as it really affects my self-esteem. I’m so embarrassed by it.”
Like many women, Vicky has struggled with treatments for her BV. “I’ve tried antibiotics multiple times – including metronidazole, which in turn causes thrush – and usually this works for a couple of days before my symptoms return. I was also given a cream to treat BV internally, and reassured that this would be really effective, but again my symptoms recurred almost immediately,” she says.
After two years of treatment trial and error, Vicky says: “I’m at my wit’s end. I’ve given up on going to the doctor for further treatment, and I’ve resigned myself to life with BV as no treatments have worked, not even in the short term.”
But she adds: “It’s heartening to hear that progress is being made in the US, and I’m excited to hear about how vaginal fluid transplants could help. It sounds like a very straightforward, pain-free procedure, and at this stage I would be prepared to try anything. I hope that if trials in the US are successful then similar studies will take place in the UK – I’d definitely put myself forward if it means I can be BV-free. This would be a massive boost to my self-esteem and confidence.”
BV makes you disconnect from your vagina, and sex, and you become completely obsessed about the smell. I do speak to women who are constantly getting it, going on antibiotics, getting thrush.Samantha, Sexual Health Nurse
“I whacked probiotic yoghurt up there on a tampon”
Samantha Evans, sexual health expert, former nurse, and founder of online sex toy store Jo Divine, suffered from recurrent bouts of both thrush and BV during her 20s and 30s – in her case triggered by the ingredients in her lubricant.
“I’m 51 now, but in my 20s and 30s I suffered from infections over a 10-year period, before there were over-the-counter treatments. I was a nurse but I didn’t have a clue about BV. I’d buy probiotic yoghurt from my local health store and whack that up there on a tampon, because I had this vague idea that it would restore [the bacteria], but that probably didn’t do any good either,” she says.
Today, Samantha regularly hears from customers affected by vaginal infections, and is passionate about ensuring women understand how the products they’re putting in their vagina – like feminine hygiene washes and douches – can affect its delicate pH and bacterial balance, causing or aggravating issues like BV.
“BV makes you disconnect from your vagina, and sex, and you become completely obsessed about the smell. I do speak to women who are constantly getting it, going on antibiotics, getting thrush,” she says. “Then they’re desperate, and buying any old intimate hygiene product to get rid of the smell, which then exacerbates or masks the problem. This is really exciting research, and the transplants would be utterly amazing to help women break out of that cycle.”
Beyond bacterial vaginosis
While trialling vaginal fluid transplants for BV is the next step for researchers, Dr Ensign says there’s also scope to use VMT in the treatment of other conditions, like recurrent urinary tract infections and yeast infections.
“There are also indirect implications for vaginal microbiota and preterm birth, and rarer conditions like pelvic inflammatory disease or other types of sexually transmitted infections. Or really, in any case where a woman has to take antibiotics for any reason, if there’s a resulting alteration of the vaginal microbiome that you need to reset,” she says.
Further down the line, it could also feed into emerging research looking at the links between the vaginal micobiome and gynaecological cancers. “If you could reset someone’s [vaginal] microbiome as a young adult, would that end up affecting their cancer risk later?” Dr Ensign asks. “As we start to learn more about the links, there are very interesting questions to look at.”
*Name has been changed
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