Changing bacterial mix may lead to painful sex after menopause

Lubricants with intercourse or vaginal moisturizers are considered first-line therapies for women with VVA symptoms. And when VVA is moderate to severe, low-dose estrogen in the vagina is the therapeutic standard. But these therapies have drawbacks. Some women, including certain cancer survivors, cannot use vaginal estrogen, and some women don't wish to use hormones. On the other hand, some lubricants or moisturizers may have detrimental effects on the bacterial mix or the vaginal lining or may even increase a woman's susceptibility to infction. So, alternative treatments such as probiotics will certainly be welcome.

Knowing just what bacterial mixes are healthy or unhealthy is the critical first step toward modifying the mix to treat the troubles. In their study of 87 women from 35 to 60 years old, the investigators found that distinct mixes were typical of the different stages of a woman's reproductive life and that a certain mix that becomes much more common after menopause was typical in the women who had VVA symptoms.

All these distinct mixes have types of Lactobacillus in them, a genus of bacteria typical in yogurt cultures and over-the-counter probiotics. When levels of Lactobacillus bacteria are low, the vagina tends to be dry. But the article's authors think that using products like these with lactobacilli that aren't native to an individual woman's vagina might do more harm than good. Personalized probiotics may be needed to treat or prevent VVA.

The article, "Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy," will be published in the May print edition of Menopause.