Do You Know The State Of Your Vagina’s Microbiome? Here’s Why It Matters

We all know people who are stable as rocks: they lose their jobs, break up with their partners, and crash their cars, yet they remain steady and calm. (I am not one of these people, but I know they exist.) On the other hand, there are people who are barely holding it together, where you know any tiny stressor might just push them over the edge.

Vaginas are like this too. A resilient vagina can take multiple insults, and its microbiome quickly recovers to its usual state. However, for a fragile vagina, even a small insult like semen or menstrual blood can push it into a state of chaos. (Note that vaginal resilience does not appear to be related to emotional stability. You can be a hot mess and have a vagina of steel.)

Many forces can affect the resilience of the vagina, and one of the most powerful of these is estrogen. Lactobacillus thrive when estrogen is most plentiful, typically during the decades after puberty and before menopause. When perimenopause strikes, the roller coaster of waxing and waning estrogen levels doesn’t just cause hot flashes and changes in bleeding. This hormonal instability can result in declines in Lactobacillus, placing a previously stable vagina in a more vulnerable state.

This isn’t just a women’s issue. When transgender men begin testosterone therapy, estrogen levels in the vagina plummet, and the vaginal microbiome transitions toward a menopausal state. So just when transgender men might be enjoying the masculinizing effects of testosterone, they may face more vaginal troubles than they did before they began their hormonal transition.

Once menopause has fully set in, the vaginal community changes yet again. Without estrogen, the vagina’s surface thins out and becomes drier. Its tissues produce less glycogen, which means less food for Lactobacillus species. And it’s not just Lactobacillus that moves out of the neighborhood—the BV-associated bacteria often do too. A vagina once crowded with bacterial inhabitants becomes more deserted after menopause.

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