The vagina has a naturally acidic environment.  This acidic environment protects against many diseases including yeast infections, bacterial vaginosis, gonorrhea, chlamydia, and HIV infections. Although it is not 100% protective, it is a very important barrier against illness. The vaginal bacteria, not epithelial cells, are the primary source of lactic acid in the vagina (Hum Reprod. 2001 Sep;16(9):1809-13). 

Bacterial Vaginosis Common in U.S.Teens Low in Lactobacillus: In 89 female adolescents, the majority of lactobacillus species were H2O2-producing and predominated by Lactobacillus acidophilus. Bacterial vaginosis was present in 36% of adolescents and negatively correlated with the presence of vaginal lactobacilli. The majority of locally associated cytokines and antibodies were similar in those with or without BV or lactobacilli. Vaginal lactobacilli in adolescents: presence and relationship to local and systemic immunity, and to bacterial vaginosis. Alvarez-Olmos MI, Barousse MM, Rajan L, Van Der Pol BJ, Fortenberry D, Orr D, Fidel PL Jr. Tulane University. Sex Transm Dis. 2004 Jul;31(7):393-400

Trichomonas: L. Acidophilus Might Help: Type of Lactobacillus Might be Important: T. vaginalis infections of estrogenized young mice pretreated with Lactobacillus vaginalis or Lactobacillus rhamnosus were more frequent and persistent than those in mice pre-treated with Lactobacillus gasseri or Lactobacillus acidophilus. Am J Trop Med Hyg. 2000 Nov-Dec;63(5-6):284-9

Vaginitis due to Candida Markedly Reduced by Live Yogurt: A Long Island Jewish Med Center study of 21 women with recurrent vaginal candidiasis found that those assigned to eat live-culture yogurt daily had a dramatically lower rate of yeast infections: 0.4 vs. 2.5. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT. Ann Intern Med. 1992 Mar 1;116(5):353-7

Vaginosis: Yogurt, Boric Acid Help Treat Vaginal Candidiasis and Bacterial Vaginosis: A University of Washington review reports Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review. Van Kessel K, Assefi N, Marrazzo J, Eckert L. Obstet Gynecol Surv. 2003 May;58(5):351-8.

Vaginitis, Chronic: Alternative Treatments Common: In a survey of 105 women seeking medical attention for chronic vaginitis, 41.9%) had used alternative medicines, most frequently acidophilus pills orally (50%) vaginally (11.4%), yogurt orally (20.5%) or vaginally (18.2%), vinegar douches (13.6%), and boric acid (13.6%). 73% had also used over-the-counter medications for yeast. The authors demeaned such self-help efforts, calling them "unlikely to be of benefit." 29% had confirmed candidiasis, 10% bacterial vaginosis, 15% irritant dermatitis, and 17% vulvar vestibulitis. Temple Univ. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Nyirjesy P, Weitz MV, Grody MH, Lorber B. Obstet Gynecol. 1997 Jul;90(1):50-3

Vaginitis in HIV Patients Prevented as Well with Lactobacillus acidophilus as with Clotrimazole: In a randomized 21-month DB PC study of 164 HIV patients, weekly intravaginal clotrimazole and L. acidophilus tablet each markedly decreased yeast infections with the clotrimazole doing non-significantly better. Yale. Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV. Williams AB, Yu C, Tashima K, Burgess J, Danvers K. J Assoc Nurses AIDS Care. 2001 Jul-Aug;12(4):51-7. Ed: Eating yogurt daily would probably have a similar effect but at the same time accomplish many other useful purposes.

Vaginosis: Live Yogurt Intra-vaginally Cures Bacterial Vaginosis Quickly: In a Turkish study of 22 1st trimester pregnant women, 10 ml of a commercially available live Lactobacillus acidophilus yogurt introduced vaginally with a 10 cc syringe without a needle by the women themselves once a day for 7 days and again on the 14th day found that the symptoms of bacterial vaginosis were gone by the 3rd day in every women. 86% had none of the four classic symptoms (foul-smelling discharge, vaginal pH more than 4.7, presence of clue cells in the vaginal discharge, and foul odor caused by the addition of 10% potassium hydroxide to the vaginal discharge (i.e., positive amine test)) six weeks after starting treatment. Alternative treatment for bacterial vaginosis in pregnant patients; restoration of vaginal acidity and flora. Tasdemir M, Tasdemir I, Tasdemir S, Tavukcuoglu S Arch AIDS Res. 1996;10(4):239-41. Ed: The intra-vaginal approach of 2 teaspoons of live yogurt seems a much more direct, rapid, and efficient approach to establishing colonization of lactobacillus in the vagina than the oral approach. Others have used lactobacillus in tablet or suppository form have shown clinical efficacy as a treatment for vaginal infections.  Univ Washington. Am J Health Syst Pharm. 2001 Jun 15;58(12):1101-9.  However, live yogurt is much less expensive and is readily available.

Vaginosis: Standard Treatment Often Not Successful: In a STD clinic, the first-line treatment for bacterial vaginosis (BV) was oral Metronidazole 2 g single dose. Second line was Metronidazole 500 mg twice daily orally for 7 days or oral Clindamycin 300 mg twice daily for seven days. BV was confirmed in 74 women (15.4%). Most often it was observed in women aged 17-30 years of age. Thirty-three (44.6% of total) were young women 14-21 years of age. Thirty-one (42%) women received a follow-up examination and of those, 11 (38.7%) needed a repeat treatment for BV due to unsatisfactory results of this treatment. Effectiveness of current therapy of bacterial vaginosis. Andreeva PM, Omar HA. Int J Adolesc Med Health. 2002 Apr-Jun;14(2):145-8

Vaginosis: Metronidazole 2 g Slightly Better than Hydrogen Peroxide 20 cc: In a random assignment study of 140 women with vaginosis, cure rates were 78% for metronidazole vs 62% for intravaginal hydrogen peroxide one time. Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial. Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C. J Med Assoc Thai. 2003 Jun;86 Suppl 2:S379-84. Ed: Other research has found that hydrogen peroxide 30 cc intravaginally daily for seven days is very effective and almost certainly better than metronidazole.  The same is true of yogurt. Interestingly, Lactobacilli produce hydrogen peroxide.

Vaginosis: Live Yogurt Quick Cure, But Not for Trichomonas: In a small Japanese study of 11 women treated with a single 5 cc of live-culture yogurt intra-vaginally, in just three days all 14 types of gram-negative bacteria had been eliminated. 55% were cured, and 27% partially cured. Japan. Ecological treatment of bacterial vaginosis. Chimura T, Funayama T, Murayama K, Numazaki M. Jpn J Antibiot. 1995 Mar;48(3):432-6; One of the first published studies reporting live culture yogurt helping vaginitis notes that it did not help trichomonas vaginitis. S Afr Med J. 1975 Apr 12;49(16):675-6; The bactericidal effect of yogurt was mentioned as early as 1950. Am Pract Dig Treat. 1950 Dec;1(12):1252-9

Vaginosis: Treated Successfully with Yogurt Intravaginally: An Israeli study of 30 pregnant women with bacterial vaginosis found that intravaginal yogurt was a successful treatment. Bacterial vaginosis in pregnancy treated with yoghurt. Neri A, Sabah G, Samra Z. Acta Obstet Gynecol Scand. 1993 Jan;72(1):17-9; 

Vaginosis Linked to Tubal Infertility: In a study of vaginal smears of 749 women undergoing IVF stimulation for various types of infertility, women with tubal infertility were three times more likely to have bacterial vaginosis diagnosed by the smears than women with endometriosis, male factor or unexplained infertility. These findings support an association between BV, pelvic inflammatory disease (PID) and tubal damage. Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility. Wilson JD, Ralph SG, Rutherford AJ. BJOG. 2002 Jun;109(6):714-7; Ed: This study strongly suggests that women eating yogurt on a regular basis should be less likely to develop vaginosis and tubal infertility.

Vaginosis: Women More Likely to Get Infected with Gonorrhea or Chlamydia: In a study of the 255 female partners (ages 15-30) of men diagnosed with gonorrhea, chlamydia, or non-specific urethritis, the women with bacterial vaginosis were much more likely to be infected with gonorrhea (OR 4.1) or chlamydia (OR 3.4) than were female partners with normal hydrogen-peroxide producing lactobacillus vaginal flora. The authors conclude that normal vaginal flora create a barrier against STDs. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL.

Vaginosis: In a review, vaginosis has a strong decrease or lack of lactobacilli and a major increase in the following microorganisms: G. vaginalis, Mobiluncis spp., Bacteroides spp. (without B. fragilis), Peptostreptococcus spp., Mycoplasma hominis, Ureaplasma urealyticum. The condition is a predisposition to a disturbance of natural defense mechanisms and to a spread of infectious agents towards the upper female genital tract. The author holds that its treatment is important to avoid infertility. Akush Ginekol (Sofiia). 2002;41(4):35-9

Vaginal Flora: Lactobacillus Protect Against Pre-Term Deliveries: A prospective study of the vaginal flora in the second trimester in 1958 women with singleton pregnancies found that Lactobacillus species were not cultured from 28% of 118 women who delivered at < 33 weeks, 10% of 224 women who delivered between 33 and 36 weeks, and 5% of 1616 women who delivered at > 37 weeks of gestation. Lactobacilli (odds ratio OR: 0.15), Mycoplasma hominis (OR 2.3), and glucose non-fermentative gram-negative rods (OR 2.1) were identified as independent risk factors for preterm delivery at < 33 weeks of gestation. Absence of lactobacilli (sensitivity and positive predictive value: 28% and 25%) was a better predictor of preterm delivery at < 33 weeks of gestation than the presence of Mycoplasma hominis (7% and 13%, respectively) or glucose non-fermentative rods (9% and 11%). Vaginal lactobacilli and preterm birth. Usui R, Ohkuchi A, Matsubara S, Izumi A, Watanabe T, Suzuki M, Minakami H. J Perinat Med. 2002;30(6):458-66

Douching Increases Vaginosis: In a study of 1200 women at high risk for STDs, douching at least once per month was associated with an increased frequency of bacterial vaginosis. Those who douched recently (within 7 days) were at highest risk [odds ratio (OR) 2.1]. Douching for symptoms (OR 1.7) and for hygiene (OR 1.3) both related to bacterial vaginosis risk. The associations between douching and Gardnerella vaginalis, Mycoplasma hominis, and lack of hydrogen peroxide-producing lactobacilli were similar to those between douching and bacterial vaginosis. Gonococcal or chlamydial cervicitis was not associated with douching. Univ. Pittsburgh. Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Ness RB, Hillier SL, Richter HE, Soper DE, Stamm C, McGregor J, Bass DC, Sweet RL, Rice P. Obstet Gynecol. 2002 Oct;100(4):765

Thomas E. Radecki, M.D., J.D.

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