A pair of underwear with a pH test strip kit

The Vaginal Microbiome

We’ve all had moments when we know things just aren’t right in our vaginas.

I have a good friend who is a urogynecologist. She is known as Captain Vagina and talks about something called the “vaginal microbiome”. This refers to the magical underworld of our vaginas and what needs to happen in order for us to have a healthy environment of organisms within.

What is vaginal pH?

Research tells us that the ideal pH of the vagina should be acidic. That pH can be thrown off by just about anything: the use of oral birth control, detergents on our clothing, vaginal washes with flowery scents or good, old-fashioned stress.1

The other thing that I have noticed anecdotally is that the higher the muscle tension of the pelvic floor, the more that unwanted organisms or the wrong pH environment get to fester within the vagina.

Recurrent yeast infections, bacterial vaginosis, and chronic UTI’s are all signs that the delicate balance of the vaginal microbiome is out of whack. For many people, these conditions are unabating and persist over time, despite pharmaceutical treatments touted to cure them.

This leads to discomfort in the vagina and surrounding tissues as well as a change in vaginal odor.

If you’ve been to see a doctor with a yeast infection or bacterial vaginosis, you know what they will prescribe to help you eradicate these problems. We need these specialists to rule out other infections like STI’s, so it is important to consult with one and not go all rogue with our own treatments.

pH treatments that aren't working

But what happens when the prescription treatments for yeast infections, bacterial vaginosis or UTI’s are not working? What is driving this persistent imbalance of the vagina?

My good friend Captain Vagina has educated me on why these organisms continue to thrive in certain women. She has also given me ideas on what to tell my patients to address vaginal odor and discomfort with a few simple remedies.

Finding the correct pH

The ideal vaginal pH should hover around 4. Women with bacterial vaginosis have an elevated pH of 7 or higher (less acidic).1

This tells us that the “bad” bacteria which are causing the infection are having a blast in the vagina that is at a higher pH. Rather than taking repeated antibiotics to treat the bacterial vaginosis, another way of addressing it would be to restore the acidic environment.

How can we do this?

Boric Acid suppositories
Boric acid can be purchased and inserted within the vagina. There is one study that followed women with recurrent bacterial vaginosis and found that their symptoms were decreased by the use of boric acid suppositories over the span of 13 months. Few adverse effects were noted with this treatment.2Vaginal Washes

Soap is typically an alkaline substance. Even if you are using a fragrance free version, you’ll still be putting something alkaline close to the vagina when washing.

Look for a vaginal wash with an acidic pH between 3-4 to prevent disruption to your vaginal microbiome. Avoid anything with fragrance.


Another study found that the presence of lactobacilli, a “good” bacteria, resulted in improved vaginal pH. The study also suggests that the use of probiotics, combined with an acidic pH in the vagina, provided multiple defense mechanisms to prevent against infection of the female genital tract.3

Captain Vagina believes that making a paste of a probiotic with a little bit of water and smoothing it within the vagina can rebalance this “good” bacteria, which can then fight against the “bad” bacteria and result in a healthy microbiome without the use of prolonged antibiotics.

Sleeping without undies and vaginal hygiene

This is my final tidbit from a pelvic floor standpoint. Wearing underwear and clothing all day, prolonged sitting, and high levels of stress are going to tighten those pelvic floor muscles. This is going to prevent that wondrous garden of the vaginal microbiome from flourishing because there isn’t enough breathing room for the right things to grow and the unfavorable things to be sloughed off.

Taking off underwear at night can be a game-changer for women with these unrelenting symptoms. Combined with the above ideas, it can be possible to manage vaginal hygiene with fewer doctor’s visits.

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