Table of contents:

1. Urinary versus genital tract
2. Which probiotics to use?
3. How do gynaecological probiotics work?
4. When to use a gynaecological probiotic?
5. Different types of probiotics
6. What is the difference in the action of the two forms of probiotics?
7. Errors in the selection of probiotics

The most common reason for patients' visits to gynaecological outpatient clinics is infections of the genitourinary system. Untreated diseases of this system can lead to many complications, including infertility, and can even be life-threatening.

Urinary system vs. genital system

Urinary tractinfections are infectious conditions that very often do not produce any specific symptoms, although not always. Clinical symptoms include:

• frequent urination,
• urgency,
• pain in the lower abdominal area with or without raised body temperature.

Diagnosis of the disease is made on the basis of the above-mentioned clinical symptoms, as well as by the results of laboratory tests in which the urine culture is positive.

Urinary tract diseases, photo: panthermedia

Risk factors for urinary tract infections include:

• older age,
• urinary stasis,
• urolithiasis,
• diabetes mellitus,
• vesicoureteral reflux,
• catheterisation,
• instrumentation in the urinary tract,
• immunosuppressive treatment.

In contrast, the most common cause of genital tract infections is infection with vaginal cysticercosis, Chlamydia trachomatis, Mycoplasma genitalium and hominis,Ureaplasmya species, Candia glabrata, albicans and crusei, and herpes virus (HSV I/II).

Among the genital symptoms can be noted:

• burning during urination,
• discharge,
• ulcers or the appearance of unusual sores and rashes on the genitals.

Untreated infections of this system can lead to diseases of the reproductive system, including infertility; they are also a significant risk factor for the health of pregnant women, as well as for the normal development of the foetus.

Which probiotics to use?

The infections described above include the use of gynaecological probiotics; however, due to the diversity in the composition of each woman's vaginal microflora, probiotic therapy needs to be individualised.

The decisive element for the use of a given probiotic, which should contain a minimum of two strains of bacteria populating the physiological vaginal microflora of a woman from a given population, is, among other things, the woman's origin from a given latitude. For example, in the microflora of the vaginas of Polish women, L . acidophilus, L. fermentum and L. plantarum predominate.

Giencological probiotics, photo: panthermedia

How do gynaecological probiotics work?

The purpose of probiotics is to multiply the population of microorganisms that are beneficial to the body and - secondarily - to stop the growth of unfavourable pathogenic microorganisms.

The use of a probiotic helps to restore and maintain the normal environment of the female vagina; this prevents bacterial and fungal infections. This is because, along with the probiotic, lactic acid bacilli are supplied to the body, which produce this acid, leading to the maintenance, along with other organic acids, of the normal vaginal pH.

The resulting acidic reaction of the vaginal secretions prevents the growth of most pathogenic microorganisms. Lactic acid bacilli also produce hydrogen peroxide, which has bactericidal properties, protease inhibitors, which have antifungal effects, and bacteriocins - acidophilin, lacticidin - which have bacteriostatic or bactericidal effects.

Gynaecological probiotics: how do they work, photo: panthermedia

When to use a gynaecological probiotic?

It is up to the gynaecologist to decide when and which probiotic to use, but it is worth knowing that the aforementioned probiotic treatment is recommended in the following cases. Factors negatively affecting the vaginal bacterial flora thus include:

• long-term antibiotic therapy,

• vaginal contraception, hormonal disorders,

• use of vaginal antibacterial or antifungal drugs,

• surgery performed on the genitourinary tract,

• poor intimate hygiene,

• poor diet, including a diet high in fat,

• smoking,

• immune disorders,

• use of hot tubs, swimming pools and public toilets,

• sexual activity with frequent change of partners.

Which gynaecological probiotic to use, photo: panthermedia

Different types of probiotics

Gynaecological probiotics can come in two forms:

• vaginal (globules, suppositories, gels, tampons or probiotic pads)

or

• oral (tablets).

The choice of form depends not only on the patient's preference, but also on the phase of the cycle - for example, oral probiotics and probiotic tampons or pads are recommended during menstruation.

What is the difference in the effect of the two forms of probiotics?

Oral probiotics offer double protection - they colonise the vagina, rectum and also the digestive tract with probiotic bacteria. However, it takes fourteen days for the bacteria to colonise the body; in contrast, the effects of a vaginal probiotic appear after just three days, directly at the site of administration.

Errors in the selection of probiotics

Despite the fact that the concept of probiosis dates back to the early 20th century and its development has been extremely rapid, knowledge on the subject is still incomplete, which is why gynaecologists still make mistakes when selecting probiotics for a specific clinical purpose.

When choosing a probiotic, doctors should pay particular attention to:

• strain identification (three-part name),

• the human origin (dairy or even soil origin),

• the isolation from the target site where the probiotic should act,

• origin from the target population,

• adaptation of the probiotic to the flora of the target population,

• the form (live strains or lysate/liophilisate),

• clinical trials (proven efficacy, obtained preferably in the Polish population),

• adaptation of the route of administration to the expected clinical effect.

Currently, in the modern probiotic strategy in gynaecology and obstetrics, it is recommended to use a vaginal and an oral route of administration of probiotics simultaneously, which increases the effectiveness of the therapy.