nikaLIVE: How to deal with intimate infections?

The health of the urogenital system is inextricably linked to the rest of our body. It is a two-way relationship. On the one hand, the health of other organs and systems affects how often we have vaginal and urinary tract infections. On the other hand, recurrent intimate infections may lead to serious complications or be dangerous, for example, if we are planning a pregnancy. How to take care of your overall health to prevent intimate infections and urinary tract infections, was told on nikaLIVE by Anna Bartnicka, M.D. , Ph.D., dietitian, laboratory diagnostician, who has been researching the topic of microbiota for 13 years, propagating knowledge about intestinal health and probiotics (on Instagram @dr_anna.bartnicka ). You can listen to the recording of this conversation at this link .

Looking at the products advertised on TV and those found in pharmacies and drugstores, one may get the impression that intimate infections are a plague, or maybe even an epidemic, nowadays. Are these diseases really becoming more and more common?

Anna Bartnicka, MD: Indeed, the media shows us this all the time and suggests that there is demand - there is also supply. In fact, I observe that the frequency of intimate infections is increasing. Paradoxically, this is caused by excessive hygiene of life, and not, as it might seem, too little hygiene. Not only in terms of intimate hygiene, but also the broadly understood hygienization of life, for example: eating only "sterile" food , highly processed, with a small amount of pickled products and fermented products; living in urban agglomerations, lack of contact with nature, animals, and often - other people. This excessive hygienization of our lifestyle leads to a reduction in the diversity of intestinal bacteria and, consequently, an increase in the risk of intimate infections. These infections are important for our health. In the long term, they may cause problems with getting pregnant, the ability to maintain the pregnancy, as well as obstetric complications. Thank you very much for discussing this topic, because it is extremely important!

And what exactly is the relationship between our diet and the development of potential intimate infections?

This is a very common question and the connection is very close. Patients do not understand, for example, why they should take oral probiotics for intimate infections and eat appropriately and take care of their digestive system. We must realize that the element that unites all these topics will be the mucous membranes. What happens on the mucosa of the digestive system, in the intestines, translates into the health of other mucosa in our body - for example those in the urogenital system. Gut microbiota , those beneficial bacteria in our digestive system, influence our entire immune system . First of all, mucosal immunity in the form of secreted IgA - immunoglobulin present on the surface of mucous membranes. Its appropriate level makes the mucous membranes more resistant to infectious agents. In order for sIgA to be produced in the right amount, we must have these "good bacteria" in our intestines. Therefore, how we nourish our intestinal bacteria and what microbiota we have will be reflected in the health of our mucous membranes , regardless of whether we are talking about the upper respiratory system or the urogenital system. That's why our lifestyle, our diet and whether we take care of our intestines or not are so important .

If we are talking about urinary and genital infections, are their causes common? Do, for example, cystitis and vaginal mycosis result from the same reasons?

Most of the factors are common. Although both problems concern two different systems in our body, many of the causes actually overlap . The common denominator will again be the mucosa and the related issue of intestinal microbiota , which in this case is the key issue of the immune system. But not only microbiota and diet are important here. The same applies to stress, which we often underestimate and downplay its impact on our health. When stress is permanent , it has a very destructive effect on our intestinal microbiota, and therefore leads to a weakening of the mucous membranes' immunity. Hormonal disorders , which we observe more and more often, as well as carbohydrate metabolism disorders , which means we go back to the diet. Consuming mainly simple sugars and saturated fats. The underwear we wear is also important . It is best if it is cotton and airy. Of course, intimate hygiene is also very important here.

So what type of prevention is worth introducing and how frequent should intimate hygiene be? Yes, to take care of yourself, but not to overdo it.

What I said at the beginning is important here - excessive hygiene can also be harmful to us. The vaginal environment, just like the intestines, has its own microbiota. It is dominated by lactic acid bacteria , i.e. bacteria of the Lactobacillus genus . Intimate infections may be related to a deficiency of these protective lactic acid bacteria. For this reason, vaginal irrigation is a procedure that absolutely should not be performed because it flushes out these bacteria (unless there are serious medical indications for irrigation, which is extremely rare). I do not recommend introducing a stream of water into the vagina, but rather focus on washing the labia majora - i.e. the body from the outside. Never try to wash the vagina from the inside , it is completely unnecessary for our body. Thanks to such treatments, we get rid of our natural immunity. In the case of the vaginal environment - lactobacilli are responsible for generating the appropriate pH thanks to the production of lactic acid. Our vaginal pH should be 3.8 – 4.2. This is a very acidic environment, which does not favor infections and prevents the multiplication of pathogenic bacteria and fungi. In the case of washing out lactobacilli, we deprive our vaginal microenvironment of a basic element for building immunity.

Do we have to choose intimate hygiene fluids that have a lower pH?

Exactly. We are talking about vaginal pH - this environment is an acidic environment . However, when we talk about our skin and the labia majora, it is different. Human skin has a pH higher than the vaginal environment. During puberty, girls are often ashamed of this changing body odor, but I warn you - we should not use perfumed intimate hygiene products. This can burden our mucous membranes even more and irritate them, leading to e.g. allergies. When buying an intimate hygiene liquid, we should choose one that has a pH close to the pH of our skin - about 5-6 . Any alkaline soap that has a pH of 8-11 will cause severe drying. We apply the liquid on the skin - the external area of ​​the intimate organs. The vagina inside does not need washing. In fact, we don't have to use intimate hygiene fluid, we can use ordinary soap that has the right pH for our skin. Let's pay attention to the composition and whether the ingredients used in production are as natural as possible and not perfumed. Let's make sure we don't dry out the vaginal environment , as this will certainly lead to infections.

Is liquid or soap even necessary? I see an increasing range of intimate hygiene products on store shelves - gels, wipes, liquids, sprays. Several dozen years ago, women did not have access to such preparations, and the incidence of intimate infections was not so common. Isn't water alone able to provide us with complete intimate hygiene?

In most cases this is enough. If someone needs or likes to have a separate liquid for intimate hygiene and a separate one for the body, remember to read the ingredients so that such a product does not disturb the natural bacterial environment. But if we don't have such a need, our body soap should also meet these standards. The vagina has a very high self-cleaning capacity, so in the absence of permanent diseases or doctor's recommendations - water alone is enough .

You mentioned maturing teenagers, but today it happens that mothers buy special intimate hygiene fluids even for their babies. Is this necessary? Is there a certain age for girls when we should start taking special care of our intimate areas?

When it comes to early start taking care of our daughters' intimate health, we should teach them not so much about the correct selection of the product, but about the technique of intimate hygiene . For example, to avoid transferring bacteria from the anus to the vaginal area. When it comes to special preparations for girls, it is pure marketing . Before a girl enters puberty, her vaginal pH is identical to that of her skin. Until a girl's body starts producing estrogen, her microbiota is completely different than that of a menstruating woman. Estrogens are necessary for the life of Lactobacillus bacteria and, therefore, for the formation of lactic acid, which acidifies the vaginal environment . Therefore, let's educate about intimate health as a whole: focusing on washing techniques, wearing appropriate underwear, and the frequency of hygiene. It is better to invest in a good diet, supplements and, if necessary, probiotics and avoid excessive hygiene.

Let's expand on the topic of diet - you mentioned that we need to "well feed" our intestinal bacteria so that they can protect us against infections. Do we need to eat any special foods to ensure that the bacteria function well? Is simply a healthy, balanced diet enough here?

First of all, fiber will be key here. For our intestinal microbiota to be in good condition, we must give it the best possible food - fiber . An ingredient that we don't digest is a feast for our gut bacteria. Thanks to our consumption of vegetables, fruits, seeds, seeds and cereal products , these bacteria function properly and can produce short-chain fatty acids, primarily butyrate . It is a source of energy for intestinal cells. In this way, our diet influences the reconstruction of the tightness of the intestinal barrier and its maintenance. When the immune system associated with the intestine works properly , all mucous membranes in our body are immune. Another issue here is the supply of polyphenols , which are also excellent food for the microbiota. The current summer season is conducive to providing polyphenols in food - eating all berries helps us in this process. Of course, an anti-inflammatory diet is important , i.e. rich in unsaturated fatty acids, especially Omega-3. It is worth taking supplementation, because unfortunately when it comes to dietary sources of Omega-3 acids, their quality leaves much to be desired. It is important to provide yourself with the appropriate amount of vitamin D3 while monitoring this ingredient in the blood, because as a population we are deficient in this vitamin.

I would also like to talk about probiotics. You mentioned that taking probiotics, even orally, affects the vaginal microbiota. But there are also many strictly vaginal preparations that contain lactobacilli. Are they ineffective?

Preparations and the way of taking them depend on the intentions - whether we use them preventively or to fight recurrent infections. I recommend the use of oral probiotics as a preventive measure . Thanks to them, we will take global care of our body. In case of recurring problems, it is worth combining these two types of taking probiotics for a specific period of time, with breaks and under the supervision of a doctor. Let's not forget about vaginal preparations, because they provide long-term effects . I have also come across tampons containing probiotics - they are also good. However, I am a fan of oral or vaginal supplementation with the possibility of measuring the amount of delivered substances. In the case of hygiene products such as tampons, sanitary pads or pads, we also have to pay attention to the composition and origin - just like when choosing a liquid.

Can menstrual hygiene products of questionable quality also disturb the proper functioning of the vaginal microbiota?

Exactly. Unfortunately, when it comes to menstrual hygiene products, the manufacturer is not obliged to precisely present the composition and origin of the ingredients from which they are made. Tampons and pads may be bleached with chlorine, which is a toxin . As a result, chlorine will not only disturb the functioning of the microbiota , but also accumulate in our body . If we use these products every month, they will certainly cause allergies and deepen existing problems. Let's choose products made of organic cotton , let's check what these products are wrapped in - plastic is ubiquitous, and bisphenol A contained in it is an endocrine-active compound, i.e. it affects the condition of our body. Better to avoid it. Therefore, by menstruating for many years and using toxin-laden hygiene products every month , we unknowingly endanger our health.

Will sanitary pads be a better choice for people who struggle with recurrent infections? Does giving up inserting a tampon inside the body have a chance to eliminate permanent problems in this area?

Certainly in the first stage of therapy – yes. However, our psyche is also important here. Let's choose products that give us the greatest sense of confidence during our period. First of all, we must pay attention to the quality of these products . This will be a very big step in terms of prevention.

We have already mentioned hygiene, diet, supplementation, and the quality of hygiene products. Are there any other ways to reduce the risk of infection? Or if these infections keep recurring, are there other types of actions we can implement?

Moderate physical activity will certainly have a positive impact on the condition of our microbiota. But I will come back to medical activities in this area - let's look for the cause of the infection . Very often we receive an antifungal or antibiotic from a doctor, without examining the cause of the problem. When it comes to fungal infections, studies say that 75% of women will have such an infection at least once in their lives . This is normal and does not result in any major problems if it happens only once. However, if these infections recur, we feel constant discomfort, stinging, itching, we struggle with vaginal discharge that is not the same as natural vaginal discharge (discharge usually has an unpleasant odor, a changed consistency of the discharge), this indicates that the problem is chronic. Let's look for the cause in our lifestyle, in our nutrition , but above all, let's focus on the VagiStatus test at the Institute of Microecology , which will quantitatively determine the level of lactic acid bacteria. Then we know exactly whether we need to use a vaginal probiotic, whether we are exposing this microbiota in some way, or whether we suffer from any venereal diseases. This study is the first step in understanding the path of action.

I have heard the opinion that intestinal microbiota testing is not necessary to choose the right probiotic for supplementation. What about vaginal microbiota testing?

When it comes to vaginal microbiota, we know exactly what bacteria we should definitely not find in the test results. The same with the presence of the right bacteria - we know which ones we care about the most. We do not look for specific strains that we need to supply, but we focus on the functional groups of a given area. In the event of a significant reduction in the value of Lactobacillus in the microbiota, we must focus on rebuilding the entire protective system of this sphere. We then use probiotic vaginal globules that will take care of this reconstruction.

So in the case of probiotics, we support the functionality of the microbiota and allow our own bacteria to rebuild during this time?

Yes exactly. We use probiotics to displace harmful bacteria on the mucous membrane and reduce their presence. Probiotics "take space" for pathogens , compete with them for nutrients, and as a result, create unfavorable conditions for their functioning. The bacterium Gardnerella vaginalis is often omitted in standard screening tests - one of the main causes of bacterial vaginosis, i.e. vaginitis. You should pay attention to it, because its presence can cause endless problems with your intimate health. In the VagiStatus study it is also determined. To sum up : probiotic therapy may be crucial for rebuilding mucosal immunity and supporting the vaginal microenvironment, and thus reducing the risk of intimate infections.