Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Lactobacillus species are a dominant part of the healthy vaginal microbiota, where they play a key role in maintaining an acidic pH and inhibiting the growth of pathogenic organisms. The rationale for using Lactobacillus as a supplement or probiotic treatment for vaginitis, particularly bacterial vaginosis (BV) and vulvovaginal candidiasis, is based on both mechanistic understanding and clinical evidence. Several randomized controlled trials and meta-analyses have shown that oral or intravaginal administration of Lactobacillus probiotics can improve clinical cure rates and reduce recurrence rates of BV when used alone or as an adjunct to antibiotics. The effect on vulvovaginal candidiasis is less robust, but some studies have reported symptomatic relief and reduced recurrence. The proposed mechanism involves the restoration of a Lactobacillus-dominant flora, competitive inhibition of pathogens, and production of lactic acid and bacteriocins. However, not all studies show benefit, and differences in probiotic strains, dosages, and treatment durations contribute to variability in outcomes. Major guidelines (such as those from the CDC and WHO) recognize the potential benefit but do not universally recommend probiotics as first-line therapy due to inconsistent evidence quality. In summary, there is moderate scientific support for the use of Lactobacillus in vaginitis, particularly for BV, but more research is needed to firmly establish efficacy and optimal protocols.

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