Maintaining Balance of the Vaginal Flora for Vaginal Health


This article was sponsored by Church & Dwight Co., Inc.

The human vaginal microbiota is composed of a balance of both beneficial microbes and opportunistic pathogens, including bacteria and yeast.1 In a healthy vagina, the microbiota exists in a mutualistic relationship with the body.2

Both internal and external factors can disrupt the balance of the vaginal microbiome. When there is an imbalance of the vaginal microflora, this is called vaginal dysbiosis. One feature of vaginal dysbiosis is an increased vaginal pH, which can be caused by reduced concentrations of lactic acid.2 Lactobacillus species, commonly found in the female reproductive tract, are believed to play an important role in the vaginal microbiome because of their production of lactic acid, which helps maintain the vaginal pH.2,3

The composition of the vaginal microbiome is constantly changing. Hormonal fluctuations throughout the women’s reproductive life (eg, menstruation and pregnancy), medications (eg, antibiotics and hormonal contraceptives), sex, and vaginal douching are all factors that can disrupt the normal flora.4,5,6,7

To maintain the balance of the vaginal flora, women may benefit from a daily probiotic formulation that contains Lactobacillus strains to help maintain the microflora in a normal range and help support vaginal health.

Lactobacillus are the dominant bacteria species found in a healthy and balanced vagina.2 This bacteria species thrives in an anaerobic environment, like the vagina, and produces byproducts such as lactic acid, hydrogen peroxide, and bacteriocins. As the main source of lactic acid production in the vagina, Lactobacillus species help maintain the pH of the vagina below 4.5.1

The International Scientific Association for Probiotics and Prebiotics defines probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”8 Two main sources of probiotics are foods with natural or added probiotics (eg, yogurt and infant formula) and dietary supplements.8 Depending on the probiotic strains offered in the dietary supplement product, the health benefits will vary. Some probiotic supplements support digestive or immune health, others have different health benefits.*9

There are some supplements that are specifically formulated to provide vaginal health support. One such example is RepHresh Pro-B Probiotic Feminine Supplement, an OTC option that is formulated with specific strains, Lactobacillus reuteri RC-14 (formerly classified as L. fermentum RC-14) and Lactobacillus rhamnosus GR-1, that support vaginal health. Both bacteria strains have been studied and shown to positively affect the composition of the vaginal microbiota.*9

Taken once a day, RepHresh Pro-B capsules contains 5 billion colony forming units of 2 clinically-tested beneficial probiotic strains, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. A clinical study demonstrated that RepHresh Pro-B Probiotic Feminine Supplement begins working in as few as 7 days. It provides 24/7 protection when used daily and helps maintain the balance of yeast and bacteria flora, which in turn supports a healthy vagina.*9 This dietary supplement is free of dairy, egg, fish, peanut, gluten, and soy and has a shelf-life of 90 days once opened.9

Lactobacillus strains are probiotic strains that have a long history of safe use in humans.10 Women should speak with their healthcare provider before starting a dietary supplement or if they suspect a vaginal infection, develop an unfamiliar discharge, pain, or any symptoms that cause concern.9

Pharmacists can be a helpful resource to answer any questions regarding effective and safe probiotic options available in the pharmacy. When asked for a product recommendation, pharmacists can provide information on the differences between each probiotic formulation (eg, digestive health formulation, yogurts with added probiotics, vaginal health formulation) and the benefits associated with the different strains.8

Pharmacists have an opportunity to help women who come to the pharmacy, and desire information regarding a product that supports vaginal health and wish to maintain their vaginal pH within a normal range. Pharmacists can share information regarding RepHresh Pro-B Probiotic Feminine Supplement, including its 2 clinically-tested probiotic strains, to help maintain the flora important to overall vaginal health, balancing yeast and bacteria to maintain feminine health.*9

*These statements have not been evaluated by the United States Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.


1. Chen X, Lu Y, Chen T, Li R. The female vaginal microbiome in health and bacterial vaginosis. Front Cell Infect Microbiol. 2021;11:631972. doi:10.3389/fcimb.2021.631972

2. Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol. 2012;66(1):371-389. doi:10.1146/annurev-micro-092611-150157

3. Ceccarani C, Foschi C, Parolin C, et al. Diversity of vaginal microbiome and metabolome during genital infections. Sci Rep. 2019;9(1):14095. doi:10.1038/s41598-019-50410-x

4. Lin YP, Chen WC, Cheng CM, Shen CJ. Vaginal pH value for clinical diagnosis and treatment of common vaginitis. Diagnostics (Basel). 2021;11(11):1996. doi:10.3390/diagnostics11111996

5. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception. 1995;51(5):293-297. doi:10.1016/0010-7824(95)00079-p

6. Cribby S, Taylor M, Reid G. Vaginal microbiota and the use of probiotics. Interdiscip Perspect Infect Dis. 2008;2008:256490. doi:10.1155/2008/256490

7. Amabebe E, Anumba DOC. The vaginal microenvironment: The physiologic role of lactobacilli. Front Med (Lausanne). 2018;5:181. doi:10.3389/fmed.2018.00181

8. Hill C, Guarner F, Reid G, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014(11): 506–514. doi:10.1038/nrgastro.2014.66

9. RepHresh PRO-B Feminine Probiotic Supplement. Package Insert. Church and Dwight Co., Inc. 2022.

10. Probiotics and prebiotics. World Gastroenterology Organisation. Published February 2017. Accessed May 24, 2022.

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