Are Vaginal Probiotic Suppositories Actually Effective?

The Science Behind Probiotics for Treating and Preventing Vaginal Infections

• Do You Need Vaginal Suppositories?|
• Are Suppositories Effective?|
• Simple and Effective: Oral Probiotics|
• Understanding the Vaginal Microbiome|
• What is a “Normal” Vaginal Microbiome?|
• Simplifying Probiotics for Vaginal Health|

If you struggle with recurring yeast infections or bacterial vaginosis (BV,) you may be wondering if there are other, more effective options for treating them than the go-to OTC treatments. Or you may have heard about vaginal probiotic suppositories and are wondering if those are truly the best option to treat and prevent infections. 

Many of the products you see in stores claim that vaginal suppositories and creams are the best options because they contain specific ingredients needed for vaginal health. They also claim that suppositories are more targeted because they are inserted directly into the vagina as opposed to other medications and supplements taken by mouth.  

However, many OTC options can disrupt the delicate balance of bacteria in the vagina, come with potential side effects, and are actually a short-term solution. This has amplified the growing interest in probiotic suppositories, in an attempt to find natural and effective methods for treating the root-cause of issues “down there”. 

Research shows that probiotics do help balance the delicate vaginal microbiome and decrease the risk of the overgrowth of bad bacteria that contributes to infections. But is a vaginal probiotic suppository really the most effective way to support your vaginal microbiome? And what makes them superior to oral probiotics (if at all)? 

This article will look at the research around probiotic suppositories, how effective they are, and what is the best probiotic for vaginal health. 

Quick Snapshot: Do You Need a Probiotic Suppository?

While vaginal probiotic suppositories in research studies seem to be effective at treating bacterial vaginosis, we do not have research that shows that probiotic suppositories are really any more effective than oral probiotics in most cases. In fact, one meta-analysis showed that oral probiotics were more effective than suppositories [1].

Additionally, while there are quite a few commercially available vaginal probiotic suppositories, none have been thoroughly tested for effectiveness and safety in humans [2]. 

Since oral probiotics are so successful, effective and safe in humans, and easier to take than probiotic suppositories, you probably do not need a suppository. 

That’s the short answer, but now let’s take a closer look at the research around probiotics for vaginal health and suppositories vs. oral supplements so you can make an informed decision about your health. 

Are Probiotic Suppositories Effective?

This is a difficult question to answer, as the evidence backing the use of probiotic suppositories is sorely lacking. In fact, none of the commercially available suppositories have been tested for efficacy or safety [2]. However, the small amount of research we do have on the use of probiotics vaginally suggests they are effective in treating and preventing urinary and vaginal infections. 

The scientific literature shows probiotic suppositories help with: 

• Treating bacterial vaginosis (BV): Vaginal probiotics were as good as or better than antibiotics in curing BV [1, 3]. Both vaginal and oral probiotics containing Lactobacillus species naturally found in the vagina work better than placebo at curing and preventing BV, although not better than probiotics with antibiotics together [2, 4, 5, 6, 7, 8]. 
• Preventing bacterial vaginosis: Probiotic suppositories reduced the number of recurrences and increased the time between recurrences in women treated with antibiotics for bacterial vaginosis [8, 9].
• Restoring the microbiome: Vaginal probiotics balanced pH balance, which is essential for preventing infections, and restored a healthy vaginal flora [10, 11].
• Preventing urinary tract infections (UTIs): Oral and suppository probiotics have been shown to effectively prevent UTIs [12, 13, 14]. 
• Clearing ​​human papillomavirus (HPV): Oral and vaginal probiotics cleared HPV lesions in women [13]. This should be used alongside regular PAP smears to monitor for cellular changes on the cervix.

However, the research is mixed on whether vaginal probiotics enhance antibiotics when treating bacterial vaginosis, as one large trial found that vaginal probiotics given with antibiotics were not more effective than antibiotics alone [15]. Additionally, more evidence is needed to determine whether vaginal probiotic suppositories can treat vaginal yeast infections [2, 13].

Vaginal Probiotics vs OTC Treatments

We would be remiss to skip this topic, as many of you are likely here to see if probiotic suppositories have fewer side effects (and the same potency) compared to over-the-counter products. Overall, it seems that they do, though they may not be complete substitutes in some cases like a persistent or severe infection. 

Compared to nearly all over-the-counter medications, probiotics are superior in that they treat the root cause of symptoms, an imbalance in the vaginal microbiome, which gives them preventative benefits that other medications don’t. OTCs can even perpetuate women’s health issues, as they can further disrupt the vaginal flora and pH.

The popular cream/suppository Monistat is a favorite choice among women dealing with unpleasant symptoms of itching, burning, or pain “down there”. Its activity comes from the ingredient miconazole, which is used to treat Candida albicans in the reproductive tract. 

Unfortunately, it comes with side effects of increased burning and itching, and even hives in more serious cases [16, 17]. These side effects have not been noted with the use of vaginal probiotics, giving them an edge over this product in terms of safety [2], especially for recurrent infections that require frequent treatment.

The verdict is still out on whether probiotic suppositories are effective for Candida, so if your symptoms are acute and severe, Monistat (and a trip to the gynecologist) may be the way to go. But if your symptoms are milder, you’ve tried Monistat with no help, or you get recurrent infections, probiotic suppositories are a great choice. 

However, in the case of BV, probiotic suppositories are the clear winner as there are no over-the-counter medications approved for this type of dysbiosis, only prescription antibiotics and antifungals. Probiotics’ ability to balance the vaginal pH has an added benefit of preventing future imbalances. 

Vagisil is another common OTC product with anesthetic properties that allow it to rapidly reduce itching. There is a slight chance of it causing skin hypersensitivity, but it is otherwise side-effect-free [18] . If you have severe itching due to an infection, probiotic suppositories can help treat the issue, but won’t work nearly as quickly or effectively to reduce your discomfort.

What About UTIs?

In the case of UTIs, safety becomes a bigger concern, both on the side of and against probiotic suppositories. Many UTIs clear on their own, and probiotics can help hasten that process and prevent future infections without the need for antibiotics. 

Common antibiotics used for lower urinary tract infections include amoxicillin, nitrofurantoin, and cephalexin. These come with a long list of side effects, like damage to the gut microbiome, which may lead to diarrhea, gas, and bloating. If you experience recurrent UTIs, probiotics may be a safer bet than repeatedly taking oral antibiotics.

A 2013 study discovered that oral probiotics can reduce the risk of developing recurrent UTIs by 50% [19], and another on five women with recurrent UTIs showed that twice weekly probiotic suppositories led to longer symptom-free periods. However, the evidence was low quality, due to it’s small number of participants and non-randomized design, and the effects on urinary pathogens were variable [20]. 

The research on probiotics for UTIs may still be in its nascency, but they appear to be a safer option than antibiotics for recurrent urinary infections.

However, if you have an existing urinary tract disease, like kidney issues, have worsening or develop new symptoms, or have symptoms that don’t improve after 5 days, you should talk to your doctor about antibiotics. In these cases, a simple UTI can progress to a kidney infection, which is not treatable with probiotics alone, though they can certainly help with antibiotic side effects.

In all, it seems that probiotics may be a better choice for urovaginal infections that cause minor symptoms, low-grade recurrent infections, and/or when looking for preventative treatment. But if your symptoms are severe, you should definitely seek something that can give you more immediate relief. This brings us to our next debate on whether probiotic suppositories are superior to oral probiotics for women’s health issues.

Vaginal vs Oral Probiotics: Which Is Better?

The winner of this debate doesn’t purely come down to whether one is more effective as we really don’t know which one is. To put it simply, one recent study states that “the preferred route of administration of probiotics [for bacterial vaginosis] has been controversial” [1]. Determining which one is “better” purely comes down to your unique needs and preferences, as seen below.

Some trials show that oral probiotics combined with antibiotics are superior to vaginal probiotics and antibiotics alone in treating bacterial vaginosis [1, 3]. Another systematic review of studies found that oral probiotics (Lactobacillus rhamnosus, Lactobacillus acidophilus, and Lactoferrin) were better than vaginal probiotics for treating bacterial vaginosis. 

Does this mean we should write off probiotic suppositories? No. Both delivery methods appear beneficial and more studies that directly compare the effectiveness of oral vs vaginal probiotics are scarce and leave us with no clear answer to this question.

In fact, there is a promising vaginal probiotic suppository being studied right now, Lactin-V. The above preliminary research on commercial vaginal probiotics shows that suppositories are a great option for certain conditions [2]. Furthermore, we know that they are safe [2, 4, 5, 6, 9, 10, 11, 15], similar to oral probiotics. 

But how do you know which is best? Fortunately, we don’t need to rely on research for an answer — it’s whichever delivery form works for you. 

Probiotic Suppositories: Are They Practical?

Deciding between oral vs suppository probiotics mostly concerns ease of use, what forms you have tried in the past, and if you have any other health issues. Let’s look at these, and more concerns, one-by-one:

1. Ease of use: Both oral and suppository probiotics often need refrigeration to protect from losing their potency and from melting (as in the case of some suppositories). Suppositories often need to be worn with a pad or panty liner since the suppository can leak when melting. Some women also have difficulty or pain with inserting a suppository, while others may have a hard time swallowing capsules. 
2. Duration of use: Since it’s unclear how long either form takes to work for specific concerns of the vaginal and urinary tracts, try to pick a form that you can stick with for at least a month or two before reassessing. This is especially important if you are taking them long-term for preventative use.
3. Cost friendliness: Probiotic suppositories come at a higher price point than a dose of oral probiotics, due to added ingredients (look out for those if you have any sensitivities) and extra packaging and shipping requirements. 
4. Therapeutic benefits: Vaginal suppositories are primarily targeted to the reproductive system and lower urinary tract. If you have other concerns, like brain fog or symptoms of an unhealthy digestive tract, oral probiotics may be the way to go.
5. Prior treatments tried: If you have already given multiple types of oral probiotics a fair shot for your women’s health-related concerns, there’s really no point in trying it again. This might be a great place to experiment with probiotic suppositories. But if you are new to oral probiotics, you may get a better bang for your buck and address multiple health concerns at once for less mess.

Most of the time, women will be able to get symptom relief when using oral probiotics alone and they seem to complicate daily routines far less than daily suppositories. Let’s look into what type of probiotics to take and their role in the vaginal microbiome.

Simple and Effective: Oral Probiotics 

Right now, though, with the current research we have, adding a well-researched oral probiotic supplement with at least a Lactobacillus species found in the human vagina is an effective option for supporting vaginal health.

However, in my clinical experience, I have found that patients do best with triple-therapy probiotics. 

Triple therapy probiotics include probiotics from three categories: Lactobacillus and Bifidobacterium species, Saccharomyces boulardii, and soil-based probiotics. This kind of multi-species probiotic has been shown to be more effective than just one category alone in other conditions such as leaky gut, diarrhea (including antibiotic-associated diarrhea,) and brain fog [21, 22, 23, 24].

Taking all three types together gives you the most comprehensive probiotic support for not only vaginal health but whole body health as well. 

Understanding the Vaginal Microbiome

It can be helpful in this discussion of probiotics to know a bit more about the importance of the vaginal microbiome and how it can help improve your health. 

The vaginal microbiome (the balance of microbes such as bacteria and fungi in the vagina) maintains vaginal health and prevents against infections caused by an overgrowth of bacteria, such as in bacterial vaginosis and yeast infections. 

There are two common reasons why people consider probiotics for vaginal health — to prevent or improve either a vaginal yeast infection or bacterial vaginosis. Both of these conditions are caused by an imbalance of the vaginal microbiome. 

The most common symptoms of a yeast infection are a thick white discharge and itching. With BV, people often experience an increase in vaginal discharge that is thin and gray or white, and has a fishy odor, painful urination, or pain before or after sex [25]. Many people experience recurring infections, and it greatly decreases their quality of life. 

While these infections may be frequent, they certainly shouldn’t be your daily norm. So when it comes to vaginal health, what is normal?

What is a “Normal” Vaginal Microbiome? 

There are many oral and suppository probiotics that are marketed to support healthy vaginal flora, in particular by claiming that the vaginal microbiome only needs certain bacterial strains. However, we can not yet define what a “normal” vaginal microbiome is because the right microbiome varies between individuals monthly and throughout their lifespan [26]. 

But generally speaking, current data suggests that most women of reproductive age have vaginal flora dominated (more than 50%) by one of four Lactobacillus species: L. crispatus, L. jensenii, L. iners, and Lactobacillus gasseri [26].

Lactobacillus is certainly not the only species needed, but it does support vaginal health by producing a few key components [27]:

• Lactic acid, which keeps the pH low (acidic, pH 4.5 or lower) and inhospitable to many bacteria [28].
• Bacteriocins, which are toxic proteins that kill other bacteria [29].
• Hydrogen peroxide, which may prevent bacteria from growing or may kill them directly. Although more research is needed for us to know the true effect of hydrogen peroxide on the vaginal microbiome [27, 30].

While the Lactobacillus species makes up half of the vaginal microbiome, a healthy vaginal environment can include many other species of bacteria and fungi [26]. In general though, a good Lactobacillus oral or suppository probiotic is a great option for supporting the vaginal microbiome. 

The Changing Vaginal Microbiome

Why might people get recurring infections? 

The vaginal microbiome changes throughout the month in women of reproductive age around menstruation. In fact, your monthly menses is a major disruptive factor in the vaginal microbiome that can cause dysbiosis to emerge [26]. 

These monthly swings in your vaginal biome are also why the benefits from probiotics can take several months to appear. Again, this makes them a great fit for recurring infections or for prevention, but not ideal for acute or severe cases.

Most women return to their normal flora type or alternate between lactic acid-producing species periodically after menstruation [26]. In people whose microbiome has a hard time making these natural shifts, they may experience recurrent bacterial vaginosis.

The vaginal flora is also vulnerable to change after sexual activity and during the hormonal fluctuations of perimenopause and menopause [26]. 

Hormones play a significant role in the balance of the microbiome. The use of estrogen In menopausal women helps to normalize the vaginal microbiota and can help prevent vaginal infections [31, 32]. One study found that high levels of estrogen and progesterone during ovulation were associated with greater stability of the vaginal microbiome [33].

Antibiotic use due to recurring UTIs, bacterial vaginosis, or really any other health concern can wreak havoc on your vaginal flora. Antibiotics change the acidity of the vagina and increase the risk of bacterial vaginosis, making the use of antibiotics for women’s health issues a vicious cycle [34].

As you can see, many things can affect the vaginal microbiome, and while for many people their body is able to balance the microbiome, when your body can not or you have factors preventing you from doing so, you can have frequent infections that start to impact your quality of life. 

Fortunately, probiotics are a great way to keep a good balanced vaginal microbiome and/or recover the microbiome after a bout of antibiotics or anything that creates disruption. Because of the variances in the vaginal flora beween populations, and from month-to-month, you shouldn’t get hung up on which type of probiotic you need to take. Just find a good-quality one that works for your symptoms and your lifestyle.

Simplifying Probiotics for Vaginal Health

Undergoing a health improvement plan can be overwhelming. People get the best results when a treatment is not only backed by research but also accessible and easy to maintain. 

Because oral probiotics are easier to take for most people and they are at least as effective as suppositories, most people will do well with a good quality triple therapy oral probiotic set.

Consistency is key with probiotics though, so try adding oral probiotics into your daily personal care plan for probably about two months to see if they help lessen the occurrence of vaginal infections. Remember that your vaginal microbiome changes throughout your cycle, with hormone changes, and with sexual activity, so it can take a few months to really see if the probiotics are helping you consistently.

If you are struggling with recurring infections and would like more support, you can apply to become a patient at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.