Maintaining balance of vaginal flora for vaginal health

This article is 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 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, it is called vaginal dysbiosis. One feature of vaginal dysbiosis is elevated vaginal pH, which can be caused by decreased lactic acid concentrations.2 Lactobacillus species commonly found in the female reproductive tract are thought to play an important role in the vaginal microbiome due to the production of lactic acid, which helps maintain vaginal pH.2,3

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

To maintain the balance of the vaginal flora, women can benefit from a daily probiotic formula that contains Lactobacillus strains that help maintain the microflora within normal limits and support the maintenance of vaginal health.

Lactobacillus are the dominant types of bacteria found in a healthy and balanced vagina.2 This type of bacteria thrives in anaerobic environments, such as 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 vaginal pH below 4.5.1

The International Scientific Association for Probiotics and Prebiotics defines probiotics as “live microorganisms that, when administered in adequate amounts, provide health benefits to the host.”8 Two main sources of probiotics are foods with natural or added probiotics (eg, yogurt and infant formula) and nutritional 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 support for vaginal health. 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. yeast RC-14) and Lactobacillus rhamnosus GR-1, which support vaginal health. Both bacterial strains have been studied and shown to positively influence the composition of the vaginal microbiota.*9

Taken once daily, RepHresh Pro-B capsules contain 5 billion colony-forming units of 2 clinically tested beneficial probiotic strains, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. A clinical study showed that the probiotic women’s supplement RepHresh Pro-B begins to work after only 7 days. It provides 24/7 protection when used daily and helps maintain the balance of yeast and bacterial flora, which in turn supports a healthy vagina.*9 This dietary supplement is free of dairy, eggs, fish, peanuts, gluten and soy and has a shelf life of 90 days after opening.9

Lactobacillus are probiotic strains that have a long history of safe use in humans.10 Women should talk to their health care provider before starting a 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 for answering any questions about effective and safe probiotic options available at the pharmacy. When asked for a product recommendation, pharmacists can provide information on the differences between each probiotic formula (eg, digestive health formula, yogurts with added probiotics, vaginal health formula) and the benefits associated with the different strains.8

Pharmacists have an opportunity to help women who come to the pharmacy and want information about a product that supports vaginal health and wants to keep their vaginal pH within normal limits. Pharmacists can share information about RepHresh Pro-B Women’s Probiotic Supplement, including its 2 clinically tested probiotic strains to help support flora important to overall vaginal health by balancing yeast and bacteria to support women’s health.*9

*These claims have not been evaluated by the US 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 simple vaginitis. Diagnosis (Basel). 2021;11(11):1996. doi:10.3390/diagnostics11111996

5. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The influence 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 physiological role of lactobacilli. Front Med (Lausanne). 2018; 5: 181. doi:10.3389/fmed.2018.00181

8. Hill C, Guarner F, Reid G, et al. Consensus statement of the International Scientific Association for Probiotics and Prebiotics 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 Probiotic Supplement for Women. Package leaflet. Church and Dwight Co., Inc. 2022

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

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