Neovaginal health
“Bio-vagina” functioning: hormones, glycogen and probiotics
In order to look at neovaginal health, it is important to understand how biovaginas work. (Note that I call biovaginas the vaginas of cis-women and AFAB people only for writing convenience, acknowledging that the term might not be ideal. Neovaginas are in many ways biovaginas as well.)
We are probably all aware of the vaginal flora and of its importance for vaginal and cervix health. What is less known is the evolution of this flora, and its relationship to hormonal balance.
Vaginal flora, or vaginal microbiota/microbiome, are microorganisms (mainly bacterias and yeasts) that colonize the vagina. If the right mix of species form a good balance, they will provide defense against pathogenic species (responsible for infections, such as Candida Albicans…). The bacterial world is a world of survival, of constant fight for food and space. It is only natural that, if a colony is strong enough, it will not leave enough food and space for other colonies to spread. But if the good bacteria were to be weakened (by a topical or systemic antibiotic, for example, or extra cleaning…), it leaves room for the pathogenic species to take over, and start an infection.
The lactobacillus: yogurts, sauerkraut and vaginas
The main bacterias of the healthy vaginal microbiome is a group called Lactobacillus (sometimes referred to as “Doderlein’s flora”, from the name of the German dude who figured it out). Most of the vaginal bacterias come from a transfer from the colon microbiome: they move from the anus, to the perineum, the labias, and hop, in the vagina! Gross? Maybe, but healthy. And also, first, they come from the stomach flora, and from what you eat. Actually, the lactobacillus are the same bacterias that make yogurt, cheese, or fermented vegetables like pickles, kimchi, or sauerkraut. This yogurt in your fridge, or this juice in your jar of sauerkraut is very similar, in terms of bacterial presence, to what’s inside a healthy vagina. And the same fermentation process also happens in your vagina.
The idea, when making sauerkraut for exemple, was to be able to keep this huge amount of cabbage we harvested from going to waste - that is, being colonized by pathogenic bacterias. The fermentation process consists in making sure that the natural bacterias present on the cabbage - the lactobacillus - develop. As they develop, they need food, and start eating and digesting the sugars naturally present in the cabbage. The result of this bacteria feast is lactic acid. It is sour, and the pH balance it provides keeps pathogenic bacterias at bay. The cabbage - now sauerkraut, or kimchi, can then be kept for a long time. The same thing applies for yogurts and cheese: how to keep all this nutritious milk over the winter: remove the water and ferment it; you can now keep your “milk” (cheese) for months.
Back to the vagina. The lactobacillus, that came from this kimchi you ate (and, originally, from you licking the vaginal walls of the person who gave birth to you - if you were not born through C-Section), and went all the way down to your vagina, will eventually have the chance to be fed on the spot by… the vagina itself! Indeed, under the effect of estrogens, the vagina starts producing glycogen, that is, sugar. The lactobacillus will eat and digest this glycogen, and produce lactic acid as well as hydrogen peroxide (among others), who will both keep pathogenic agents at bay. The biovagina is a self-sufficient protective device: it feeds and keeps alive the good bacterias that will protect it from pathogenic agents.
This is why the vaginal flora is also quite different in its composition in prepubertal and post-menopausal vaginas, since glycogen is produced under the influence of estrogens. Less or no estrogen means less or no vagina-made sugar, which means a different macrobiotic balance. It results that postmenopausal individuals can be more vulnerable to vaginal infections. This is also true for prepubertal individuals, who can be exposed to pathogenic agents because of lack of hygiene.
What care for neovaginas?
So, what does this mean in regard to your neovagina? Actually, knowledge is extremely limited on this matter. A team of researchers in France is currently leading one of the first research project on neovaginas’ microbiome to try to figure it out, and examine the vaginal flora of post-SRS transfeminine people. The project is called Transbiome.
What we can infer, however, is that a neovaginal flora is more likely to be closer to the one of a prepubertal or postmenopausal biovagina. Indeed, despite all the estrogens you can take, your neovagina tissue (former penile tissue in most cases) will not be able to secrete glycogen to feed the lactobacillus. This is true to all surgery techniques (penile inversion, colon graft or peritoneum graft). You may take all the topical prebiotic capsules you can find at your pharmacy, if the new colony you installed can’t be fed, it will fade away.
An idea is to add glycogen as well. Such medication exists, which combines both prebiotic (lactobacillus) and glycogen. Theoretically, once the lactobacillus colony is well established, all you would have to do is to feed it regularly; do manually what the biovagina does by itself. Reinstalling a healthy flora is quite important after taking antibiotics (oral or local). But how often, how much, and with what sugars? Until proper research is published, we do not have the answers to this, and many post SRS transfem people are left experimenting in order to figure out what works best for them.