61. The Vital Role of Vaginal Microbiome Health: Insights from Dr. Craig Cohen
This episode is proudly supported by Evvy
Evvy is a women's health company that is unlocking precision healthcare for women & people with vaginas. Their mission is to close the gender health gap by discovering and leveraging overlooked female biomarkers — starting with the vaginal microbiome.
Ever wondered why the vaginal microbiome plays such an essential role in women's health? Dr. Craig Cohen recently shed invaluable light on this topic during an in-depth conversation with Hetal Baman. From the significance of bacterial vaginosis (BV) to the future of microbiome research, Dr. Cohen's insights are a must-know for anyone interested in reproductive health.
Understanding the Vaginal Microbiome
Dr. Craig Cohen emphasized that the vaginal microbiome is a complex ecosystem that significantly impacts a woman’s overall health. The dominant bacteria, particularly Lactobacillus species such as Lactobacillus crispatus, are essential for maintaining this delicate balance. The presence of these bacteria helps prevent infections, promote healthy pregnancies, and even influence susceptibility to HIV and other sexually transmitted infections.
The Personal Journey of Dr. Craig Cohen
Our interview kicked off with a glimpse into Dr. Cohen's path into studying the vaginal microbiome. Trained at the University of Washington, Dr. Cohen was inspired by mentors like Dr. David Eschenbach. His work has pivoted on understanding and improving bacterial vaginosis treatment, especially in the context of HIV prevention during his extensive career in Kenya.
What is the Vaginal Microbiome?
This microbiome consists of trillions of microbes residing in the vagina, forming a community that women have co-evolved with over centuries. Optimal vaginal health is often characterized by the dominance of Lactobacillus species. These bacteria serve as gatekeepers, supporting both the immune system and reproductive functions.
Challenges with Current BV Treatments
Dr. Cohen shared that the current treatments for BV, mostly involving antibiotics like metronidazole, are far from perfect. While effective initially, they do not replace the healthy Lactobacillus bacteria, leading to high recurrence rates. The solution? More research and better treatments that include Live Biotherapeutics to restore the optimal vaginal microbiome.
Sex and BV
BV isn't just about sexual transmission, but it's closely associated. Sexual behaviors, contraceptive methods, and menstruation can all impact the vaginal microbiome. Studies show that BV can be transmitted through shared sexual toys between women or by a male partner with multiple partners. Even non-sexual factors like menstruation can significantly alter the vaginal microbiome, making it vital to maintain optimal conditions.
The Importance of Awareness and Testing
Unfortunately, a large majority of women may not even be aware they have BV because they're asymptomatic. Dr. Cohen stressed that improved diagnostics and routine checks could significantly benefit women's health. Testing for BV typically occurs when symptoms are reported, but considering asymptomatic cases, more proactive screening is advised.
Dr. Craig Cohen
Live Biotherapeutics: A Ray of Hope
Dr. Cohen’s research includes developing Live Biotherapeutics using Lactobacillus crispatus to rectify the imbalance caused by BV. This approach could revolutionize BV treatment by replenishing beneficial bacteria post-antibiotic treatment. While still in the trial phase, early results are promising, offering renewed hope for more effective and lasting solutions.
Addressing the Investment Gap
Despite the promising research, there remains a troubling lack of investment in women's reproductive health. Many pharmaceutical companies haven’t prioritized developing new treatments for BV, partly due to a lack of consumer awareness and advocacy. According to Dr. Cohen, a collective push for funding and awareness could change the landscape of women’s health.
Call to Action: What You Can Do
Dr. Cohen emphasized the need for a grassroots advocacy movement to educate and push for more research and funding. Start by asking your healthcare provider questions about the vaginal microbiome and its importance. Making BV a topic of discussion can create a ripple effect, pushing for better diagnostics and treatment options.
Dr. Craig Cohen is a Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California San Francisco, with over three decades of experience in global health. Dr. Cohen’s pioneering research focuses on reproductive health, HIV prevention, and the development of live biotherapeutics to optimize vaginal health. Notably, he has been at the forefront of advancing LACTIN-V, a groundbreaking vaginal probiotic aimed at improving vaginal health, preventing recurrent bacterial vaginosis and HIV. His leadership in numerous international clinical trials has been instrumental in creating innovative interventions that enhance women’s health in resource-limited settings. Renowned for his dedication to advancing global health education and research, Dr. Cohen’s work continues to inspire and drive impactful change in global health policies and practices.
