Equilibria Health - Vaginal Dysbiosis Image Blog

Pop quiz for pelvic physios: what is the common denominator in these patient presentations?  

(These are all real patients, but I bet you feel like you have seen them too!) 

  • 30-something woman plagued with recurrent thrush and BV (bacterial vaginosis).
  • 30-something woman who had vaginal Group B strep during pregnancy and persistent bladder irritation after.
  • 60-something woman with recurrent UTIs (urinary tract infections), but often with negative culture.
  • 40-something woman with severe vision impairment and chronic vulval burning.
  • 60-something woman with vaginal atrophy and chronic vulval itch.
  • 20-something woman with dyspareunia, overactive pelvic floor, and irritation wearing jeans and riding a bike 

What’s your guess?

Vaginal/vulval unhappiness? Yes.

But more specifically? It’s vaginal dysbiosis – and treating it helped all of them. 

What is vaginal dysbiosis?  

I have a free clinician resource on vaginal dysbiosis, but in a nutshell, it’s a state of imbalance. Imbalance in the normal makeup of microorganisms that live in the vagina and at the vulva. Populations of bacteria are not the same in the urethra as the vulva or as the vagina, but they overlap. For example, lactobacilli usually dominate a healthy vagina, but they are there in high levels in the healthy urethra as well. For this reason, we could more accurately talk about urogenital dysbiosis. In good health, these microbes keep the vagina, vulva and urethra in a state of harmony. Out of balance, we get urogenital dysbiosis, and a range of symptoms we know so well ensues… 

  • Vulvovaginal itch
  • Vulval burning
  • Dyspareunia
  • Urogenital irritation
  • Stinging with micturition
  • Urinary frequency
  • Irritation with tight clothing and jeans
  • None of the above, but an increased and annoying “awareness” of the area.

So is vaginal dysbiosis the root of all evil? 

By no means am I suggesting vaginal dysbiosis is the only cause – or even the main cause – of these symptoms. Many of your patients with these symptoms will have a separate diagnosis: vulvodynia, vaginismus, chronic pelvic pain, OAB, bladder pain syndrome, IC, genitourinary syndrome of menopause (vaginal atrophy), lichen sclerosus. But urogenital dysbiosis could be a big driver in these conditions. Recurrent UTI, for example, can arise due to an ongoing state of urogenital dysbiosis. (This is much more likely the case for uncomplicated UTI than complicated UTI – learn the difference, and help these patients, through my online course Resolving Recurrent UTI) 

Pelvic physios can make a huge difference in the life of these women through two simple steps. 

Step 1 – Facilitate assessment and diagnosis.

We are REALLY good at this. We want the best for our patients, so we go the extra mile to get them to have the comprehensive medical assessment they need. This means discouraging going to the pharmacy and buying thrush cream as self-diagnosis and treatment. It means not accepting the patient being handed out antibiotics yet again without urine culture. It means convincing our patients to get a vaginal swab done rather than making assumptions about what’s going on. If a medical condition is diagnosed, the right medical treatment can be initiated. However, so much more often, these tests bring up nothing clear.

Does that rule out urogenital dysbiosis as a possibility? Heck no – this is where you proceed to Step 2! 

Step 2 – Learn and apply evaluation and management skills for urogenital dysbiosis.

Learn about the healthy vulvovaginal microbiome, and apply the research-supported principles to transform your patients’ experience.

This does not mean you stop using your tried and true, evidence-supported methods for treating the condition (OAB, vulvodynia, chronic pelvic pain). It does mean we see the whole person and consider the multiple ways we can help achieve the desired outcome. Physios don’t treat conditions, we treat people. There’s no sense thinking “they have vulvodynia, and I do X for vulvodynia.” If the person’s clinical picture a) includes vaginal dysbiosis b) it’s affecting their quality of life c) they are not getting effective treatment for this elsewhere and d) we understand the condition and what the research says about it, then it’s a no-brainer!

Addressing the urogenital dysbiosis leads to a happier, healthier patient, and profound job satisfaction for us! 

This online course will show you how to do it.  

In my online course pHantastic pHlora, I help you as a pelvic physio incorporate research-supported assessment and management strategies for vaginal dysbiosis into their current patient care. It’s simpler than you think and can be a game-changer for your practice. Best of all, you can do it at your own pace, but receive ongoing support through the clinical discussion in the associated private Facebook group.


Have a look here at pHantastic pHlora: enhanced clinical outcomes for physiotherapists via manipulation of the vaginal microbiome.

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