• Fact Checked
  • September 27, 2025
  • 13 min read

Lactobacillus Iners: Vaginal Health Ally or Sneaky Frenemy?

Table of Contents
  1. 1. What Is Lactobacillus iners?
  2. 2. The Connection Between L. iners and Vaginal Infections
  3. 3. Why L. iners Is Often Missed in Tests
  4. 4. Who Should Get Tested for L. iners, and How?
  5. 5. What to Do If Your Microbiome Is Dominated by L. iners
  6. 6. Final Thoughts

Key Takeaways

  • Lactobacillus iners is one of the most common vaginal bacteria in healthy women, but it’s not always protective like other Lactobacillus species.
  • Despite its prevalence, it’s hard to detect with traditional vaginal health tests, which means it’s often underestimated or misunderstood.
  • If you’re dealing with frequent bacterial vaginosis (BV), yeast infections, or even UTIs, targeted probiotics and advanced genome sequence testing can help restore balance to your vaginal microbiota.

When it comes to vaginal health, you are likely familiar with the “good bacteria” Lactobacillus. Lactobacillus species help maintain a low vaginal pH, protect against infections, and keep things in balance1. Well, most do, anyway.

Lactobacillus iners (L. iners) is the exception. It’s incredibly common, especially in the vaginal microbiome of reproductive-age women2, but it's more of a shape-shifter than a superhero. It tends to show up during times of change, like after your period, after antibiotics, or when you're recovering from an infection. And unlike other Lactobacillus species, it doesn’t always help your body fight back.

So what does that mean for your vaginal health? And what should you do if L. iners is running the show?

This post is for informational purposes only and does not constitute medical advice. See full disclaimer below.

What Is Lactobacillus iners?

L. iners is one of the four main types of gram-positive Lactobacillus species found in the vagina, alongside L. crispatus, L. gasseri, and L. jensenii. But unlike the other three, L. iners doesn’t consistently protect against infections3. In fact, it’s often found during bacterial vaginosis (BV), yeast infections, urinary tract infections (UTIs), and other microbial disruptions, including sexually transmitted infections (STIs) and other infectious diseases4.

L. iners is the most prevalent and adaptable Lactobacillus species in the vaginal microbiome. It thrives especially during times of change, like after menstruation, sex, or antibiotic use. That makes it a context-dependent species, neither strictly protective nor harmful, but often dominant when your vaginal microbiota is in flux.

Here’s what sets L. iners apart:

It’s A Survivor, Not a Fighter

Lactobacillus iners produces lactic acid5, which helps keep vaginal pH slightly acidic—a good thing for vaginal health. But unlike other vaginal Lactobacillus species, L. iners doesn’t make hydrogen peroxide (H₂O₂), a powerful antimicrobial compound that helps fight off harmful bacteria6.

Because of this, L. iners tends to survive during disruptions—like after antibiotics7, your period, or sex—when other, more protective Lactobacillus species are wiped out. That makes it resilient, but also means it may hang around alongside anaerobic microbes (the kind that cause infections).

It Can Inhibit Harmful Bacteria, But Only Sometimes

In vitro studies (aka lab tests), L. iners has been shown to inhibit BV-related bacteria like Gardnerella vaginalis and Fannyhessae vaginae. This suggests it may help defend the vaginal microbiome, especially during or shortly after treatment with antibiotics like metronidazole.

But that protection doesn't always last. L. iners often helps in the short term but gets outcompeted over time by stronger bacteria like L. crispatus8, which provide longer-lasting protection. So while L. iners may be present after successful treatment, it doesn’t always mean the microbiome is fully recovered or protected from future infections9.

It Competes Differently Than Other Lactobacillus Species

Unlike other Lactobacillus species, L. iners relies on a nutrient called cysteine, which is found in vaginal fluid. This makes it uniquely vulnerable to certain inhibitors.

Researchers have discovered that blocking cysteine uptake in lab models can stop L. iners from growing, without harming the highly protective L. crispatus. That opens the door to new treatments that could help stronger, more protective Lactobacillus strains thrive after BV or other vaginal infections.

It’s Hard to Detect

Traditional tests like the Nugent score, which rely on looking at bacteria under a microscope, often miss L. iners. That’s because it has an unusual shape (morphology) and doesn’t look like other Lactobacillus species.

To accurately detect L. iners, clinicians need to use genomic tools, such as:

  • 16S rRNA gene sequencing (for a full picture of vaginal microbiota)10
  • Species-specific PCR (for pinpointing L. iners directly)

These advanced microbiological methods are much better at identifying L. iners and helping researchers understand how it behaves in reproductive health and vaginal immunology11.

The Connection Between L. iners and Vaginal Infections

While L. iners does not directly cause vaginal infections, there’s a definite link between a vaginal flora dominated by L. iners and infections like bacterial vaginosis, yeast infections, and urinary tract infections, which account for tens of millions of doctor’s visits every year in the USA alone.

Bacterial Vaginosis (BV)

Bacterial vaginosis (BV) is the most common vaginal infection and often a sign that your vaginal microbiome is out of balance (also called dysbiosis)12. It usually happens when there’s a drop in protective Lactobacillus species and a rise in anaerobic bacteria like Gardnerella vaginalis (#1 cause of BV)13.

Interestingly, Lactobacillus iners often sticks around—or even takes over—during BV.

Why does this happen?

  • L. iners can tolerate imbalance, but it isn’t great at fixing it.
  • It doesn’t produce hydrogen peroxide (H₂O₂), which means it’s not very good at fighting harmful bacteria.
  • It’s often linked with BV recurrence because it doesn’t restore a healthy microbiome the way L. crispatus does14.

That said, some studies show that when someone has a higher amount of L. iners before treatment with antibiotics like metronidazole, they may respond better to the medication. This means L. iners might be a useful marker to help predict who will respond well to BV treatment.

Yeast Infections

Candida yeast infections happen more easily when protective vaginal Lactobacillus species are low15. While L. iners does help keep the vaginal environment acidic (thanks to its lactic acid production), it doesn’t have strong antifungal powers.

That’s because L. iners:

  • Doesn’t make hydrogen peroxide
  • Doesn’t produce special peptides that break up Candida biofilms

This makes L. iners-dominant microbiota more likely to lead to recurrent or symptomatic yeast infections.

By comparison, L. crispatus, L. gasseri, and L. reuteri have been shown in microbiology and immunology research to:

  • Block the growth of Candida albicans
  • Break apart tough biofilms that protect yeast
  • Reduce inflammation in the genital tract

Urinary Tract Infections (UTIs)

There’s a strong connection between your vaginal microbiome and urinary tract health. When L. iners dominates your vaginal microbiota, you are at an increased risk of UTIs, especially recurring ones.

Here’s why:

  • L. iners doesn’t provide strong antimicrobial defense in the vaginal–urinary zone
  • It doesn’t produce H₂O₂ or bacteriocins (natural antimicrobial substances)
  • It may not stop harmful bacteria like E. coli from moving into the urinary tract—especially if L. crispatus and other protective species are missing

This makes L. iners a weak defender when it comes to UTI prevention.

Why L. iners Is Often Missed in Tests

Despite being one of the most common microbes in the vaginal microbiota of reproductive-age women, Lactobacillus iners is frequently overlooked or misidentified in standard diagnostic tests. That’s because it breaks the mold—literally and figuratively—when it comes to how vaginal bacteria are typically identified.

Here’s why it’s so tricky to detect and what to know if you want accurate results.

Nugent Score: Good for Some, Not for L. iners

One of the most common ways doctors check for bacterial vaginosis (BV) is with the Nugent score. This test looks at vaginal bacteria under a microscope and sorts them by shape and how they react to a special stain (called a Gram stain)—a process based on phenotypic characteristics.

But here’s the problem: Lactobacillus iners doesn’t look like most other Lactobacillus species. It’s smaller and has a shape that can easily be confused with non-beneficial bacteria.

Because of that:

  • L. iners is often missed or misidentified
  • The test might say everything is “normal,” even if your vaginal microbiome is off balance
  • It can underestimate the presence of helpful (or not-so-helpful) Lactobacillus bacteria

Bottom line: The Nugent score is good for spotting obvious infections, but it’s not detailed enough to pick up on L. iners—or to tell the difference between truly protective and weaker lactobacilli16.

Genomic Testing: What Actually Happens in the Lab

The most accurate way to detect L. iners and other vaginal bacteria is through DNA-based testing. This is how it works:

  • Sample Collection: A vaginal swab is taken from the upper third of the vaginal wall (where bacteria are most representative).
  • Preservation: The sample is frozen or treated to keep the DNA stable.
  • DNA Extraction: Scientists isolate the bacterial DNA from the swab.
  • Amplification & Sequencing: Special regions of bacterial DNA (like the 16S rRNA gene) are copied and read using machines like Illumina NovaSeq.
  • Bioinformatics: The sequences are matched to databases to identify bacteria. A match of 99% or more confirms species like L. iners17.

This type of genomic testing is much more accurate than microscopy. It can clearly identify L. iners, L. crispatus, L. gasseri, and many other species that shape your vaginal health.

Growing L. iners in the Lab: A Scientific Breakthrough

For a long time, researchers couldn’t grow L. iners in lab settings. It was thought to be "unculturable" using normal methods for Lactobacillus.

That’s because L. iners:

  • Has a unique genome
  • Needs cysteine, that special nutrient not found in standard lab media

Recent breakthroughs solved that. Scientists added cysteine to growth media, which now lets them culture L. iners successfully. This opens the door for studying L. iners strains, testing treatments, and learning how it behaves.

However, culturing is slower and less detailed than DNA sequencing, so it’s mostly used in research labs, not in everyday clinical testing.

Side-by-Side: Genomic vs. Culture-Based Detection

Method Can Detect L. iners? Speed Detail Level Used For
Nugent Score Rarely (misses shape) Fast Low (morphology) BV screening in clinics
Culture (traditional) Historically no Slow Medium (grows few species) Research, strain isolation
Culture (cysteine-enhanced) Yes (in labs) Moderate Medium–High (experimental) Lab studies, strain profiling
16S rRNA Sequencing Yes (high confidence) Moderate High (species-level) Clinical microbiome testing
Species-Specific PCR Yes Fast High (targeted) Research or targeted testing

 

Who Should Get Tested for L. iners, and How?

Knowing the dominant bacterial communities in your vagina is not necessarily need-to-know information for every woman, but it can be helpful to get tested for L. iners if you:

  • Struggle with recurrent bacterial vaginosis, yeast infections, or UTIs.
  • Experience persistent vaginal symptoms (discharge, odor, irritation) but receive normal test results.
  • Want a clearer understanding of your vaginal microbiota for preventative care.
  • Are planning to start probiotic or therapeutic interventions to support vaginal health.

How to Get Tested

To accurately detect L. iners, you’ll need a molecular vaginal microbiome test that identifies bacteria at the species level. You can get these tests performed in your doctor’s office or using an at-home service.

Here’s what that typically includes:

  • A vaginal swab taken from the upper anterior vaginal wall
  • Sample storage and shipping with DNA stabilization or deep freezing
  • Lab-based PCR or 16S rRNA sequencing to identify species like L. iners, L. crispatus, and Gardnerella vaginalis
  • A full report detailing microbial composition, dominance patterns, and clinical implications

Best Practices for Accurate Testing

Whether you’re planning to test your vaginal microbiome in the privacy of your home or work with a provider in their office:

  • Choose DNA-based methods like 16S rRNA sequencing or species-specific PCR to detect L. iners.
  • Ensure the sample is collected from the upper anterior vaginal wall.
  • Confirm that samples are properly preserved (e.g., frozen or stabilized) before processing.
  • Look for labs or test providers that offer species-level microbiota characterization, not just broad “good vs. bad” reporting.

What to Do If Your Microbiome Is Dominated by L. iners

Lactobacillus iners plays a bit of a double role in vaginal health. It can be helpful in some situations, but not so great in others. For some people, having lots of L. iners is no big deal. But in others, especially during times of change like after your period, antibiotics, or sex, it might be a sign that your vaginal microbiome is off balance.

An L. iners–dominant microbiome isn’t always something to stress about. Still, if it comes with ongoing symptoms or recurring infections like bacterial BV, yeast infections, or UTIs, it could mean your body needs a little extra support.

Here are a few things you can do to help rebalance your vaginal microbiome and support the more protective types of Lactobacillus:

1. Add a Targeted Vaginal Probiotic

Choosing a high-quality vaginal probiotic with clinically studied strains like Lactobacillus crispatus (L. crispatus), Lactobacillus rhamnosus (L. rhamnosus), and Lactobacillus gasseri (L. gasseri) can help promote a healthier, more stable microbial environment18.

These vaginal Lactobacillus species:

  • Produce hydrogen peroxide and lactic acid, which lower vaginal pH and inhibit pathogens19.
  • Support the vaginal immune system and reduce biofilms linked to recurrent BV and yeast infections.
  • Compete more effectively with L. iners and anaerobic bacteria often involved in vaginal dysbiosis.

Happy V’s Prebiotic + Probiotic is specifically designed with these protective strains to help shift the vaginal microbiota away from L. iners dominance and toward a more resilient, lactobacillus-dominated environment.

In fact, preclinical research shows that Happy V’s unique blend of Lactobacillus species significantly inhibits the growth of both Gardnerella vaginalis (associated with BV) and Candida albicans (linked to yeast infections), helping to restore balance and reduce the risk of recurrence.

2. Avoid Disruptive Habits

Protect your vaginal ecosystem by steering clear of activities that disrupt your natural flora, like:

  • Overuse of antibiotics or douching
  • Tight or synthetic underwear
  • Scented vaginal products, including wipes and washes (stick with warm water and mild, unscented soap)
  • Smoking or excessive alcohol consumption (which can affect gut and vaginal microbiota via the gut-vagina axis)

3. Support with Diet and Hydration

Diet plays a critical role in microbiome resilience. To support your vaginal microbiota:

  • Eat foods rich in prebiotic fiber, like asparagus, oats, garlic, and bananas
  • Include fermented foods such as yogurt, kefir, or kimchi for microbiome diversity20
  • Stay hydrated to maintain optimal genital tract tissue function and immune health (aim for 8-10 glasses of water a day)

4. Retest and Monitor Your Vaginal Microbiome

Because L. iners often appears during microbial transitions, it’s important to retest your vaginal microbiota every few months, especially if you’re recovering from an infection or trying a new treatment. Regular testing using 16S rRNA gene sequencing or species-specific PCR can help you and your provider track progress and determine whether more protective lactobacillus spp., like L. crispatus, are taking hold.

Final Thoughts

Lactobacillus iners is a unique figure in the vaginal microbiome: not quite a villain, but not your best defense either. While it may help predict how you respond to treatment for infections like bacterial vaginosis, its presence is often a sign that your vaginal flora is in transition.

With the right tools, science-backed strategies, and clinical support, you can help shift your vaginal microbiota toward a more stable, lactobacillus-dominated environment, even if L. iners is currently in charge.

Keep the Conversation Going

 

Disclaimer: This blog is for informational and educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Statements about supplements have not been evaluated by the Food and Drug Administration. For more information about vaginal infections, visit the CDC or speak to a licensed healthcare provider.

FAQ

What probiotic strains are included in Happy V® Prebiotic + Probiotic?

Happy V® Prebiotic + Probiotic includes 7 clinically-studied strains:

  • Lactobacillus acidophilus LA-14®
  • Lacticaseibacillus rhamnosus HN001™
  • Lactobacillus crispatus CCFM1110™
  • Lactobacillus gasseri HLG13™
  • Lactobacillus reuteri HR7™
  • Bifidobacterium lactis HN019™
  • Bacillus subtilis DE111®

These strains are chosen for their proven ability to support both gut and vaginal flora balance.*

Does Happy V® Prebiotic + Probiotic really work for BV and yeast infections?

Yes. Happy V® Prebiotic + Probiotic includes probiotic strains that have been clinically studied for their ability to reduce symptoms and recurrence of both bacterial vaginosis (BV) and yeast infections (YI) – especially when used as a daily preventive. In clinical studies, these strains improved symptoms like itching, discharge, and odor, and significantly reduced infection recurrence over 3 to 6 months.*

Is Happy V® Prebiotic + Probiotic FDA approved?

Like all dietary supplements, Happy V® Prebiotic + Probiotic is not FDA approved. However, many of its ingredients have FDA-recognized GRAS (Generally Recognized As Safe) status and are made in facilities that follow FDA current Good Manufacturing Practices (cGMP).

[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.

Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub AY. Ecological dynamics of the vaginal microbiome in relation to health and disease. Am J Obstet Gynecol. 2019;220(4):324-335. doi:10.1016/j.ajog.2018.11.1089.

[2] Macklaim JM, Clemente JC, Knight R, Goor GB, Reid G. Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microbial Ecology in Health and Disease Volume 26, 2015 - Issue 1

[3] Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Frontiers in Reproductive Health. 2023;5:1100029. doi:10.3389/frph.2023.1100029.

[4] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. Rev Obstet Gynecol. 2009;2(1):28-37. doi:10.3909/ —

[5] Pendharkar S, Cribby S, Macklaim JM, et al. Lactobacilli and Their Probiotic Effects in the Vagina. Front Cell Infect Microbiol. 2023;13:1128480. doi:10.3389/fcimb.2023.1128480.

[6] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. PubMed Central. 2009. Figure 1. Gram stain of normal vaginal contents (original magnification, ×400).

[7] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. Rev Obstet Gynecol. 2009;2(1):28-37. doi:10.3909/ —

[8] Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023;5:1100029. doi:10.3389/frph.2023.1100029.

[9] Amabebe E, Tatiparthy M, Kammala AK, Richardson LS, Taylor BD, Sharma S, Menon R. Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. NPJ Biofilms Microbiomes. 2025;11:6. doi:10.1038/s41522-025-00748-0.

[10] De Alberti D, Russo R, Terruzzi F, Nobile V, Ouwehand AC. Lactobacilli vaginal colonisation after oral consumption of Respecta® complex: a randomised controlled pilot study. Arch Gynecol Obstet. 2015;292(4):861-867. doi:10.1007/s00404-015-3711-4.

[11] Livengood JB. Bacterial Vaginosis: An Overview for 2009. Am J Obstet Gynecol. 2009.

[12] Amabebe E, Tatiparthy M, Kammala AK, Richardson LS, Taylor BD, Sharma S, Menon R. Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. NPJ Biofilms Microbiomes. 2025;11:17. doi:10.1038/s41522-025-00748-0.

[13] Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, Sreenivas V, Kochupillai N. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007;30(2):312-317. doi:10.2337/dc06-1469

[14] Edris H, Makhdoumi P, Taha P, Hossini H, Pirsaheb M, Omid S, Stelling R, Stelling J. A review of available techniques for determination of nano-antimicrobials activity. Toxin Rev. 2017;36(1):18-32. doi:10.1080/15569543.2016.1237527.

[15] Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23(2):253-273. doi:10.1128/CMR.00076-09.

[16] Livengood CH. Bacterial vaginosis: an overview for 2009. Rev Obstet Gynecol. 2009 Winter;2(1):28-37.

[17] Abraham C. Think You Have a Vaginal Infection? Here’s What You Need to Know. The American College of Obstetricians and Gynecologists.

[18] Ang XY, Roslan NS, Ahmad N, Yusof SM, Abdullah N, Nik Ab Rahman NN, Woon JJ, Teh CS, Todorov SD, Liu G, Liong MT. Lactobacilli reduce recurrences of vaginal candidiasis in pregnant women: a randomized, double-blind, placebo-controlled study. J Appl Microbiol. 2022;132(4):3168-3180. doi:10.1111/jam.15158.

[19] Morales B, et al. Evaluation of the Probiotic In Vitro Potential of Lactic Acid Bacteria from Canine Vaginal Samples. PMC. 2022.

Kim YH, Kim CH, Cho MK, et al. Hydrogen peroxide–producing Lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes. Int J Gynaecol Obstet. 2006;93(1):22-27. doi:10.1016/j.ijgo.2006.01.013.

Tachedjian G, O’Hanlon DE, Ravel J. The implausible “in vivo” role of hydrogen peroxide as an antimicrobial factor produced by vaginal microbiota. Microbiome. 2018;6:29.

[20] Bodke P, et al. Role of Probiotics in Human Health Cureus. 2022;14(7):e26872. doi:10.7759/cureus.26872.

[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.

Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub AY. Ecological dynamics of the vaginal microbiome in relation to health and disease. Am J Obstet Gynecol. 2019;220(4):324-335. doi:10.1016/j.ajog.2018.11.1089.

[2] Macklaim JM, Clemente JC, Knight R, Goor GB, Reid G. Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microbial Ecology in Health and Disease Volume 26, 2015 - Issue 1

[3] Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Frontiers in Reproductive Health. 2023;5:1100029. doi:10.3389/frph.2023.1100029.

[4] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. Rev Obstet Gynecol. 2009;2(1):28-37. doi:10.3909/ —

[5] Pendharkar S, Cribby S, Macklaim JM, et al. Lactobacilli and Their Probiotic Effects in the Vagina. Front Cell Infect Microbiol. 2023;13:1128480. doi:10.3389/fcimb.2023.1128480.

[6] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. PubMed Central. 2009. Figure 1. Gram stain of normal vaginal contents (original magnification, ×400).

[7] Livengood CH III. Bacterial Vaginosis: An Overview for 2009. Rev Obstet Gynecol. 2009;2(1):28-37. doi:10.3909/ —

[8] Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023;5:1100029. doi:10.3389/frph.2023.1100029.

[9] Amabebe E, Tatiparthy M, Kammala AK, Richardson LS, Taylor BD, Sharma S, Menon R. Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. NPJ Biofilms Microbiomes. 2025;11:6. doi:10.1038/s41522-025-00748-0.

[10] De Alberti D, Russo R, Terruzzi F, Nobile V, Ouwehand AC. Lactobacilli vaginal colonisation after oral consumption of Respecta® complex: a randomised controlled pilot study. Arch Gynecol Obstet. 2015;292(4):861-867. doi:10.1007/s00404-015-3711-4.

[11] Livengood JB. Bacterial Vaginosis: An Overview for 2009. Am J Obstet Gynecol. 2009.

[12] Amabebe E, Tatiparthy M, Kammala AK, Richardson LS, Taylor BD, Sharma S, Menon R. Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. NPJ Biofilms Microbiomes. 2025;11:17. doi:10.1038/s41522-025-00748-0.

[13] Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, Sreenivas V, Kochupillai N. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007;30(2):312-317. doi:10.2337/dc06-1469

[14] Edris H, Makhdoumi P, Taha P, Hossini H, Pirsaheb M, Omid S, Stelling R, Stelling J. A review of available techniques for determination of nano-antimicrobials activity. Toxin Rev. 2017;36(1):18-32. doi:10.1080/15569543.2016.1237527.

[15] Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23(2):253-273. doi:10.1128/CMR.00076-09.

[16] Livengood CH. Bacterial vaginosis: an overview for 2009. Rev Obstet Gynecol. 2009 Winter;2(1):28-37.

[17] Abraham C. Think You Have a Vaginal Infection? Here’s What You Need to Know. The American College of Obstetricians and Gynecologists.

[18] Ang XY, Roslan NS, Ahmad N, Yusof SM, Abdullah N, Nik Ab Rahman NN, Woon JJ, Teh CS, Todorov SD, Liu G, Liong MT. Lactobacilli reduce recurrences of vaginal candidiasis in pregnant women: a randomized, double-blind, placebo-controlled study. J Appl Microbiol. 2022;132(4):3168-3180. doi:10.1111/jam.15158.

[19] Morales B, et al. Evaluation of the Probiotic In Vitro Potential of Lactic Acid Bacteria from Canine Vaginal Samples. PMC. 2022.

Kim YH, Kim CH, Cho MK, et al. Hydrogen peroxide–producing Lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes. Int J Gynaecol Obstet. 2006;93(1):22-27. doi:10.1016/j.ijgo.2006.01.013.

Tachedjian G, O’Hanlon DE, Ravel J. The implausible “in vivo” role of hydrogen peroxide as an antimicrobial factor produced by vaginal microbiota. Microbiome. 2018;6:29.

[20] Bodke P, et al. Role of Probiotics in Human Health Cureus. 2022;14(7):e26872. doi:10.7759/cureus.26872.