“If men had yeast infections, we’d never put up with this nonsense.” So says Larry Forney, an evolutionary ecologist with the University of Idaho. He’s talking about an itching, burning problem experienced by over a third of the people on the planet at some point in their lives. It’s not fatal or permanent, but it’s damned annoying. And because it’s so taboo, he believes, it hasn’t gotten the attention or treatment it deserves.
“If more people knew the problems women have to deal with so often, there’d be more attention paid to them,” he says in his fourth-floor office in the heart of the Moscow campus. “But if you call your doctor [about this], they’ll tell you to go to the pharmacy. They won’t even see you — ‘Don’t worry your pretty little head. Go to Rite-Aid and get this gel.’” Forney says he’s disturbed at the amount that we don’t know about women’s reproductive health. And perhaps even more disturbed by what we think we do know.
For the past few years, he and a team of students and researchers at Idaho and the University of Maryland have been studying the bacteria teeming inside the vagina. Here, as in every other part of the body, these tiny organisms (10 times more numerous than our cells), eat up the nutrients we provide, metabolize them, and in so doing, lower the surrounding pH level, making everything a little more acidic and creating an environment hostile to most infections.
It’s the same principle — even some of the same bacteria — you find in yogurt, sausage, pickles. Bacteria help things keep.
But two separate studies that Forney’s team conducted suggest that what the medical community thought it knew about vaginal bacteria was wrong. In one study, his team took one sample each from 400 healthy, reproductive-age women from four different ethnic groups and found that pH levels tended to be higher among black and Hispanic women than among white and Asian women. (Forney readily concedes that ethnicity is an imperfect demographic descriptor here.)
That alone was surprising. In addition, while textbooks say that a pH level above 4.5 is unhealthy, Forney’s study showed that more than half of his black and Asian subjects exceeded that level. “So if you apply the common wisdom, the conclusion is that 50 percent of these women are not healthy. That’s pretty absurd. Of course they’re healthy. But they’re different,” he says. “The rules you learn when studying Caucasian women cannot necessarily be applied to other women.”
In a separate study, the team had 33 women take self-samples every three or four days over a 16-week period. The women would then send these samples to a lab, which would fire up a new and expensive machine — $8,000 per batch of samples — to sequence the DNA. What they found was that while one woman’s vagina might be dominated by a particular strain of Lactobacillus bacteria, another might be controlled by a different type. Not only that, but the species composition of these vaginal communities can change — sometimes wildly, and for no particular reason — from day to day, week to week.
“The conception [has been] that vaginal communities are pretty stable. The only time they change a lot is when they have a problem,” he says. “But no, even when people are normal and healthy, they’re changing a lot.” (The team is now embarking on an even larger version of the same study, with 200 respondents taking daily swabs.)
What science has missed is what Forney calls the “ecosystem” of the vagina — its unique and sometimes changing set of conditions. By unraveling the genetics behind these observations, they hope to be able to determine how those bacterial ecosystems relate to risks of infections like bacterial vaginosis, yeast infections and HIV. In the future, using the science conducted in Moscow and Maryland, doctors giving yearly screenings could use a simple color-changing dipstick to get a sense of a patient’s vaginal ecosystem and be able to give that patient advice about the risks they run and how to prevent infection and disease.
Forney motions to one wall of his office, where he has hung a framed print of Rene Magritte’s famous oil painting The Treachery of Images. It depicts a tobacco pipe with the words, “This is not a pipe.”
“I use Magritte when talking to students about research. What we’re trying to do is to develop an understanding of what happens in the real world. And oftentimes people lose sight of the fact that they’re not actually describing the real world — they’re describing an impression of the real world,” Forney says. “It could be that they don’t have enough data. Or they haven’t seen enough of the real world to get a completely accurate picture.
“Well, that’s what Magritte’s doing here. This is not a pipe. This is a painting of a pipe. It’s very different. Otherwise people think that we know all there is to know, and we’re done.”
