hey ladies (and theybies)!

I have an update since my previous post on the topic.

Basically it just works - my vagina no longer has ups and downs with occasional weird smells. I douche once a week now, and I exclusively use home-made lube for dilation (which is currently twice a week), and I insert a small amount of home-made prebiotic gel to feed the lactobacillus - and it just works! My vagina mostly doesn’t have much of an odor at all anymore, and my overnight pads have various smells in the morning that are much more consistent and I would mostly describe as smelling even a bit tasty and a bit like a young cheese or yogurt and maybe a bit like sourdough bread? I take this to be a sign the lactobacillus are remaining dominant, and when I deviate from my routine (e.g. skipping depositing the gel one night), I notice an impact on the odor (which corrects when I get back on my routine).

Here are the details:

upfront, I just want to disclaim: I’m not a doctor, none of this is medical advice, what I’m doing is probably crazy and making mistakes could have health consequences - so … I don’t know, be entertained, but don’t assume because I’m doing this that it’s safe. I feel like a doctor would probably tell you to not do what I’m doing, so that’s probably worth pointing out. Evidence-based medicine is important, listen to your doctors.

Douching

I stopped douching with 2.5% vinegar (acetic acid) solution, instead I now douche with a 5% lactic acid solution

I stopped douching every other day, instead now I douche once a week (once I heal enough that my dilation schedule is less than once a day, I might reduce this to “as needed” - maybe every other week?)

Lube

As far as the home-made lube: I use it exclusively now because I find normal lube has a pH of around 7.0 which disrupts my vaginal microbiome and causes weird smells that only go away after douching. I use a home-made lube that is made to be around a pH of 4.0 - 4.5 using lactic acid, which promotes an environment friendly to lactobacillus in my vaginal canal while being hostile to other bacteria and yeasts.

If you don’t want to make your own lube, the only lube I know of that you can buy that is pH adjusted is made by a company called Good Clean Love. They do put fragrance in their lube, and it’s rather expensive (which really doesn’t work for me because dilation requires lots of lube), but it’s effective and you can just buy it if you have the money and don’t have time to make your own lube.

Here’s how I make my home-made lube, the base starts with:

• 50% aloe vera gel
• 50% distilled water

so, a few notes: I started with 100% water-based lube (just distilled water), but I found that the resulting gel was too structured and that resulted in the unpleasant sensation of my dilator forming a kind of vacuum with my vagina, such that when I tried to pull my dilator out of my vagina it would create negative pressure and I had to carefully and patiently apply pressure to successfully pull the dilator out of me (often having to try to twist it back and forth in the attempt to break up the structural lock the lube made).

The aloe gel seems to help break this up and makes the dilator glide more. I would like to replace the aloe with something better, but I don’t know what would work. I’m not a scientist or chemist, etc.

I found a base of 25% aloe vera gel and 75% water was still too “structural” and created some negative pressure still - but 50% seems to work fairly well and is a decent compromise.

The aloe vera gel is a real liability as an ingredient - you have to be careful to buy a good gel that doesn’t have additives that will mess up the purpose of the lube. It’s not uncommon to find preservatives and ingredients like citric acid added to aloe vera to make it shelf-stable.

The aloe gel I buy is 99% aloe vera gel, and 1% vegetable glycerin. Glycerin is generally an ingredient I explicitly avoid in lubes, as it can feed yeasts and cause yeast infections. It’s also a humectant and can draw moisture out of mucus membranes causing irritation, so it’s generally not recommended as safe or desirable in lube.

That said, in the context of my lube, the glycerin actually helps with the gliding and breaking up the structure of the lube, even if it’s a liability. Ideally I would find an alternative, but right now it’s the least bad additive I have found to the aloe gel that I’m using in my base.

It also probably helps that the neo-vagina is not a mucus membrane (particularly my vagina, which is lined with scrotal skin grafts), which might help with reduced risk of irritation and damage from glycerin. Also, in lubes with glycerin as an ingredient use significantly more glycerin (quick googling shows it ranges between 2 - 40% of the lube is glycerin), whereas my lube would have less than 1% glycerin.

OK, once you have your base, you weigh it and then add:

• 1% lactic acid powder
• 0.2% potassium sorbate
• 0.3% sodium benzoate
• 1% xanthan gum
• 0.4% agar agar powder (not flakes)

I used to slowly add more and more lactic acid until I got the pH I wanted, but so far the batches I have made found 1% lactic acid always got me within my desired pH window, so I stopped taking the careful titrating approach and just trust the 1% now.

The lactic acid I used originally was a food-grade powder you might find vegans using to make vegan cheeses and so on (brands like Druid Grove and Crait), but I noticed those had additives like calcium lactate and anti-caking agents like silicon dioxide so I switched to a more pure medical grade lactic acid powder (like is used for face masks and other cosmetics), as that has no other ingredients or additives.

I still use the food-grade powder for douching, as I don’t think the additives are going to make much of a difference in that context as in lube and prebiotic gel.

So, if you have 100 g of base lube, in the end these would be the ingredient amounts:

• 50 g distilled water
• 50 g aloe vera gel
• 1 g lactic acid
• 0.2 g potassium sorbate
• 0.3 g sodium benzoate
• 1 g xanthan gum
• 0.4 g agar agar

I keep playing with the levels of xanthan gum and agar agar to change the consistency. So far I like this consistency - it’s thin enough to be able to be pumped through a bottle pump, but it’s thick enough that it mostly stays where I put it (like, if I pump some onto a dilator, I can turn the dilator upside down and pump some on the other side without worrying the lube will slide off).

I find if I add too much agar agar that the lube becomes “chunky” and it can be hard to suck up into a lube syringe.

I will probably continue to tinker with these numbers, but I’m definitely happy with this recipe and I’ve used it daily dilation for around a month with great results.

The potassium sorbate and sodium benzoate are both preservatives, and this helps keep the lube from going bad. I use those preservatives in particular because they’re what Good Clean Love uses, and they are common ingredients in lots of cosmetics and food products, so I consider them relatively safe while still being effective. They’re more effective at a lower pH, so the fact that the lube is acidic significantly increases the preservative effects of these compounds. I also store the lube in the fridge when I’m not using it to help prevent it from going bad (and I use a beer koozie to keep it chilled outside the fridge).

I bought some pump lids that screw onto mason jars, and I make my batches in a mason jar and then screw on a lid with a pump. I didn’t like the pump that came with the lids, so I reused a pump from a Slippery Stuff lube bottle and screwed it onto the mason jar lid, and then I cut the pump’s “straw” to size. It works like a charm!

The agar agar has to be boiled to be activated.

You also need a scale that can handle fine measurements - like a yeast scale for baking, or a jewelry scale. Something that can measure accurately for at least a tenth of a gram, but I think typical accuracy is to 0.01 to 0.001 g.

Also, I use a stick immersion blender to blend the ingredients - I add the base ingredients to the mason jar, then weigh out my powders on the side, then I add the powders to the base and use the stick blender to combine the ingredients thoroughly. It’s important to do the xanthan gum last, as it is very difficult to get it to blend and it has a tendency to clump into little gel balls. It’s much easier to incorporate the other powders into the aloe + water (even easier into just water), but the xanthan gum makes it difficult to incorporate further ingredients as it reacts with the water and thickens. (The xanthan gum is what creates so much structure that the gel was able to form a “seal” and create negative pressure when I tried to pull the dilator out. The obvious solution to prevent this would be to reduce the amount of xanthan gum, but then I lose the thick viscosity I need so that I don’t have to worry about the lube being runny - this is a research task for me to finesse at some point so I can avoid using aloe vera gel.)

Once the agar agar is well incorporated, I put the jar in the microwave and microwave it until the gel is boiling hard. I like to do the mixing in a tall, wide-mouth 3 or 4 cup (~0.7 - 1 L) mason jar so that I have time to stop the microwave before it bubbles over - I’ve had some disasters where I microwaved too long and most of my lube ended up on the microwave plate outside of my jar 😭

I microwaved a 500 g batch of lube in a quart (~1 L) mason jar and it was boiling after 2.5 minutes of microwaving, but this will depend on your microwave’s power settings.

You have to give the lube time to gel up - the xanthan gum in particular has to thicken and absorb the water, and I find the consistency is much thinner even after cooling than the next day when I find it has become thicker in the fridge overnight.

So don’t plan to use the lube until the next day at the earliest.

You can buy sensitive pH test strips that test for a particular range (like I think the ones I use are sensitive between a pH of 3.0 and 5.0). I always test my batches to ensure the pH is what I intend, because a pH that is too low (like 3.0 - 3.5) can cause irritation and actually can make it harder for lactobacillus to grow. And of course a pH that is too basic (5.0 and higher) is not acidic enough to suppress other bacteria and yeast and give lactobacillus an advantage.

OK, enough about the lube: next topic is my favorite, the prebiotic gel.

Prebiotic Gel

The prebiotic gel is the real solution to the microbiome problem.

It replaces the cervical mucus that is typically produced in a natal vagina - cervical mucus has a concentration of glucose around 3% and that’s what I aim for in my prebiotic gel. I insert the gel (usually around 2 mL) once a night using a lube syringe.

The ingredients for the gel are similar to the lube, but there are some slight variations:

• 100% water
• 1% lactic acid powder
• 0.1% potassium sorbate
• 0.1% sodium benzoate
• 3% glucose
• 0.75% xanthan gum
• 0.5% agar agar powder

So the base is all water, no aloe vera (since this isn’t used for dilation, so there is no need to solve the structural problems caused by xanthan gum).

I use more agar and less xanthan gum because I want a gel that is more solid and will deposit and stay in place rather than “flow” and potentially leak out. This is another area where I need to tinker and find the right amounts that are not so chunky that they can’t easily be sucked into a lube syringe, but chunky and thick enough that it will stay in the canal and not leak out when I pee or sit.

Just like for the lube, this prebiotic gel has to be boiled to set the agar (and I microwave it as well to do so).

The preservatives are also reduced in concentration. This is an area that could use some more research and tinkering. I noticed that bacteria and yeasts were still successfully feeding on Slippery Stuff lube to create a bacterial-vaginosis-like environment, and that’s despite the preservatives used in Slippery Stuff. I also noticed that when I used a lactobacillus probiotic vaginal suppository and then deposited some home-made gel with sucrose (powdered sugar), that the lactobacillus were able to feed on that gel despite the fact that it was made with a Slippery Stuff base that had preservatives …

So my running hypothesis is that under the right conditions, the lactobacillus are able to “overpower” the preservatives and eat the sugar in the gels I’m making. So I need some amount of preservative to make the gel safe to store and use over time (otherwise I would have to make a new, small batch of gel every single night - something I did as a test / trial-run when I first developed this prebiotic gel idea, but which I only did once before incorporating preservatives), but I need the preservatives to not be so strong that the gel won’t function as food for the lactobacillus.

I don’t know if it’s irresponsible to use the preservative concentrations I picked out - but I reasoned that the preservatives are even more effective than normal in acidic solutions like this gel, and that the acidity itself is a major barrier to spoiling, so I thought I would try it. So far, the prebiotic gel I made over a month ago has not gone rancid or shown any signs of contamination. I keep it in a mason jar in the coldest part of my fridge with a secure lid, and the main vector of contamination is when I open it once a day to suck a little of the gel into a clean lube syringe. So far so good, we’ll see if I have to adjust the proportions.

Importantly, the gel seems to be feeding lactobacillus. If I skip a day, there is a noticeable difference in my smell and it seems less lactobacillus-dominant (smells less like the typical yogurt smell, and is more smelly). This corrects when I go back to depositing the prebiotic. So, my guess is that the gel is working as fuel.

I changed the sugar from sucrose (powdered sugar) to glucose because it more closely matches the contents of cervical mucus (glycogen), but my observations so far is that lactobacillus is happy to use sucrose just as well, and there is no noticeable difference using glucose. 3% sucrose seems to be a completely reasonable substitute, and I would even recommend it as it’s easier to get your hands on powdered sugar at any given grocery store than to find a glucose powder (which is a specialty ingredient you probably would have to buy online).

The amount of cervical mucus produced in a natal vagina varies, and seems to change with the menstrual cycle. Several milliliters are produced per day leading up to and during ovulation, and much less being produced after ovulation and during menstruation.

I’ve considered trying to adjust the amount of prebiotic gel I deposit to match my weekly hormonal cycle, depositing more after my injection as my estrogen levels increase and peak, then depositing less or none at all as my estrogen wanes - but I think so far it seems like daily deposits are most helpful right now (particularly as I have daily dilation, and dilation is disruptive to the microbiome).

I think depositing less frequently will be more possible once I don’t have a daily dilation schedule, and that might be a time to experiment with syncing prebiotic gel amounts with my hormones.

Closing Thoughts

My experience so far has been that lactobacillus seem easy to cultivate and keep happy, given you maintain an environment that supports them by only using acidic lube and feeding them a sugar.

I am skeptical oral vaginal probiotics are that helpful, and I’m skeptical you even need something like a probiotic vaginal suppository - I have tried both, but I have found even months after using them that if my microbiome gets disrupted, that it rights itself if you maintain the right pH and feed with prebiotic gel.

Maybe I benefitted from introducing strains through oral and vaginal probiotics that otherwise wouldn’t have appeared, but lactobacillus strains are likely already present and will probably be able to grow and maintain dominance as long as you provide a supportive environment.

There’s really not much left for me to do on this front. There is room for tinkering and finesse, but by and large I feel I have succeeded in what I set out to do, and I just hope this can be helpful to other women who want to help promote healthier vaginal microbiomes. I suspect the same principles applied for natal vaginas as neovaginas (creating the right environment results in lactobacillus-domanince and a happy vagina), but the neovaginal environment has some minor differences that lead to different practices (e.g. douching is not recommended in a natal vagina, as the vagina “self cleans” as the vaginal epithelium is special in that it constantly exfoliates and sloughs off). A natal vagina also provides its own prebiotic (the cervical mucus produces glycogen, but the vaginal epithelium also contains high levels of glycogen and estrogen helps those cells also acidify the environment).

So a typical natal vagina that is properly estrogenized will naturally create an environment conducive to lactobacillus, and when it’s failing to do that it’s usually just a matter of resetting with antibiotics so the bacteria or yeast that managed to gain dominance over the lactobacillus is defeated, and then making adjustments so that the natural mechanisms are effective (sometimes this means for women who are menopausal, introducing HRT like a vaginal gel that ensures the vagina remains estrogenized; sometimes this means using a pH adjusted lube during sex so that penetration doesn’t as negatively disrupt the microbiome, it will depend on the person).

A neo-vagina on the other hand is not self-cleaning and does not constantly exfoliate, and so it requires occasional douching. (It’s a good idea to douche a neo-vagina every time after penetrative sex, for example, and it’s recommended that you don’t allow men to ejaculate inside you.)

A neo-vagina also doesn’t have any of the mechanisms that promote lactobacillus: there is no cervical mucus or vaginal-specific epithelium that produces glycogen that feeds the lactobacillus, nor is there a vaginal epithelium that responsd to estrogen by acidifying the enivornment (thus promoting lactobacillus).

So the neo-vagina requires more interventions, but it does not seem that hard. It’s a bit like having a sourdough starter, but in your coochie. ;-)

If you’re still reading, thanks for entertaining my Special Interest, I hope you have gleaned something valuable from this.