How can probiotics help male genital health?

The male genital microbiome is a relatively recent discovery and has been the subject of limited research compared with other areas of the microbiome (gut, vaginal, skin). The studies that have been done indicate that the composition of this genital microbiome is linked to fertility and sexual behaviour and, as with other parts of the body, is key in supporting immune responses.

We have written about the composition and structure of the male genital microbiome in another article, and here will be discussing the potential impact of this microbiome on specific conditions and how probiotics may be able to help with their prevention and management.

Key male genital conditions

Some of the main health issues related to the male genitalia include yeast infections, urinary tract infections (UTIs), sexually transmitted infections (STIs), erectile dysfunction (ED) and other issues specifically related to sex, and of course, fertility.

1. Yeast infections

The most well-known yeast infection is thrush, which is caused by a group of yeasts called Candida, and primarily Candida albicans. Genital yeast infections are extremely rare in men, but, if it does occur, can cause irritation, burning, itching, redness on the top of the penis, and a discharge that may have an unpleasant smell.

• Urinary tract infections

Whilst urinary tract infections are far more common in women, they can also be experienced by men and involve an imbalance of bacteria in the urethra, bladder, ureters or kidneys. This can lead to symptoms related to urination (urgency, more need, pain whilst peeing, cloudy urine or blood in the urine), abdominal or back pain, fever and possibly a discharge from the penis.

• Sexually transmitted infections

There are a number of sexually transmitted infections that impact men, including genital warts, chlamydia, syphilis, gonorrhoea and genital herpes. Symptoms of these infections can include sores, blisters, burning or itching on the penis, a discharge from the penis, pelvic pain, pain when urinating and an increased need to pee. These infections are thought to be caused by a variety of bacteria that can be passed on via sexual contact.

• ED and other sex-related issues

Erectile dysfunction is a common problem that affects millions of men worldwide and makes it difficult for them to get or maintain an erection. It is thought to occur due to physical trauma affecting blood flow to the penis, as a symptom of heart and blood sugar-related diseases, or as a result of stress and/or anxiety. It is more common in older men and can be occasional or persistent, and vary in severity.

Other male sex-related issues include low libido, premature ejaculation, delayed ejaculation and low testosterone.

• Fertility

Fertility issues have become a key concern for both men and women and have been linked to a variety of causes in men, including issues with sperm count and function, physical injuries, chronic health problems, hormone balance, age, and lifestyle factors, such as drug usage, electromagnetic radiation, and nutrient deficiency.

What role does the male genital microbiome have in these conditions?

The microbiome is directly related to many of the above conditions as it is the community of bacteria that live on or in our bodies and we each have our own unique composition of bacteria that can potentially become imbalanced and lead to symptoms.

Some strains of yeast live alongside the vast numbers and variety of bacteria in our bodies and are a normal part of our complex human ecosystem. If we are sick, have a weakened immune system, take medications such as antibiotics, or have other major stress or trauma, the balance of these microbes can become altered and this can allow opportunistic bacteria and yeast strains, such as Candida, to overgrow and cause problems. Some STIs might also increase the risk of a man developing thrush.

Similarly, UTIs are related to an imbalance of bacteria and particularly to an overgrowth of Escherichia coli (E. coli), which can attach to the cell walls lining the urinary tract easier than other bacterial strains and can potentially overgrow, leading to a UTI.

A key role of the microbiome is to support immunity and a balance of commensal microbes is key in this respect. The male genital microbiome is known to comprise many species and a myriad of strains of bacteria and maintaining balance in these microbes may help to prevent STIs and related symptoms, although there is no specific research showing that this is the case.

There is currently no specific evidence showing that the microbiome plays a role in the prevention of ED and other sex-related issues, although stress is known to impact both sexual complaints and the composition of the microbiome, which can then lead to a vicious cycle of health issues. Similarly, people with lowered immunity, a high-sugar diet, and a generally unhealthy lifestyle might make us more susceptible to a number of health issues.

Finally, in relation to fertility, the existence of a male genital microbiome (and in particular the testicular microbiome) indicates that there is a potential for dysbiosis in this area, which may, in turn, affect the environment in which sperm are produced and developed. The gut microbiome itself may also impact sperm production as it is closely related to hormone metabolism and has a role in managing inflammation throughout the body.

Can probiotics help?

As proxies (substitutes) for the bacteria in our microbiome, probiotics are live microorganisms that help to restore bacterial balance throughout the body. In this way, probiotics can help to prevent health-related issues specifically linked to bacteria and yeast and also to support the immune system in fighting potential infection.

Bacteria also act as part of the mucosal barriers in our body, thus helping to prevent unwanted microbes from attaching to them and supporting their function as physical protection from the outside world.

Thus, probiotics can help to support a balanced microbiome and may help to prevent some health issues related to the male genitals, such as yeast, bacterial and urinary tract infections.

Maintaining an environment in which healthy commensal bacteria can thrive is also important – throughout the whole body, as well as in the genito-urinary organs. The latest research papers are starting to hypothesise about the interplay between diet, gut microbiota and male infertility and more research is likely to be forthcoming in this area in the coming years. The relationship between these elements is complex, but the gut-testis axis and the therapies that might support it, including probiotics, are now a key part of the discussion around therapeutic strategies for diseases and conditions specific to men.