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Vaginal Microbiome – Function and Health

The vaginal microbiome refers to the community of microorganisms living in the vagina. It protects against infections and is essential for female reproductive health.

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Things worth knowing about "Vaginal Microbiome"

The vaginal microbiome refers to the community of microorganisms living in the vagina. It protects against infections and is essential for female reproductive health.

What Is the Vaginal Microbiome?

The vaginal microbiome is the collection of microorganisms – primarily bacteria – that inhabit the vagina. These microbial communities play a central role in female health by protecting the vaginal environment from infections, inflammation, and the colonization of harmful pathogens. Unlike the gut microbiome, which thrives on high diversity, a healthy vaginal microbiome is characterized by low microbial diversity and the dominance of Lactobacillus bacteria.

Composition and Function

In most women of reproductive age, the vaginal microbiome is dominated by Lactobacillus species, particularly:

Lactobacillus crispatus
Lactobacillus iners
Lactobacillus gasseri
Lactobacillus jensenii

These bacteria produce lactic acid, which lowers the vaginal pH to approximately 3.8 to 4.5. This acidic environment inhibits the growth of harmful pathogens such as fungi (e.g., Candida albicans) and harmful bacteria. Lactobacilli also produce hydrogen peroxide and bacteriocins, which further contribute to antimicrobial defense.

Factors That Influence the Vaginal Microbiome

The balance of the vaginal microbiome can be affected by a range of internal and external factors:

Hormonal changes: Pregnancy, menstruation, menopause, and hormonal contraceptives all influence microbial composition.
Antibiotics: Antibiotic use can reduce Lactobacillus populations and disrupt the natural balance.
Sexual activity: The exchange of microorganisms during sexual contact can alter the vaginal microbiome.
Hygiene practices: Excessive intimate hygiene, douching, or use of harsh soaps can disrupt the natural microbial environment.
Diet and lifestyle: Dietary habits, smoking, and psychological stress can also affect microbial composition.
Ethnicity: Research indicates that the composition of the vaginal microbiome can vary across different ethnic groups.

Dysbiosis: When the Balance Is Disrupted

Vaginal dysbiosis refers to a disruption of the microbial balance in which protective Lactobacillus bacteria decline and other microbial species overgrow. The most common manifestation is bacterial vaginosis (BV), characterized by an increase in anaerobic bacteria such as Gardnerella vaginalis, Prevotella, and Mobiluncus species. Symptoms of dysbiosis may include:

Altered vaginal discharge with a fishy odor
Changes in the consistency or color of vaginal discharge
Itching or burning in the genital area
Elevated vaginal pH (above 4.5)

Vaginal dysbiosis increases the risk of sexually transmitted infections (STIs), urinary tract infections, and pregnancy complications such as preterm birth.

The Vaginal Microbiome During Pregnancy

During pregnancy, the vaginal microbiome undergoes significant changes: Lactobacillus dominance typically increases, stabilizing the microbiome and providing protection for the newborn during delivery. Babies born vaginally are colonized by the maternal vaginal microbiome during birth – a process known as microbial seeding, which plays an important role in shaping the infant immune system.

Diagnosis and Testing

Several methods are used to assess the vaginal microbiome:

pH measurement: A simple test that determines the acidity of the vaginal environment.
Microscopic examination: Assessment of a vaginal swab under a microscope (e.g., wet mount preparation, Gram staining).
Microbiome analysis: Advanced molecular techniques such as 16S rRNA sequencing allow detailed profiling of bacterial communities.
Culture methods: Growing bacteria from vaginal swabs to identify specific pathogens.

Treatment and Prevention

When dysbiosis or bacterial vaginosis is confirmed, several treatment options are available:

Antibiotics: Metronidazole or clindamycin are commonly prescribed for bacterial vaginosis.
Probiotics: Vaginal or oral probiotics containing Lactobacillus strains may help restore microbial balance and reduce recurrence.
Lactic acid preparations: Vaginal gels containing lactic acid can help lower pH and restore the acidic environment.
Hygiene recommendations: Gentle intimate hygiene without harsh products and avoiding vaginal douching support a healthy microbiome.

References

Ravel J. et al. - Vaginal microbiome of reproductive-age women. Proceedings of the National Academy of Sciences, 2011. PMID: 20534435.
Workowski KA, Bolan GA. - Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (CDC), 2021.
Petrova MI et al. - Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health. Frontiers in Physiology, 2015. doi:10.3389/fphys.2015.00081.

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