The microbiome downstairs…

Y’all already know about the gut microbiome, let’s chat about the reproductive microbiome! There’s been many advances in microbiology and molecular techniques in recent years that have allowed us to better understand the complex and delicate environment of the vagina and the role it plays in health. I wrote a whole assignment on this, but I’ll summarise the main points for you:

✿ The vaginal microbiome (VGM) plays a crucial (if not MOST important) role in maintaining sexual health and preventing reproductive disease.

✿ Flora with high levels of Lactobacillus species, in particular Lactobacillus crispatus, are most associated with optimal vaginal health.

✿ Lactobacillus thrives in the acidic environment it helps to create by producing lactic acid. This acidity deters the growth the harmful bacteria and fungi, preventing infections. It also maintains the immune integrity of the vagina by protecting the lining from penetration by unwanted cells.

✿ The bladder (previously thought to be a sterile organ) has been shown to mimic healthy populations of bacteria in the vagina, playing a protective role in preventing Urinary Tract Infections.

✿The VGM is a living ecosystem that is constantly dynamic. Sexual behaviours, personal hygiene, medications and hormonal fluctuations all can disrupt the delicate balance of the VGM. This disruption, called dysbiosis can cause a decrease in Lactobacillus and an introduction of other, less desirable bacteria, creating an environment more susceptible to infections and overgrowths.

✿Bacterial Vaginosis (BV) is characterised by dysbiosis and the presence of anaerobic bacteria such as (but not exclusive to) Gardnerella vaginalis & Ureaplasma urealyticum. Symptoms include malodour, itching, irritation and changes to discharge. Research suggests a large portion of people with BV are asymptomatic, however it is important to note that even when asymptomatic, BV is still a risk factor for STIs, HIV and poor birth outcomes.

✿ The VGM plays a role in fertility and pregnancy. Lactobacillus dominance contributes to healthy vaginal lubrication and improves sperm motility and survival. VGM dysbiosis is associated with early pregnancy loss, excessive inflammation and pre-term birth.

✿ Safe sex practices, hygiene, sex hormones and contraception all influence the VGM. Unprotected penetrative sex is most likely to affect the VGM due to the unique bacterial profile of the penile microbiota (that’s right fellas). Semen also introduces a distinct bacterial population that can transiently decrease Lactobacillus levels, introduce new pathogens and illicit an immune response. You know what I’m going to say… wrap it 😎.

✿ In this same vein, anything that enters the vagina (i.e sex toys, menstrual cups, tampons, fingers, lubricant, condoms) has the potential to introduce new bacteria, keeping these things clean (clean ingredients, materials, washing before sexual activity) is key!

✿ Many other lifestyle factors, such as smoking & diet, can influence the VGM. A holistic view is essential in maintenance. Probiotics are showing promising results in treating dysbiosis, which is significant given typical medical treatment for BV results in a 50% chance of reoccurrence within 12 months.

Just when you think you’ve got bodily autonomy, you realise there’s actually thousands of little bacterium governing your health. Don’t be scared!! We can learn to care for them, weed out the baddies and make sure they can do their work properly.

References

Bradshaw, C. S., Morton, A. N., Hocking, J., Garland, S. M., Morris, M. B., Moss, L. M., ... & Fairley, C. K. (2006). High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with
recurrence. The Journal of infectious diseases, 193(11), 1478-1486.

Chen, X., Lu, Y., Chen, T., & Li, R. (2021). The female vaginal microbiome in health and bacterial vaginosis. Frontiers in cellular and infection microbiology, 11, 631972. https://doi.org/10.3389/fcimb.2021.631972

Cherpes, T. L., Hillier, S. L., Meyn, L. A., Busch, J. L., & Krohn, M. A. (2008). A delicate balance: risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide-producing lactobacilli, black race, and positive herpes simplex virus type 2 serology. Sexually transmitted diseases, 35(1), 78-83.

DOI: 10.1097/OLQ.0b013e318156a5d0

De Seta, F., Lonnee-Hoffmann, R., Campisciano, G., Comar, M., Verstraelen, H., Vieira-

Baptista, P., Ventolini, G., & Lev-Sagie, A. (2022). The vaginal microbiome: III. The vaginal microbiome in various urogenital disorders. Journal of Lower Genital Tract Disease, 26(1), 85-92.

Homayouni, A., Bastani, P., Ziyadi, S., Mohammad-Alizadeh-Charandabi, S., Ghalibaf, M., Mortazavian, A. M., & Mehrabany, E. V. (2014). Effects of probiotics on the recurrence of bacterial vaginosis: a review. Journal of lower genital tract
disease, 18(1), 79-86. DOI: 10.1097/LGT.0b013e31829156ec

Lewis, F. M., Bernstein, K. T., & Aral, S. O. (2017). Vaginal microbiome and its relationship to behavior, sexual health, and sexually transmitted diseases. Obstetrics & Gynecology, 129(4), 643-654. DOI: 10.1097/AOG.0000000000001932

Mehta, S. D., Zhao, D., Green, S. J., Agingu, W., Otieno, F., Bhaumik, R., ... & Bailey, R. C. (2020). The microbiome composition of a man's penis predicts incident bacterial vaginosis in his female sex partner with high accuracy. Frontiers in cellular and infection microbiology, 10, 433. https://doi.org/10.3389/fcimb.2020.00433

Saraf, V. S., Sheikh, S. A., Ahmad, A., Gillevet, P. M., Bokhari, H., & Javed, S. (2021). Vaginal microbiome: normalcy vs dysbiosis. Archives of microbiology, 203, 3793- 3802. https://doi.org/10.1007/s00203-021-02414-3

Torcia, M. G. (2019). Interplay among vaginal microbiome, immune response and sexually transmitted viral infections. International journal of molecular sciences, 20(2), 266. https://doi.org/10.3390/ijms20020266

Vitale, S. G., Ferrari, F., Ciebiera, M., Zgliczyńska, M., Rapisarda, A. M. C., Vecchio, G. M., ... & Cianci, S. (2021). The role of genital tract microbiome in fertility: a systematic review. International journal of molecular sciences, 23(1), 180. https://doi.org/10.3390/ijms23010180