The vaginal microbiota – what is normal?

Today we look at a recently published paper about the vaginal microbiota throughout women’s lives and what is considered ‘normal’. 

The journal:

Journal of Lower Genital Tract Disease

The paper:

The Vaginal Microbiome: I. Research Development, Lexicon, Defining “Normal” and the Dynamics Throughout Women’s Lives (Dec 2021)

The authors: 

Hans Verstraelen, MD, MPH, PhD, Pedro Vieira-Baptista, MD, Francesco De Seta, MD, Gary Ventolini, MD, FACOG, Risa Lonnee-Hoffmann, MD, PhD,  and Ahinoam Lev-Sagie MD

Take-home points:

• The vaginal microbiota has been studied extensively in recent years, with a focus on understanding how it affects women’s health and the risk of various diseases.
• The authors also discuss the concept of a “healthy” or “normal” vaginal microbiome, which is typically dominated by Lactobacillus species. However, the definition of a healthy microbiome is not clear-cut and may vary depending on factors such as age, hormonal status, and sexual activity.
• The paper also explores the changes that occur in this microbiome throughout a woman’s life, from birth to menopause. These changes can be influenced by a variety of factors, including hormonal changes, sexual activity, and pregnancy.

What can change the vaginal microbiota?

Hormonal changes: 

The vaginal microbiome can be influenced by hormonal changes, such as those that occur during puberty, the menstrual cycle, pregnancy, and menopause. For example, it tends to be dominated by Lactobacillus species in women of reproductive age, but may shift to a more diverse community of bacteria after menopause.

Sex:

Sexual activity can also impact the composition of the vaginal microbiome. For example, women who are sexually active tend to have a more diverse microbiome compared to those who are not sexually active.

Antibiotic use:

Antibiotics can disrupt the balance of the vaginal microbiome by killing off beneficial bacteria, allowing other bacteria to overgrow.

Contraceptives:

Some types of hormonal contraceptives, such as the birth control pill, can affect the vaginal microbiome by altering hormone levels. Additionally, certain types of contraceptives, such as intrauterine devices (IUDs), may increase the risk of bacterial vaginosis.

Tampons and pads:

The use of certain types of menstrual hygiene products, such as tampons and pads, can also impact the vaginal microbiome. For example, the use of scented products or those containing certain chemicals may disrupt the microbiome.