Vaginal microbiota

In general, the study of the vaginal microbiome can be a valuable test to assess a woman's vaginal and reproductive health.

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What is the vaginal microbiota?

Vaginal microbiota is the set of microorganisms that live in symbiosis in the woman's vagina and are involved in maintaining good vaginal and reproductive health in women. The vaginal microbiota is constantly changing and any alteration in its balance could lead to different gynaecological pathologies.

Microbiota and impact on women's vaginal and reproductive health.

The composition of microorganisms in the vaginal microbiota is influenced by several factors, such as genetic predisposition, age, menstrual cycle, childbirth, vaginal microbiota, antibiotic use and sexual practices. Studies have shown that disruption of the vaginal microbiota may lead to negative outcomes in women's vaginal and reproductive health. The main genus in the vaginal microbiota is Lactobacillus, so a Lactobacillus-dominated vaginal microbiota is associated with a healthy bacterial community.

Why is it useful to know the patient's vaginal microbiota?

Alteration of the vaginal microbiota could explain those cases of patients with vaginal and reproductive health problems where conventional test results are normal. Therefore, normalisation of the vaginal flora could improve the prognosis in these patients with appropriate treatment. The study of the vaginal microbiota allows a more accurate and effective approach to the prevention, diagnosis and treatment of various gynaecological and obstetric conditions, thus improving the overall health and well-being of the patient.

How do we conduct a vaginal microbiota study?

The study of the vaginal microbiota is carried out on the basis of a vaginal sample taken by a gynaecologist and using the most advanced techniques in mass sequencing (Next-generation sequencing (NGS)). Metagenomic analysis of the sample will allow us to identify and quantify the different microorganisms by sequencing the 16S rRNA gene present in the woman's vaginal flora.

What are the advantages of using sequencing in the study of the vaginal microbiome?

  • Accuracy and precision: Sequencing can identify and quantify microorganisms with greater precision than traditional methods, detecting even those that cannot be cultured.
  • Discovery of new species: Helps to identify new microbial species and variants that could influence vaginal health.
  • Monitoring changes: Allows to monitor changes in the composition and function of the microbiome over time, in response to different factors.
  • Association with disease: Helps identify associations between microbiome composition and different gynaecological diseases.
  • Development of new treatments: May help develop personalised treatments for diseases related to the vaginal microbiome.
  • Understanding vaginal health: Contributes to a better understanding of vaginal health in general, including the role of the microbiome in fertility, protection against pathogens and the overall health of the female reproductive system.

Should we test vaginal or endometrial microbiota?

Vaginal sampling is taken from the vaginal canal, and is usually performed with a sterile swab inserted into the vagina to collect cells and fluid. Endometrial sampling, however, is taken from the endometrium, which is the inner layer of the uterus, and is performed by endometrial aspiration or biopsy, a procedure that may require local anaesthesia. Both samples are clinically similar, so vaginal sampling would be less invasive, more comfortable and painless for the patient, and therefore preferable to endometrial sampling, which is invasive and uncomfortable.

In which cases is a vaginal microbiome study indicated?

Vaginal microbiome testing, also known as vaginal flora analysis, can be useful in a number of situations to assess a woman's vaginal and reproductive health. The following are some of the most common cases in which this type of study is recommended:

  • Recurrent vaginal infections: The study of the microbiome can help identify the specific cause of recurrent vaginal bacterial infection (bacterial vaginosis) and guide the most appropriate treatment to restore a woman's vaginal health.
  • Fertility problems: Alterations in the balance of the vaginal microbiome can affect a woman's ability to achieve a successful pregnancy. Studying the microbiome can help identify bacterial dysbiosis and determine whether it may be contributing to fertility problems.
  • Endometritis: Endometritis is an inflammation of the inner lining of the uterus that may be related to an imbalance in the vaginal microbiome. Studying the microbiome can help diagnose endometritis and determine if antibiotic treatment is necessary.
  • Preterm birth: Some research suggests that an imbalanced vaginal microbiome may be associated with an increased risk of preterm birth. Studying the microbiome during pregnancy can help identify women at increased risk and take preventive measures.
  • Cervical cancer: Human papillomavirus (HPV) is the main risk factor for cervical cancer. However, some research suggests that the vaginal microbiome may also play a role in the development of this disease. Studying the microbiome can help to identify women at increased risk of cervical cancer and to take preventive measures.
  • Prior to in vitro fertilisation (IVF) treatment: Vaginal microbiome study prior to IVF can help identify possible alterations that could affect fertility treatment success rates. In patients with recurrent implantation failure and repeated miscarriages, a study of the vaginal microbiome is recommended in order to improve the IVF treatment prognosis.
  • Menopause: Hormonal changes during menopause may affect the balance of the vaginal microbiome, which may increase the risk of infections and other vaginal health problems. Studying the microbiome during menopause can help identify these alterations and take preventive measures.

How to restore the vaginal microbiota? Oral probiotics and antibiotics.

A woman's vaginal and reproductive health is fundamental to a healthy life, so it is important to review a woman's lifestyle habits, avoid toxic habits, and eat a balanced diet. Oral probiotics are a good therapy to restore the vaginal flora to a healthier one and improve female health. In certain cases, in which the vaginal microbiota is altered and pathogenic bacteria have been detected, antibiotic treatment should be considered.

In general, the study of the vaginal microbiome can be a valuable test to assess a woman's vaginal and reproductive health.

 

5 Studies supporting the usefulness of the vaginal microbiome study:

  1. "The Role of the Vaginal Microbiome in Reproductive Health and Disease" (2018): Este estudio de revisión exhaustivo analiza la evidencia actual sobre el papel del microbioma vaginal en la salud reproductiva y las enfermedades. Los autores concluyen que el microbioma vaginal juega un papel crucial en la protección contra infecciones, la regulación de la inflamación y el mantenimiento de la salud vaginal general. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183339/
  2. "Association of the Vaginal Microbiome with Recurrent Vulvovaginal Candidiasis" (2016): Este estudio investiga la relación entre el microbioma vaginal y la candidiasis vulvovaginal recurrente (CVV). Los autores encontraron que las mujeres con CVV tenían un microbioma vaginal menos diverso y con mayor abundancia de bacterias relacionadas con la enfermedad. https://pubmed.ncbi.nlm.nih.gov/36816582/
  3. "The Vaginal Microbiome and Its Role in Human Health and Disease" (2020): Este estudio proporciona una descripción general completa del microbioma vaginal, incluyendo su composición, función y papel en la salud y la enfermedad. Los autores discuten el potencial del microbioma vaginal como biomarcador y objetivo terapéutico para diversas enfermedades. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183339/
  4. "The Influence of the Vaginal Microbiome on Assisted Reproductive Technology Outcomes" (2021): Este estudio revisa la evidencia sobre el impacto del microbioma vaginal en los resultados de las tecnologías de reproducción asistida (TRA). Los autores concluyen que un microbioma vaginal saludable puede mejorar las tasas de éxito de la FIV y otras técnicas de TRA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693990/
  5. "The Vaginal Microbiome and Cervical Cancer Risk" (2017): Este estudio investiga la asociación entre el microbioma vaginal y el riesgo de cáncer de cuello uterino. Los autores encontraron que las mujeres con un microbioma vaginal dominado por bacterias relacionadas con la enfermedad tenían un mayor riesgo de desarrollar cáncer de cuello uterino. https://pubmed.ncbi.nlm.nih.gov/35276341/

 5 IBernabeu Studies supporting the usefulness of the vaginal microbiome study:

  1. Effect of the vaginal microbiome on the pregnancy rate in women receiving assisted reproductive treatment (2019): Este estudio investiga cómo la composición del microbioma vaginal influye en las tasas de embarazo en mujeres que se someten a tratamientos de reproducción asistida (TRA). Los hallazgos indican que un microbioma vaginal dominado por Lactobacillus, está asociado con mayores tasas de éxito en los TRA. https://pubmed.ncbi.nlm.nih.gov/31446545/
  2. Characterization of the vaginal and endometrial microbiome in patients with chronic endometritis (2021): Este estudio demuestra cómo la composición del microbioma vaginal y endometrial está relacionada con la endometritis crónica. Mujeres con endometritis crónica presentan un microbioma alterado en comparación con mujeres sin endometritis crónica. https://pubmed.ncbi.nlm.nih.gov/34144490/
  3. Impact of the Vaginal and Endometrial Microbiome Pattern on Assisted Reproduction Outcomes (2021): Este estudio analiza cómo los patrones del microbioma influyen en los resultados de la reproducción asistida. Las mujeres que lograron un embarazo clínico tenían una mayor abundancia de lactobacilos. https://pubmed.ncbi.nlm.nih.gov/34575174/
  4. Identification of vaginal microbiome associated with IVF pregnancy (2022): Este estudio investiga cómo la composición del microbioma vaginal influye en los resultados de la fertilización in vitro. Resalta la importancia de considerar el microbioma vaginal en los tratamientos de fertilidad. https://www.nature.com/articles/s41598-022-10933-2
  5. Characterization of the Endometrial Microbiome in Patients with Recurrent Implantation Failure (2023): Este estudio indica que analizar el microbioma endometrial podría proporcionar información valiosa para tratar a pacientes con fallo de implantación recurrente, aunque tomar una muestra endometrial es un procedimiento invasivo. Dado que el microbioma vaginal también ofrece información relevante y es más fácil de obtener, podría considerarse una alternativa menos invasiva en algunos contextos clínicos. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10054712/