The Vaginal Microbiome in Health and Disease-What Role Do Common Intimate Hygiene Practices Play?

Abstract

The vaginal microbiome is a dynamic, sensitive microenvironment. The hallmark of a 'healthy' vaginal microbiome is currently believed to be one dominated by Lactobacillus spp., which acidifies the vaginal environment and help to protect against invading pathogens. However, a 'normal' microbiome is often difficult, if not impossible, to characterise given that it varies in response to numerous variables, including pregnancy, the menstrual cycle, contraceptive use, diet, ethnicity, and stress. A Lactobacillus-depleted microbiome has been linked to a variety of adverse vaginal health outcomes, including preterm birth (PTB), bacterial vaginosis (BV), and increased risk of sexually transmitted infections. The latter two of these have also been associated with feminine intimate hygiene practices, many of which are practised without any evidence of health benefits. The most extensively studied practice is vaginal douching, which is known to cause vaginal dysbiosis, predisposing women to BV, pelvic inflammatory disease, and PTB. However, little is known of the impact that intimate hygiene practices and associated products have on the vaginal microbiome. This review aims to outline the major factors influencing the vaginal microbiome and common vaginal infections, as well as to summarise current research surrounding the impact of hygiene products and practices on the vaginal microbiome.

Keywords: female hygiene; sexual health; vagina; vaginal microbiome.

Figure 1

Bacterial Dynamics of Major Bacterial Genera and Species throughout the Menstrual Cycle. The Follicular phase (Day 1–7) occurs following menses and is characterised by the gradual increase in levels of follicle-stimulating hormone (FSH), estrogen, and luteinising hormone (LH); the vaginal microbiome at this time is typically dominated by various anaerobes and L. iners. During ovulation (~Day 14) and throughout the luteal phase (Day 15–28), levels of circulating estrogen are high, resulting in the dominance of optimal Lactobacilli such as L. crispatus, L. gasseri, and L. jensenii. Created with BioRender.com.