The effects of vaginal microbiome on women’s health

Over the last ten years, research into the vaginal microbiome and how it affects women’s overall health has significantly accelerated.

As scientists, academics, and medical experts build knowledge around the vaginal microbiome, increasing evidence indicates that an imbalance of the vaginal microflora can lead to disease, infections, and fertility problems in women.¹

This article describes what the vaginal microbiome is, the properties of microorganisms that colonize the vagina, and how it impacts the overall health of women.

Covering the history of the vaginal microbiome, the aim of this article is to report how the exponential rise in research over the last decade is revolutionizing the development of diagnostic tests and treatments.

It becomes evident how different the vaginal microbiome is from other microbiomes of the human body in terms of bacteria, fungi, and viruses present and how this influences the body’s ability to combat infection and disease.

Technological innovations and advancements are being explored to help strengthen awareness and understanding of how new products and treatment solutions are being developed with the emergence of new human skin equivalent (HSE) models that simulate the vaginal microbiome. Moreover, there is an increased demand for microbiome-friendly intimate care products.

Image Credit: Labskin

The future of vaginal microbiome research will also be explored to determine how advanced diagnostic tools and treatment solutions will be able to help researchers save time, improve cost efficiency and widen its accessibility.

Approximately 95{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of the Lactobacillus genera of bacteria make up normal vaginal flora, and the approximate pH balance of a healthy vagina is 4.5, the same as tomatoes and wine.

Image Credit: Labskin

What is the vaginal microbiome?

The vaginal microbiome is a combined ecosystem of bacteria, yeasts, viruses, fungi, and other microorganisms that colonize the vagina.

The microbiome has a considerable role to play in a woman’s overall health; a balanced vaginal microbiome means the vagina is well-protected from pathogens and anaerobic bacteria, all of which help to prevent infections and other diseases.

With over one million bacterial genes, representing over 300 species of different bacteria in the vagina,³ Lactobacillus is the species that dominate the vaginal microbiome.

Lactobacilli create lactic acid to preserve a low, acidic pH within the vagina and impede the growth of undesirable pathogens such as Candida, E. coli, Gardnerella vaginalis, and Atopobium Vaginae.³ However, genes, ethnicity, and the physiological status of the vagina can also influence the balance of the vaginal microbiome.⁴

Image Credit: Labskin

The history of vaginal microbiome research

In 1982, Albert Doderlein, a German obstetrician and gynecologist, first discovered a large gram-positive bacterium in the vagina, vaginal bacillus.⁵ Since then, additional studies have demonstrated that numerous kinds of vaginal communities exist in healthy women, comprised of different bacterial species depending on ethnicity and physiological states.

Typically, one of four common Lactobacillus will be dominant:

• L. crispatus
• L. iners
• L. gasseri
• L. jensenii

While lower proportions of lactic acid bacteria are seen in other vaginal community state types, a higher proportion of strictly anaerobic organisms is also likely.⁶

Recent progress in the technological field has facilitated an increase in the amount of data on the vaginal microbiome, such as the Human Vaginal Non-Redundant Gene Catalog, or VIRGO.

New diagnostic tests and treatments can now be evaluated as this tool includes the sequences of more than one million genes in bacteria, viruses, and fungi that are active in the vagina.⁷

There are approximately 300 species of bacteria in the vagina and roughly 1 million bacterial genes.

What does the vaginal microbiome do?

As with other microbiomes, such as the gut, skin, and scalp, the vaginal microbiome is specific to each individual.

However, its primary objective is to prevent infection and preserve good vaginal health. Race, ethnicity, hygiene, and behaviors all have a significant influence on the composition of a woman’s vaginal microflora. This means the microbiome continuously fluctuates throughout a woman’s life as a result of hormonal and lifestyle changes.

Numerous studies have been conducted to evaluate the effects of the vaginal microbiome on healthy reproduction, as it has been shown that any imbalance in the vaginal microflora may increase the risk of infertility, miscarriages, and preterm births.⁸

Interestingly, as microbes are passed onto the baby’s skin during delivery, a woman’s vaginal microflora can determine the skin microbiome of a newborn baby during birth. Whereas with cesarean birth, the mother’s stomach microflora is usually found.⁹

Vaginal dysbiosis, any disparity which affects the balance of the vaginal microbiome, may reduce the protective defenses of Lactobacilli; these may be the result of:

• Antibiotics
• Hormonal changes
• Sexual activities
• Douching
• Bacterial vaginosis (BV)

Antibiotics have been historically designed to destroy bacterial infections in the body. Unfortunately, they also wipe out the good lactobacilli bacteria responsible for protecting the vagina from yeast and urinary tract infections.

Variations in hormonal activity as women age also impact the vaginal microbiome, as oestrogen typically preserves the number of lactobacilli within the vagina.¹⁰

Pregnant or pubescent females are susceptible to elevated amounts of oestrogen, which prevents imbalances. Whereas menopausal women usually experience a decline in oestrogen levels as they age, which may lead to vaginal dysbiosis. Once an imbalance in the vaginal microbiome occurs, women are at a higher risk of contracting urogenital disorders, such as:

• Bacterial vaginosis (BV)
• Sexually transmitted infections
• Yeast infections
• Urinary tract infections

Image Credit: Labskin

Vaginal microbiome and vaginal diseases

Image Credit: Labskin

No two women will have the same vaginal microbiome; this is due to factors such as race, age, and hormonal changes. This means there are a number of challenges when diagnosing and treating different types of vaginal disease.

However, with cutting-edge technologies, new ways of evaluating the vaginal microbiome and fluctuations that can be seen when infections take hold are giving space to a broader realm of research, helping to create products that can treat infections or prevent them from occurring in the first place.¹¹

Treating vaginal disease or infections can be complicated, as symptoms vary between individuals. One of the key factors to take into consideration is a focus on the right diagnosis to treat the condition successfully, especially with ailments such as:

• Bacterial vaginosis (BV)
• Candida or yeast infections
• Trichomoniasis
• STDs, including chlamydia, genital herpes, and gonorrhea

Despite the number of oral and intravaginal treatments available, diagnosing and treating BV comes with a series of unique challenges. Failure to re-establish a healthy vaginal microbiome after infection and treatment means that infections recur in up to 50{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of patients.¹²

The prevalence of BV is between 23{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} – 29{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of the global female population while treating this condition costs around US $4.8 billion per year.¹³ Therefore, prevention and sustainable treatment strategies are absolutely necessary to decrease the burden of BV on women and prevent severe health outcomes.

Approximately $4.8 billion dollars is spent on treating bacterial vaginosis (BV) yearly.

Image Credit: Labskin

Vaginal microbiome and technology advancements

Image Credit: Labskin

Accelerating the discovery of new diagnostic testing and treatment solutions

Developing treatments for vaginal infections ran parallel to the accelerated pace at which the technology has progressed. Rather than focusing on molecular and culture-independent approaches to determine the bacteria associated with BV and other infections, researchers can now take advantage of different types of sequencing technology, including:

• Next-generation genome sequencing
• Single-cell genome sequencing
• rRNA sequencing technology¹⁴

As established, genetic factors, physiological conditions, and environmental exposures all have an influence on the vaginal microbiome. However, sequencing technology, used in combination with human skin equivalent testing (HSE) innovations that mimic the vaginal microbiome, paves the way for faster, more reliable, and targeted intimate care products and treatments.¹⁵

To develop a deeper understanding of the vaginal ecosystem, species and strain level analyses used in combination with a plethora of other approaches are required to determine what intimate care products and treatments are not just safe to use but also prevent any disruption of the vaginal microbiome.

That is why cosmetic and medical companies are increasingly turning towards innovative HSE technology, as enhanced testing capabilities now make it possible to mimic the vaginal microbiome accurately in a laboratory setting.

Systems biology will also play a key role in understanding the vaginal microbiome in the future as more advanced Al and bioinformatic tools are developed,¹⁶ in conjunction with:

• Metagenomics
• Transcriptomics
• Proteomics
• Metabolomics

Knowledge relating to the individual strains of bacteria usually found in the vaginal microbiome, along with how and why it varies between women at different stages of life, is progressing continuously. It will continue to do so to ensure the demand for microbiome-friendly feminine hygiene and intimate care products is met.

Image Credit: Labskin

Feminine hygiene and intimate care product markets

Demand for vaginal microbiome-friendly products is on the rise as consumers become increasingly aware of the importance of vaginal microbiome-friendly products when it comes to preventing disease and infections.

This means the markets for feminine hygiene and intimate care products are seeing a significant year-on-year increase across the globe. As of 2019, the feminine hygiene products market was $39.73 billion dollars, and it is expected to rise to $51.13 billion dollars by 2027 with a CAGR of 4.6{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161}.¹⁷

Cosmetic and skincare companies are partnering with research and academic companies to meet this demand by testing and validating their products as consumers become increasingly self-aware of how certain products may cause imbalance and increase the risk of infections such as yeast and urinary tract infections.

With consumer knowledge continually growing as microbiome-friendly products for the skin, scalp, gut, and other microbiome regions of the body become more widely available¹⁸, so too will the demand for vaginal microbiome-friendly products, such as:

• Menstrual hygiene products
• Deodorizing wipes
• Washes
• Bathing products
• Reusable and disposable intimate care products
• Targeted probiotics for vaginal health 

As of 2019, the feminine hygiene products market was estimated to be worth $39.73 billion dollars. Yet, by 2027, it is expected to grow, reaching $51.13 billion dollars. 

Traditionally, the development of vaginal care products supported by clinical and efficacy testing standards took years due to the fluctuating amount of research material and the sheer amount of data to be interpreted in relation to the vaginal microbiome. 

However, it is now possible to address the challenges head-on with solutions that reduce research and development (R&D) costs and expedite the time it takes to bring new products to market that comply with regulatory, safety, and efficacy standards.¹⁹ 

Image Credit: Labskin

The future of the vaginal microbiome  

While research surrounding the vaginal microbiome is still in its early days, technological innovations and reductions in the cost of analysis have created a plethora of opportunities for cosmetic, skincare, and medical companies. 

Preventing or treating vaginal disease and infection is of utmost importance due to the extremity of problems that may arise when vaginal dysbiosis occurs. This is followed by the increased demand for feminine care products that can ease symptoms associated with thrush and urinary tract infections and also prevent toxic shock syndrome (TSS). 

More research is underway regarding the pathogenesis of bacterial vaginosis, ways to optimize BV treatments, and the role that sexual transmissions and endogenous infections play in BV epidemiology.²⁰  

When studied in conjunction with the vaginal microbiome, cosmetic, skincare, and medical companies will have a summary of the effects of intimate care products on the vaginal microbiome and will thus be able to offer products specific to females depending on their age, ethnicity, hormonal, and lifestyle factors. 

Early diagnoses and enhanced treatment solutions can be accomplished by swabbing the vaginal microbiome to assess disease markers that could reveal women’s susceptibility to certain infections, especially when used in conjunction with improved AI diagnostic and big data tools. 

Now that there has been an increased reduction regarding animal testing on cosmetics and skin care products,²¹ the technological breakthrough of human skin equivalent (HSE) models will lead the way in vaginal microbiome research. 

Clinical trial participant numbers can be halved by cloning data to mimic multiple test subjects, saving time and costs to bring safe and validated products to market. 

Labskin’s 3D model for testing the vaginal microbiome 

Over the last decade, Labskin researchers and scientists have worked relentlessly to develop a commercial lab-grown, full-thickness human skin equivalent that simulates the vaginal microbiome and supports the research surrounding the impact of cosmetics, pharmaceuticals, and skincare products on the body’s microbiota. 

While other living skin equivalents have been around for a while, Labskin’s 3D model is the first with the capacity to colonize skin microflora, ensuring the most accurate results from tests without conducting expensive and time-consuming human trials or the need for animal testing. 

Labskin has made access to this technology available to commercial and research institutions and encourages project collaboration to enhance the knowledge surrounding the workings of the vaginal microbiome s. 

Labskin AI technology facilitates the creation of a repository of data and predictive analysis, supporting industry and academia in developing ethical discoveries and strategies for new hygiene and care products as well as advancements in medicine. 

References 

1. White, B.A., Creedon, D.J., Nelson, K.E., & Wilson, B.A. (2011, July 13). ‘The vaginal microbiome in health and disease
2. Brouillette, M. (2020, February 28). “Decoding the vaginal microbiome” 
3. The Gynoe Center. (2021, February 18). “What your vaginal microbiome con tell you about your feminine health” 
4. Buchta, V. (2018). “Vaginal microbiome” 
5. Wikipedia. (2020, June 5). “Albert Doderlein”
6. Ravel, J., Gojer, P., Abdo, Z., Schneider, G.N., Keonig, S.S.K., McCulle, S.L., Korleboch, S., Gorle, R., Russell, J.,  
7. Tacket, C.O., Brotman, R.M., Davis, C.C., Ault, K., Perolta, L., & Forney, L.J. (2010, June 3). “Vaginal microbiome of reproductive-age women”  
8. Mo, B., Fronce, M.T., Crabtree, J., Holm, J.B., Humphrys, M.S., Brotman, R.M., & Ravel, J. (2020, February 26). “A comprehensive non-redundant gene catalog reveals extensive within-community introspecies diversity in the human vagina”  
9. Xu, J., Bion, G., Zheng, M., Lu, G., Chon, WY., Li, W., Yong, K., Chen, Z.J., & Du, Y. (2020, January 21). “Fertility factors affect the vaginal microbiome in women of reproductive age” 
10. Labskin. (2020). “An introduction to the skin microbiome” Whitepoper  
11. The Gynoe Center. (2021, Februory 18). “What your vaginal microbiome con tell you about your feminine health” 
12. Labskin. (2021, Morch) “Viruses on Lobskin” Lobskin Morch Seminar 
13. Muzny, C.A., & Kordas, P. (2020, Morch 27). “A narrative review of current challenges in the diagnosis and management of bacterial voginosis”
14. Peebles, K., Vellozo, J., Balkus, J.E., McClelland, R.S., & Barnabas, RV (2019, Moy). “High global burden and costs of bacterial voginosis: A systemic review and meta-analysis”
15. Fettweis, J.M., Serrano, M.G., Girerd, P.H., Jefferson, K.K., & Buck, G.A. (2012, Moy 1). “A new era of the vaginal microbiome: Advances using next-generation sequencing” 
16. Labskin. (2019, October 10). “Exploring the safety of hygienic tampons” 
17. Mortin, D.H., & Marrazzo, J.M. (2016, July 19). “The vaginal microbiome: Current understanding and future directions”

About Labskin

At Labskin we deliver human skin microbiology services to support your product R&D activities in the cosmetic, personal care, medical device and pharmaceutical sectors. With our sector experience and use of technology, you will be accessing industry-focused services supported by world-leading skin science expertise.

Whether you need rapid, focused analysis or flexible, tailor-made research programs we can help you develop and validate skincare ingredients and products which really work.

Our skin model is a 3D human skin equivalent that incorporates vital biological components to model normal skin function. Developed over 12 years with more than 30 scientific journal publications, it is made from young keratinocytes (human skin cells) and adult fibroblasts (metabolically-active, collagen-producing human skin cells).

“An ideal platform for basic or applied skin research, testing compounds or formulated products for the cosmetic, pharmaceutical and chemical sectors.”

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