The Vaginal Microbiota: Current Perspectives on Health and Disease

Abstract

The vaginal microbiota is a complex and dynamic microbial ecosystem that plays a fundamental role in maintaining female reproductive and urogenital health. In healthy individuals, the vaginal environment is typically dominated by Lactobacillus species, which contribute to host defense by producing lactic acid, hydrogen peroxide, and other antimicrobial compounds that maintain a low vaginal pH and inhibit the growth of pathogenic microorganisms. The composition of the vaginal microbiota is influenced by various factors, including age, hormonal fluctuations, menstrual cycle, sexual activity, pregnancy, hygiene practices, and the use of antibiotics or contraceptives. Disruptions in the normal microbial balance, commonly referred to as vaginal dysbiosis, are associated with several gynecological and obstetric conditions, such as bacterial vaginosis, vulvovaginal candidiasis, sexually transmitted infections, infertility, preterm birth, and adverse pregnancy outcomes. Recent advances in molecular and sequencing technologies have significantly enhanced our understanding of the diversity, function, and host–microbe interactions within the vaginal ecosystem, revealing variations in microbial community structures among different populations and individuals. These insights have highlighted the importance of the vaginal microbiota as a key determinant of reproductive health and disease susceptibility. Furthermore, emerging therapeutic approaches, including probiotics, prebiotics, microbiota transplantation, and personalized microbiome-based interventions, show promise in restoring microbial balance and preventing disease. This review summarizes current knowledge regarding the composition, physiological functions, determinants, and clinical significance of the vaginal microbiota, while discussing recent advances in diagnostic and therapeutic strategies. A deeper understanding of vaginal microbial ecology may contribute to improved prevention, diagnosis, and management of reproductive tract disorders, ultimately enhancing women's health outcomes and quality of life.

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