Studying the Perception of Vaginal Microbiota Transplants
Vaginal microbiota transplants (VMTs) have recently been studied and proposed as a promising treatment for various vaginal disorders and infections (1, 2, 6). Most vaginal disorders result from an imbalance in the ecosystem of microbes living in the vagina, known as the vaginal microbiota (5). A dominance of Lactobacillus species, especially Lactobacillus crispatus, is considered protective for vaginal and reproductive health (3, 4). When various other microbes grow uninhibited, bacterial vaginosis (often due to an increase in anaerobic species such as Gardnerella vaginalis) and yeast infections (an overgrowth in Candida species) can result, as well as an increased risk for negative reproductive health outcomes, such as pre-term births and sexually transmitted infections (3, 4). Vaginal microbiota transplants may serve to restore a protective and stable vaginal microbiome.
Vaginal disorders resulting from an imbalanced vaginal microbiota composition are associated with irritating symptoms like odor, itchiness, pain, and unusual discharge. An imbalanced vaginal microbiota composition is also strongly correlated with negative reproductive health outcomes (pre-term births, infertility), increased incidence of sexually transmitted infections, vaginitis, endometriosis, polycystic ovarian syndrome, and gynecological cancers (3, 5). The goal of VMTs is to transfer vaginal microbiota from healthy donors into the vaginas of females suffering from some degree of dysbiosis. Prior studies have shown VMTs to be effective at relieving vaginal irritation, increasing the abundance of L. crispatus, and even providing long-term remission for intractable bacterial vaginosis within 1-3 treatments (2, 6). They also indicate VMTs may be a more efficacious and long-term treatment than current treatments (antibiotics and anti-fungals), which have high rates of recurrence, and probiotics, which yield mixed results (3). Unlike antibiotics and anti-fungals, which lead to an indiscriminate destruction of the vaginal microbiota and further dysbiosis, VMTs may lead to a healthy, balanced, eubiotic vaginal microbiome. A balanced vaginal microbiome is also more immunologically equipped to prevent and/or eliminate human papillomavirus, thus lowering the risk of cervical cancer (3). It has been proposed, therefore, that vaginal microbiota transplants may be a modality to improve immunotherapy efficacy (1). Just as the intestinal microbiome plays myriad roles in the body (intersecting with neurology, immunology, inflammation, digestion, etc.), the vaginal microbiome seems to also greatly influence many diseases associated with vaginal health (1).
Given the potential clinical applications of a treatment like VMTs, which requires the transfer of a live bio-therapeutic into a sensitive body part, understanding people’s perceptions and willingness to undergo such a treatment is essential to successfully test and safely implement it in clinical practice. There are several studies reviewing VMTs and their future in female healthcare, indicating this is an exciting time for the field of the vaginal microbiome (1, 3). These studies discuss the safety and effectiveness of VMTs, as well as their potential to treat vaginal dysbiosis, reduce risk of sexually transmitted infections, and reduce the risk of pre-term births (1).
Considering the decades-long neglect of vaginal health and exclusion of women from health research, it is not surprising that there are few survey studies on women’s vaginal health. A feminine hygiene survey conducted at the University of Colorado’s medical school showed that 71% of women had at least one of five vulvovaginal symptoms in the past two weeks (painful, irritating, dry, itching, discharge) (7). The symptom with the highest percentage was pain (7). The “normalization” of poor vaginal health may be due to a lack of patient awareness, hesitancy to bring up symptoms to healthcare providers, and/or stigmatization associated with having an “unclean” vagina (which leads to inappropriate feminine hygienic care that can disrupt the microbiome and contribute to dysbiosis) (8). A cross-sectional survey done in Canada reported that 80% of 1,435 respondents had experienced an adverse vaginal symptom in their lifetime, and that those who had used vaginal products (which impact the vaginal microbiome) were 3x more likely to have had an adverse vaginal symptom (9). Antibiotic use may also increase incidence of vaginal dysbiosis, as seen in mice in a 2020 study focused on cervical cancer development (10). There are likely many factors involved in the high prevalence of vaginal dysbiosis, and vaginal microbiota transplants may be a long-term treatment to restore the vaginal microbiome to a state of eubiosis in the face of these various factors.
References
Meng Y, Sun J, Zhang G. Vaginal microbiota transplantation is a truly opulent and promising edge: fully grasp its potential. Front Cell Infect Microbiol [Internet]. 2024 [cited 2024 Apr 30];14:1280636. Available from: https://www.frontiersin.org/articles/10.3389/fcimb.2024.1280636/full
Wrønding T, Vomstein K, Bosma EF, Mortensen B, Westh H, Heintz JE, et al. Antibiotic-free vaginal microbiota transplant with donor engraftment, dysbiosis resolution and live birth after recurrent pregnancy loss: a proof of concept case study. EClinicalMedicine [Internet]. 2023 [cited 2024 Apr 30];61(102070):102070. Available from: https://pubmed.ncbi.nlm.nih.gov/37528843/
Han Y, Liu Z, Chen T. Role of vaginal Microbiota dysbiosis in gynecological diseases and the potential interventions. Front Microbiol [Internet]. 2021 [cited 2024 Apr 30];12. Available from: http://dx.doi.org/10.3389/fmicb.2021.643422
Ceccarani C, Foschi C, Parolin C, D’Antuono A, Gaspari V, Consolandi C, et al. Diversity of vaginal microbiome and metabolome during genital infections. Sci Rep [Internet]. 2019 [cited 2024 Apr 30];9(1):1–12. Available from: https://www.nature.com/articles/s41598-019-50410-x
Nava-Memije K, Hernández-Cortez C, Ruiz-González V, Saldaña-Juárez CA, Medina-Islas Y, Dueñas-Domínguez RA, et al. Bacterial vaginosis and sexually transmitted infections in an HIV-positive cohort. Front Reprod Health [Internet]. 2021;3. Available from: http://dx.doi.org/10.3389/frph.2021.660672
Lev-Sagie A, Goldman-Wohl D, Cohen Y, Dori-Bachash M, Leshem A, Mor U, et al. Vaginal microbiome transplantation in women with intractable bacterial vaginosis. Nat Med [Internet]. 2019 [cited 2024 Apr 30];25(10):1500–4. Available from: https://www.nature.com/articles/s41591-019-0600-6
Advances in Technical Nonwovens [Internet]. Vol. 121, women in the United States . Obstetrics and Gynecology. Elsevier; 2016. p. 773–80. Available from: https://medschool.cuanschutz.edu/docs/librariesprovider31/education-docs/colorado-springs/2019-2020-qi-projects/the-feminine-hygiene-and-vulvovaginal-symptom-survey.pdf?sfvrsn=376114b9_2
Holdcroft AM, Ireland DJ, Payne MS. The vaginal microbiome in health and disease—what role do common intimate hygiene practices play? Microorganisms [Internet]. 2023 [cited 2024 Apr 30];11(2):298. Available from: http://dx.doi.org/10.3390/microorganisms11020298
Crann SE, Cunningham S, Albert A, Money DM, O’Doherty KC. Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey. BMC Womens Health [Internet]. 2018;18(1). Available from: http://dx.doi.org/10.1186/s12905-018-0543-y
Karpinets TV, Solley TN, Mikkelson MD, Dorta-Estremera S, Nookala SS, Medrano AYD, et al. Effect of antibiotics on gut and vaginal microbiomes associated with cervical cancer development in mice. Cancer Prev Res (Phila) [Internet]. 2020 [cited 2024 Jun 14];13(12):997–1006. Available from: http://dx.doi.org/10.1158/1940-6207.capr-20-0103