Moving Forward
Studies inconsistently account for factors known to influence the
microbiome, such as hygiene practices, diet, and stress. Overlooking
these factors may explain why it remains unclear that some individuals’s
vaginal communities are dominated by Lactobacillus and others
lack it completely. By shifting the focus towards understanding the
diverse CST and factors which shape the vaginal microbiome, research can
move beyond associative understanding into relational understanding.
Investigating this gap in knowledge is especially important for
addressing health disparities and understanding the vaginal health of
minority communities given the higher prevalence of diverse CSTs among
of Hispanic and Black individuals. It is possible that accounting for
factors which are known to impact the vaginal microbiome, research can
better explain these gaps in knowledge.
The diverse CST must be understood for research on the vaginal
microbiome to translate to improved patient care. New therapies, such as
vaginal microbiota transfers, are being developed based on the concept
that Lactobacillus dominated communities are the best fit for all
individuals68.
As there are differences in vaginal microbiomes, the community of best
fit must be selected while taking into account the patient’s healthy CST
at baseline and potential moderating factors that may shift microbial
community patterns (ex: stress, hygiene practices, etc). Given that the
dominating paradigm focuses on Lactobacillus dominance, these new
therapies may lead to the exclusion of people with the diverse CST and
further health disparities.
While there are gaps in what is known and how research on the vaginal
microbiome is conveyed, these gaps are mendable. The systematic
evaluation of factors known to impact vaginal health and the vaginal
microbiome may prove important to clinical scientists in the quest to
develop effective therapies targeting vaginal conditions and
subsequently improve patient care.