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.