Introduction
The human microbiome is defined as all the microorganisms whose activity
forms ecological niches on and inside the human body, and which sustains
a dynamic and interactive relationship with their human host, becoming
crucial for their functioning and
health1.
The human microbiome is typically evaluated by body site, with the gut
microbiome being the most studied. There has been interest in exploring
the role of the vaginal microbiome on human health. The vaginal
microbiome has been linked with reproductive health outcomes, including
risk for sexually transmitted infections and adverse birth outcomes2,3.
Much of the research on the vaginal microbiome is observational and
focuses on the absence or presence of bacteria within one
genus‒Lactobacillus . The protective effect ofLactobacillus is largely attributed to its function of
maintaining an acidic environment4,5.
While Lactobacillus dominates the vaginal microbiome of most
healthy individuals, there is a significant portion of healthy people
whose vaginal microbiome is not dominated byLactobacillus , especially among Black and Hispanic
individuals6.
The goal of this review is to discuss key endogenous and exogenous
factors that clinical experts and research scientists should consider
when evaluating the vaginal microbiome and its influence on health and
disease. First, we will briefly overview the emergence of vaginal
microbiome research as it is currently understood, and highlight some of
the potential shortcomings and gaps in the science. Then, we will
outline factors which are known to impact the vaginal microbiome and
health outcomes which are important to consider in vaginal microbiome
research, such as hygiene practices, diet, and stress. Finally, we will
discuss future implications for clinical practice and research with a
focus on how to move forward in this field and overcome the barriers
discussed.