It is not well understood why some healthy vaginal microbiomes are
dominated by Lactobacillus and some are not. This review outlines
factors which impact the vaginal microbiome and may explain this
phenomenon. Specifically, hygiene practices, diet, sexual partners and
practices, gender affirming treatments, stress, and social determinants
are discussed. 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 in health and disease.