Fig. 3: Ecosystem developments along the assembly of the microbiota in the neovagina of MRKH patients.

a Heatmap distribution of the relative abundances of the 15 most abundant species within each of the three DMM clusters. The contribution of each species to each cluster is distinctly represented in three separate bar graph panels on the right-hand side. An asterisk (*) in each bar graph panel signifies the top three contributing species within each respective cluster. b DMM type transition of the vaginal microbiota in MRKH patients from PRE to P2/4Y with circles and lines scaled according to the number of patients. c PCoA showing the shifts in the vaginal microbiota from PRE to P2/4Y. Patients are divided into three panels based on the DMM type at PRE. Red, blue, and green indicate DMM type 1, 2, and 3, respectively. d Intra-individual Bray–Curtis dissimilarities between the vaginal microbiota at PRE and P2/4Y among MRKH patients within three DMM types. Two-sided Wilcoxon rank-sum test were used. Box plot elements include: Centerline for median, box limits for upper and lower quartiles; whiskers indicate 1.5× interquartile range; and points for outliers. e Co-occurrence network between bacterial species at each time-point (PRE, P14D, P90D, and P2/4Y) with nodes representing the species and edges representing significant correlations (P  <  0.05). Blue edges indicate interactions characterizing the pre-surgery state and re-captured along the assembly in the neovagina. Yellow edges indicate new interactions formed in the neovagina at P14D and P90D and lasted until 2–4 years post-surgery. Nodes outlined in yellow, along with the corresponding microbial species, have been accentuated to delineate the newly identified interactions post-surgery, as indicated by the yellow edges.