Vaginal Microbiome Dynamics and Reproductive Health

The vaginal microbiome is a dynamic ecosystem whose composition and function are closely linked to women’s reproductive health. In healthy states, communities are frequently dominated by Lactobacillus species, which help maintain a low pH and inhibit pathogen colonisation. Shifts away from lactobacilli dominance—often described as dysbiosis—are associated with conditions such as bacterial vaginosis, infertility, adverse pregnancy outcomes and susceptibility to sexually transmitted infections. Community profiles vary with age, menstrual cycle, hormonal status and lifestyle factors, reflecting a complex interplay between host physiology and microbial ecology. Emerging evidence highlights that fine-scale genetic variation within key taxa, metabolic interactions among community members and host–microbe signalling all contribute to stability or transition between health‐associated and dysbiotic states. Insights into these processes underpin novel approaches to diagnostics, personalised therapies and preventive strategies aimed at improving outcomes ranging from in vitro fertilisation success to the reduction of preterm birth rates worldwide.

Research from Nature Portfolio

Large‐scale citizen‐science sampling of over 3,000 women across the adult lifespan has mapped vaginal community structures to factors such as age, childbirth history and contraceptive use. Co‐occurrence network analyses revealed discrete modules in which Lactobacillus crispatus, Lactobacillus jensenii and related taxa correlate positively with oestrogen levels and negatively with recent childbirth, while modules enriched for Gardnerella, Prevotella and Bacteroides link to menopause and menstrual hygiene practices. A metagenomic study of pregnancies comparing preterm and term deliveries identified elevated species‐level microdiversity and a higher burden of antimicrobial‐resistance genes in preterm cases. Gardnerella species in these communities exhibited increased recombination in lipid‐metabolism genes and stronger purifying selection, suggesting evolutionary adaptation to the gestational environment may predispose to early labour. Building on these findings, a multi‐omic cohort resource integrating 16S profiling, metagenomics and cytokine measurements has shown that lower abundance of Lactobacillus crispatus and elevated levels of BV‐associated taxa coincide with proinflammatory vaginal fluid signatures in women who deliver preterm, pointing to potential biomarkers and interventional targets to reduce neonatal morbidity.

Vaginal Microbiome Dynamics and Reproductive Health publication trend

The graph below shows the total number of articles in vaginal microbiome dynamics and reproductive health across all publications each year (not limited to Nature Index journals).

Technical terms

Community State Type (CST): A classification scheme for vaginal microbiome profiles based on dominant bacterial taxa and overall community composition.

Alpha diversity: A measure of species richness and evenness within a single microbial community sample.

Microdiversity: Genetic variation and heterogeneity within populations of a single microbial species, often revealed by metagenomic analyses.

Metabolite‐targeted therapy: An intervention that uses specific biochemical compounds to modulate microbial growth and community structure.

Preterm birth: The delivery of an infant before 37 completed weeks of gestation, associated with increased neonatal morbidity and mortality.

References

1. Vaginal Lactobacillus fatty acid response mechanisms reveal a metabolite-targeted strategy for bacterial vaginosis treatment. Cell (2024).
2. Vaginal microbiota are associated with in vitro fertilization during female infertility. iMeta (2024).
3. A citizen-science-enabled catalogue of the vaginal microbiome and associated factors. Nature Microbiology (2023).
4. Microdiversity of the vaginal microbiome is associated with preterm birth. Nature Communications (2023).