Women’s health – the vagina also has a microbiome

On March 24, 2020, the research project “Isala” at the University of Antwerp was said: “200 Vaginas wanted”. This started what should develop into the largest mapping project of the vagina microbiome – with numerous offshoots in various countries. The microbioma is the specific community of microorganisms that colonize an organ. The microbiome of the intestine is now much more known, but also people have their own microbioma in the mouth, on the skin or in the vagina.

It has been known for over a hundred years that there is a acid milieu in the vagina, which is usually determined by Lactobacillus species. In 1892, the doctor Albert Döderlein published an essay entitled “The Vaginal Secretary and its importance for puerperal fever”, in which he described the discovery of lactic acid bacteria in the vagina. Since then, not so much has happened since then with the vaginal microbiome – which the researchers wanted to change from Belgium.

The Research project Isala Under the direction of Sarah Lebeer, open doors ran with his call. 200 volunteers reported within two hours. Due to the large influx, the project was expanded to over 5,500 participants at short notice. The necessary materials were sent to women or other people with vagina to make a smear for themselves. Over 3300 samples came back and could be analyzed in the laboratory. The ten most important bacteria could be identified from these, in addition to Lactobacillus species but also Species from Prevotella, Gardnerella, Streptococcus, Bifidobacterium, Limosilactobacillus and Anaerococcus.

Like Lebee’s team in the specialist journal “Trends in Microbiology” reportedfive types of healthy microbiota could be characterized, with the types being named after the dominant type of bacteria. In four cases, these belonged to the Lactobacillus group. The fifth type was a mixture of other types of bacteria and ten percent of all participants could not be classified in one of these five categories.

The success of Isala is thanks to two factors, believes project coordinator Sandra Condori. The improvement of the technologies to DNA sequencing in the past ten to 15 years would have increased interest in researching microbiota. “I also found that the health of women is becoming increasingly important,” says Condori, adding: “Isala was the first study to examine the vaginal microbiome using a Citizen Science approach, which means that women were included in the entire process. The participants even proposed questions for the survey and they later received the results. «

However, the researchers of the University of Antwerp not only want to map the microbiome, but also want to find out which types of microbiota are healthy and what influences their composition. They were able to confirm the important role of lactic acid bacteria for the majority of Belgian women. “In the vagina, these bacteria actually do the same as in yogurt. Because they use glycogen, a type of sugar that is also in the vaginal and uterus wall, as a nutrient and convert it into lactic acid. Thanks to the lactobacilli, a healthy vagina has a low acidity, which is extremely important in the fight against pathogens or viruses, «says the project’s website.

“Women’s health is becoming more and more important.”

Sandra CondoriProject coordinator

But not only the microbioma vary from person to person, its composition varies in around 30 percent of women, as can be determined with a lower number of participants, depending on the cycle phase. Age, pregnancies, use of menstrual products, sexual activity and nutrition also played a role.

The scientists also wanted to look beyond Europe. So far there have been no studies on the subject in countries with low to medium -sized incomes, says Condori. But that should change in the course of the Isala project. Condori, who comes from Peru himself, launched the Laura project as a sister project of Isala. Other sister projects started in Switzerland, Spain, France, Great Britain, Cameroon, Morocco, Uganda, South Africa and Nigeria. The greatest difficulty of the projects is to find a corresponding financing. An application was just rejected in Canada.

In the projects in which rehearsals have already been collected, this was quite different, says Condori. “When we wanted to hand over our results to the participants in Peru in 2023, we thought that they would not meet because of the taboos, but they said: No, no, let us all come together. I was very pleased. ”In the Camerooner project, which was carried out in rural areas, the manager first had to meet the respective village leaders. Only then did she talk to the women about the project.

In addition to access to a diverse pool of genetic samples, the Citizen Science approach provides much more, is at the same time education about women’s health issues and overcoming taboos. The Belgian project’s blog offers the opportunity to exchange problems with menstruation or experiences with various contraceptive methods on topics such as the use of menstrual cups. In Peru, however, written communication channels like a blog would not work as well because little is read, says Condori. Instead, short video clips would be spread. Regardless of the respective form, however: “We still have to do a lot of educational work and emphasize women to know more about their own body.”

Meanwhile, microbiota are continued under the roof of Isala, while individual researchers are devoted to specific contexts. For example, whether mothers and daughters have a similar microbiome. Or as frequent vaginal infections and the respective microbiom are mutually due to each other. And whether the administration of Lactobacilli can remedy the situation.