Modulating the Vaginal Microbiome

The Need for a Bridge Between Science and Practice

Gregor Reid


Semin Reprod Med. 2014;32(1):28-34. 

In This Article

Abstract and Introduction


Infections of the urinary and reproductive tracts continue to afflict hundreds of millions of women and girls each year. For those fortunate enough to have access to medical care, the diagnostic and treatment measures used on them have changed little in 40 years and remain far from adequate. The development of alternatives, such as probiotics, has been hindered by lack of funding, but now face bureaucratic barriers that reflect an outdated regulatory system more concerned with policies than care for the patient. The technological advances emerging from human microbiome studies are making it possible to generate a completely new understanding of how microbes interact with the host, what influences them, and when the result is an aberration requiring intervention. But until bridges are built between scientific progress and practice, it is women and girls who will continue to receive suboptimal care for their often persistent and debilitating conditions.


It has long been understood that interactions between microbes and the host vagina have major implications for the well-being of the female. Vaginal infections date back to the evolution of the female, including the hominids, in whom vaginal infections were believed to cause infertility.[1] Urinary tract infection (UTI) has likewise afflicted women through time, even though documentation is only known from the Ebers Papyrus in 1550 bc.[2] Back then, treatment comprised herbs, rest, and bloodletting, the latter presumably through urogenital veins, a practice which barbaric today was adjudged to release fever and pain. In fact, it may have actually ignited bacteremia and caused death in some patients.

The ability of Leeuwenhoek (1632–1723), a Dutch drapery maker, to detect microorganisms by light microscopy[3] was a pivotal advance in knowing the cause of disease and being able to monitor its eradication by different therapies. Yet, it took another 400 or so years to discover antibiotics. For women with recurrent bladder and vaginal infections, this must have felt like an eternity! Fortunately, a proportion of these infections resolved without intervention, albeit for reasons that remain unclear.[4] Nevertheless, a further 70 or more years has passed since the creation of antibiotics and despite great advances in medical science, little has changed in the therapies for vaginal and bladder infections in women. In this article, I will examine some of the issues surrounding the diagnosis and management of urogenital infections, and the potential to improve these through knowledge of the microbiome.