# The Role of the Vaginal Microbiome in Gynecological Diseases: Mechanistic Insights and Emerging Interventions

## TL;DR

The vaginal microbiome is essential for reproductive health, and its imbalance can lead to gynecological diseases, with new therapies like probiotics offering potential solutions.

## Contribution

This review provides mechanistic insights into how vaginal microbiome dysbiosis contributes to disease and highlights emerging microbiome-based interventions.

## Key findings

- Lactobacillus-dominant microbiomes protect against infections and support immune function.
- Vaginal dysbiosis is linked to conditions like bacterial vaginosis and increased STI risk.
- Microbiome-based therapies show promise for restoring vaginal health and treating disease.

## Abstract

Recent studies reveal that the vaginal microbiome plays a crucial role in maintaining reproductive health and preventing disease. In healthy women, the microbiome is predominantly composed of Lactobacillus species, which help prevent infections and support normal immune function. When this microbial balance is disrupted, a condition known as microbial dysbiosis, women may develop common vaginal disorders such as bacterial vaginosis and candidiasis, and may also become more vulnerable to sexually transmitted infections. This review summarizes the changes in the vaginal microbiome across different disease states, its impact on vaginal health, and the mechanisms through which microbial imbalances influence disease progression. We also discuss promising strategies, including the use of probiotics and microbiome-based therapies, that aim to restore a healthy vaginal environment. Understanding these processes may help guide the development of more personalized and effective strategies for improving women’s health.

The vaginal microbiome (VM), a complex and dynamic microbial ecosystem, is now recognized as a central determinant of female reproductive and gynecologic health. Under homeostatic conditions, a Lactobacillus-dominant ecosystem maintains vaginal acidity, provides colonization resistance, and modulates mucosal immunity. Conversely, vaginal dysbiosis—characterized by Lactobacillus depletion and anaerobic or aerobic overgrowth—is associated with infectious vaginitis, increased susceptibility to sexually transmitted infections, and non-infectious conditions such as genitourinary syndrome of menopause. This review provides an integrated overview of the composition, functional characteristics, and host interactions of the VM across health and disease. We highlight major mechanisms by which microbial dysbiosis contributes to disease pathogenesis, including biofilm formation, altered microbial metabolism, and immune dysregulation. In addition, we discuss the translational potential of the VM as a source of diagnostic and prognostic biomarkers and as a target for emerging microbiome-dependent therapeutic strategies. Collectively, current evidence supports the view that vaginal dysbiosis is a heterogeneous and context-dependent state driven by distinct pathogen- and host-related mechanisms, underscoring the importance of prioritizing microbiome restoration rather than pathogen eradication alone.