Research into life in the vagina: ‘This also concerns men’

The University of Antwerp is looking for women who want to open their vaginas to science. ‘Society is clearly waiting for this.’

Since the 1960s, humanity has been searching for extraterrestrial life in the universe – still without much success. But hardly any research has been done into the equally interesting microscopic life in the vagina of women on earth. However, the vagina contains millions of bacteria that play a crucial role in female health.

It is an almost vindictive contradiction. As a result, there have been no real breakthroughs in the last 40 years to treat typically female conditions such as vaginal infections, which affect as many as 70 percent of women.

‘The vaginal microbiome is being studied here and there worldwide, but that research mainly focuses on patients with infections,’ says postdoctoral researcher and microbiologist Sarah Ahannach. ‘The question of how a healthy vagina evolves into a diseased state has rarely been the subject of a large-scale study.’

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According to Ahannach, there are several reasons for this. Besides the fact that the techniques in the microbiome field were still in their infancy, there was always more interest in the intestinal microbiome. ‘Women have long been underrepresented at the research table. Because men do not have a uterus or menstrual cycle, it is not entirely illogical that they had less urge to delve into that subject.’

Thanks to the Isala citizen science project – named after Isala van Diest, the first female doctor in Belgium – this is now changing. A team of microbiologists, bioinformaticians and bioengineers led by Professor Sarah Lebeer at the Department of Bioscience Engineering at the University of Antwerp started the project to better understand the female microbiome. It has since grown into the largest study of the vaginal microbiome in the world.

Why are the bacteria in the vagina so important?

Ahnach: A healthy vaginal microbiome prevents vaginal infections, promotes fertilization and a healthy pregnancy. Not only women, but also children and men have every interest in research into the vaginal flora. All of humanity, actually.

In an initial research phase, you examined the vaginas of 200 women. What are the findings?

Ahnach: When we started looking for vaginal samples from 200 healthy women in 2020, we had more than 6,000 registrations within ten days, which is a clear signal that society is waiting for this. Thanks to the large number of participants, we were able to investigate many issues and were able to see connections between the vaginal microbiome and age, whether or not to have children, the menstrual cycle, the contraceptive method, sexual contact, nutrition and the use of certain menstrual products. But to demonstrate such a direct causal relationship we need more targeted studies.

Hence this second phase of research. What does that entail?

Ahnach: For example, we will investigate the impact of the tampon, the sanitary towel, the menstrual cup and menstrual underwear on the vaginal microbiome. Surprisingly, this has never happened, even though many women worldwide use menstrual products. Another study tests the impact of the cycle on the bacteria in the vagina. We will also look for possible new therapies for women who often suffer from fungal infections. We also test healthy vaginal bacteria as a probiotic for the vagina and intestines. In a final study, we investigate whether the participants share vaginal bacteria with their mothers, sisters or housemates.

Is there enough evidence to formulate certain advice for a healthy vagina?

Ahnach: We remain cautious with Isala when it comes to formulating concrete tips because we do not want to draw hasty conclusions. Women receive a lot of recommendations that are actually not entirely correct or have little impact. The standard advice for a healthy vagina remains: avoid vaginal douches or vaginal soaps. These products just lead to more infections instead of fighting them. Don’t believe the commercials. The vagina is not supposed to give off the scent of flowers, a healthy vagina will smell more like a jar of yogurt.