Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women

• Type of Material: Article
• Authors: Gaea Daniel, Emory University; Yingtian Hu, Emory University; Despina Tsementzi, Emory University; Ileen Jhaney, Emory University; Yijuan Hu, Emory University; Katherine Yeager, Emory University; Jinbing Bai, Emory University; Mary Dolan, Emory University; Deborah Bruner, Emory University
• Language: English
• Date: 2021-09-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/NNR.0000000000000538
• Title of Journal or Parent Work: NURSING RESEARCH
• Volume: 70
• Issue: 5
• Start Page: 405
• End Page: 411
• Grant/Funding Information: The secondary data analysis for this dissertation research was supported by the Alpha Epsilon Chapter of Sigma Theta Tau, the Robert Wood Johnson Foundation Future of Nursing Scholars Program, and the National Black Nurses Association.; G.A.D. is supported by National Institute of Environmental Health Sciences of the National Institutes of Health under award number T32ES012870.; Original research reported in this publication was supported, in part by a grant from the Emory University Winship Cancer Institute Winship Invest$ (D.W.B.).
• Keywords: vaginal microbiome; INTERVENTION; Science & Technology; intravaginal practices; Nursing; HEALTH; Life Sciences & Biomedicine; HIV-INFECTED WOMEN; DOUCHE; postmenopausal women; MENOPAUSE

Abstract

Background Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. Objectives The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. Methods We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. Results The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. Discussion Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.