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A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Microbiomes".

Deadline for manuscript submissions: closed (30 March 2024) | Viewed by 40253

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Dr. Sandra F. Borges

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CBQF—Centro de Biotecnologia e Química Fina, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
Interests: extraction and characterization studies of bioactive compounds derived from by-products; with an emphasis on their health-promoting properties
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Dr. Sara Baptista da Silva

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CBQF—Centro de Biotecnologia e Química Fina, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
Interests: technological systems for the sustainable valorization of food by-products; the design and analysis of food formulations, and strategies geared toward food innovation
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

The human body is a holobiont, which is based on a dynamic synergy with billions of years of co-evolution. The host and multispecies microbes, as well as their inter-play abilities, were progressively improved, and nowadays, they are mostly symbiotic. The vaginal microbiome is no exception: it is an energetic microecosystem that undergoes constant fluctuations during the female menstrual cycle and throughout a woman's life. In this vaginal ecosystem, there is a homeostatic relationship between the microbiota and the host. The host provides a moist, nutritious, and warm habitat for the microbes, while the resident microbiota produces antimicrobial and anti-inflammatory factors. Therefore, they represent the first line of defence against non-indigenous microorganisms. Vaginal microbiome homeostasis plays a vital role in reproductive health. Depending on its composition, the microbiome can protect the vagina from infectious or non-infectious diseases, or it can increase its susceptibility. The diversity and dominant bacterial taxa in the vagina are influenced by multiple intrinsic factors including age, ancestry, pathologies, immune system, hormonal status, and pregnancy. Extrinsic factors include the use of contraceptives, antibiotics, and socioeconomic status. The variations of these internal and/or external factors lead to the breakdown of a balanced ecosystem, also known as dysbiosis. Lactobacillus species are associated with vaginal health, but the role of these species in maintaining health is not yet fully defined. Overall changes in the vaginal microbiome are often seen in women with dysbiosis, but the exact ethology of most disorders is still unknown. There are also other implications for the vaginal flora in non-infectious conditions such as pregnancy, preterm birth, fertility, cancer, and other aspects of women's health.

This Special Issue aims to describe the vaginal microbiome in relation to female health, discuss the characteristics of dysbiosis, present a strong association between these and common diseases, understand the genome impact on dysbiosis, and outline the need for comprehensive diagnostics and therapies accurate and advanced to reduce the prevalence of the female forum diseases.

Dr. Sandra F. Borges
Dr. Sara Baptista da Silva
Guest Editors

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Keywords

vaginal microbiome
dysbiosis
gynaecological disorder
genome impact
theragnostic

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Published Papers (12 papers)

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16 pages, 1716 KiB

Open AccessArticle

The In Vivo Effect of Water-Based Lubricants on the Vaginal Microbiome of Women from Varying Age Groups: Exploratory Analysis of a Randomized Controlled Trial

by Jose A. Freixas-Coutin, Jin Seo, Sarah Hood, Michael Krychman and Santiago Palacios

Microorganisms 2024, 12(9), 1917; https://doi.org/10.3390/microorganisms12091917 - 20 Sep 2024

Cited by 2 | Viewed by 2242

Abstract

Vaginal mucosa undergoes physiological changes across the lifespan, such as increased pH and reduced natural lubrication which are known to impact vaginal commensal microorganisms, hence increasing the chances of vaginal infections. An improved understanding of vaginal microbiome composition in different age groups and the effect of social behaviors, such as the use of personal lubricants, could facilitate the development of new strategies to maintain good vaginal health. The objective of this study was to assess the effect of water-based lubricants on the human vaginal microbiome. Fifty females from three age groups (18–29, 30–44, and 45–65 years) with mild-to-moderate vaginal dryness were randomized to one of five lubricants (four of which were formulated to meet expert guidance on osmolality and pH). Subjects entered the study at tolerance or treatment phase (vaginal intercourse minimum once a week using assigned lubricant). Four vaginal swabs per participant were sampled during pre-(“baseline”), post-first (“2 h”, “24 h”) and post-last (“4 weeks”) lubricant application to assess bacterial and fungal diversity via amplicon sequencing. Vaginal pH and relative humidity were measured at baseline, 2 h, and 24 h post-lubricant application. Relative bacteriome abundance was statistically compared between timepoints for each lubricant group. Vaginal moisture, age, BMI, and pH were correlated with bacteriome relative abundance. Lactobacilli and Gardnerella sp. Were predominant across participants. Repeated lubricant application did not significantly alter the vaginal bacteriome during 4 weeks of product use (p > 0.05) when measured by relative abundance and alpha-diversity index. Bacteriome diversity and abundance differed significantly between age groups at baseline whereas lactobacilli relative abundance was negatively associated with age and vaginal pH. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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12 pages, 1203 KiB

Open AccessArticle

The Vaginal Microbiome: Patient- versus Physician-Collected Microbial Swab: A Pilot Study

by Xu Shan Gao, Thomas Groot, Sam Schoenmakers, Yvonne Louwers, Andries Budding and Joop Laven

Microorganisms 2024, 12(9), 1859; https://doi.org/10.3390/microorganisms12091859 - 7 Sep 2024

Cited by 1 | Viewed by 1822

Abstract

The composition of the vaginal microbiota prior to an IVF/IVF-ICSI treatment can predict the chance of achieving a pregnancy. To improve clinical applicability and be more patient-friendly, the self-collection of vaginal samples would be preferable. However, the reliability of patient-collected samples compared to physician-collected samples remains unclear. This study compares microbiome outcomes from patient-collected versus physician-collected vaginal samples. This is a prospective pilot study consisting of two cohorts: Cohort I involved patient self-sampling of the vagina, followed by a physician-collected vaginal swab, while Cohort II involved the reversed order of collection. The interspace profiling (IS-Pro) technique was used to analyze the microbiota composition in all samples. From May 2021 to March 2022, a total of 444 samples were collected from n = 222 patients (aged 21–44 years), with Cohort I (n = 109) and Cohort II (n = 113). The vaginal microbiome composition of both cohorts was highly similar, regardless of the sampling order, with a mean cosine similarity of 0.93 (95% CI 0.91, 0.95) in Cohort I and 0.94 (95% CI 0.92, 0.96) in Cohort II. Furthermore, ANOVA analysis revealed no significant differences in bacterial species abundance between physician- and patient-collected samples, nor between first and second sample collections. The self-collection of vaginal samples can be considered comparable to physician-collected samples and indicates a more patient-friendly and convenient collection of the vaginal microbiome in an outpatient clinical setting. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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14 pages, 1815 KiB

Open AccessArticle

Clinical Applicability of Microbiota Sampling in a Subfertile Population: Urine versus Vagina

by Rivka Koedooder, Sam Schoenmakers, Martin Singer, Martine Bos, Linda Poort, Paul Savelkoul, Servaas Morré, Jonathan de Jonge, Dries Budding and Joop Laven

Microorganisms 2024, 12(9), 1789; https://doi.org/10.3390/microorganisms12091789 - 29 Aug 2024

Viewed by 1454

Abstract

The urogenital microbiota is increasingly gaining recognition as a significant contributor to reproductive health. Recent studies suggest that microbiota can serve as predictors for fertility treatment outcomes. Our objective was to investigate the degree of similarity in microbial composition between patient-collected urine and vaginal samples in a subfertile population. We enrolled women of reproductive age (20–44 years) diagnosed with subfertility and requiring in vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (IVF-ICSI) treatment. They self-collected both mid-stream urine samples and vaginal swabs before commencing the IVF or IVF-ICSI procedure. All samples were analysed using the intergenic spacer profiling (IS-pro) technique, a rapid clinical microbiota analysis tool. The main outcome measures were the degree of similarity of microbial composition between the two different, but simultaneously collected, samples. Our findings revealed a high correlation (R squared of 0.78) in microbiota profiles between paired urine and vaginal samples from individual patients. Nevertheless, the urinary microbiota profiles contained fewer species compared to the vaginal microbiota, resulting in minor but distinguishable differences. Furthermore, different subfertility diagnoses appeared to be associated with differences in microbial profiles. A noteworthy observation was the exclusive presence of Escherichia coli (E. coli) in both samples of women diagnosed with male factor subfertility. In conclusion, since urinary microbiota profiles seem to represent a diluted version of the vaginal microbiota, vaginal microbiome sampling to predict fertility treatment outcome seems preferable. To enhance the success of fertility treatments, further research is needed to gain deeper insights into a putative causal role of microbiota in the mechanisms of subfertility. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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8 pages, 796 KiB

Open AccessCommunication

Analyzing Cervical Microbiome Composition in HIV-Infected Women with Different HPV Infection Profiles: A Pilot Study in Thailand

by Kanya Preechasuth, Lionel Brazier, Woottichai Khamduang, Sayamon Hongjaisee, Nantawan Wangsaeng and Nicole Ngo-Giang-Huong

Microorganisms 2024, 12(7), 1298; https://doi.org/10.3390/microorganisms12071298 - 26 Jun 2024

Viewed by 1810

Abstract

We conducted a pilot study to analyze the microbiome in cervical samples of women living with HIV with various profiles of HPV infections. The participants had an average age of 41.5 years. Sequence analysis of 16S rRNA V3 gene amplicons was performed using next-generation sequencing technology (Ion Torrent PGM^TM). The bioinformatics pipeline was analyzed using the Find, Rapidly, OTUs with Galaxy Solution system (FROGS). Common genera were determined to identify Community State Types (CSTs). The cervical microbiome profiles showed a dominance of lactobacilli in 56% (five out of nine) of samples. All three women with normal cervical cells and high-risk HPV infection were classified as CST IV, characterized by anaerobic bacteria associated with bacterial vaginitis, such as Gardnerella, Prevotella, Atopobium, and Sneathia. Among the two women with abnormal cervical cells and high-risk HPV infection, one was classified as CST III, and the other had an unclassified profile dominated by L. helveticus. Four women with normal cervical cells and no HPV infection exhibited various CSTs. Our study demonstrated the feasibility of the protocol in analyzing the cervical microbiome. However, further analysis with a larger number of longitudinal samples is necessary to determine the role of cervical microbiota in HPV persistence, clearance, or the development of precancerous lesions. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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14 pages, 1633 KiB

Open AccessArticle

Characteristics of Vaginal Microbiota of Women of Reproductive Age with Infections

by Wanting Dong, Siyi Wang, Xi Wang, Guojin Xu, Qiuying Liu, Zheng Li, Na Lv, Yuanlong Pan, Qian Xiong, Donglai Liu and Baoli Zhu

Microorganisms 2024, 12(5), 1030; https://doi.org/10.3390/microorganisms12051030 - 20 May 2024

Cited by 5 | Viewed by 4103

Abstract

The vaginal microbiota can be classified into five major community state types (CSTs) based on the bacterial content. However, the link between different CST subtypes and vaginal infection remains unclear. Here, we analyzed 2017 vaginal microbiota samples from women of a reproductive age with vaginal infections that were published in the last decade. We found that L. iners was the most dominant in 34.8% of the vaginal samples, followed by L. crispatus (21.2%). CST I was common in healthy individuals, whereas CST III and IV were associated with dysbiosis and infection. CST III-B, IV-A, IV-B, and IV-C0 were prevalent in patients with bacterial vaginosis (BV). Based on the relative abundance of bacteria at the (sub)genus level, a random forest classifier was developed to predict vaginal infections with an area under the curve of 0.83. We further identified four modules of co-occurring bacterial taxa: L. crispatus, Gardnerella, Prevotella, and Bacteroides. The functional prediction revealed that nucleotide biosynthesis pathways were upregulated in patients with human papilloma virus, and carbohydrate degradation pathways were downregulated in patients with BV. Overall, our study identified the bacterial signatures of healthy and infected vaginal microbiota, providing unique insights into the clinical diagnosis and health status prediction of women of a reproductive age. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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17 pages, 1279 KiB

Open AccessArticle

Unlocking the Uterine Code: Microbiota, Immune Cells, and Therapy for Recurrent Reproductive Failure

by Svetla Blazheva, Svetlana Pachkova, Tatyana Bodurska, Petar Ivanov, Alexander Blazhev, Tzvetan Lukanov and Emiliana Konova

Microorganisms 2024, 12(3), 547; https://doi.org/10.3390/microorganisms12030547 - 9 Mar 2024

Cited by 3 | Viewed by 2664

Abstract

The uterine microbiota has been the subject of increasing study, but its interaction with the local immune system remains unclear. Successful embryo implantation relies on endometrial receptivity, which is pivotal for immunological tolerance to fetal antigens and precise regulation of inflammatory mediators. Emerging data suggest a dynamic interplay between endometrial microflora and the immune system, making dysbiosis a potential determinant of pregnancy outcomes. Imbalances in the regulation of immune cells in the endometrium and decidua have been associated with infertility, miscarriage, and obstetric complications. A thorough comprehension of the immune system in the female reproductive tract shows potential for improving women’s health and pregnancy outcomes. The objective of this study was to evaluate the patterns of endometrial microbiota in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) and to explore their implications for endometrial immune cells and chronic endometritis (CE). Immune cells in biopsies from 107 RIF and 93 RPL patients were examined using flow cytometry. The endometrial microbial composition was analyzed using real-time polymerase chain reaction (RT-PCR). The research uncovered disrupted endometrial microbiota in most women with RIF and RPL, which was often associated with significant effects on lymphocytes, T cells, and uNK cells. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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14 pages, 1221 KiB

Open AccessArticle

Analysis of Vaginal Microbiota Variations in the Third Trimester of Pregnancy and Their Correlation with Preterm Birth: A Case-Control Study

by Catalin Prodan-Barbulescu, Felix Bratosin, Roxana Folescu, Estera Boeriu, Zoran Laurentiu Popa, Cosmin Citu, Adrian Ratiu, Ovidiu Rosca and Adrian Cosmin Ilie

Microorganisms 2024, 12(2), 417; https://doi.org/10.3390/microorganisms12020417 - 19 Feb 2024

Cited by 6 | Viewed by 2417

Abstract

This study conducted a detailed analysis of the vaginal microbiota in pregnant women to explore its correlation with preterm birth (PTB) outcomes. The primary objective was to identify microbial variations associated with increased PTB risk. Secondary objectives included investigating how changes in microbial composition relate to the local immune environment and PTB. Utilizing a retrospective case–control design, the study involved pregnant women with liveborn infants between 2019 and 2023. In total, 89 women who delivered preterm and 106 term deliveries were included. Data collection focused on third-trimester vaginal cultures. Statistically significant differences were observed between the preterm and full-term groups in several areas. The median white blood cell count (10.2 × 10³/mm³ vs. 7.6 × 10³/mm³, p = 0.009) and neutrophil count (7.2 × 10³/mm³ vs. 5.1 × 10³/mm³, p < 0.001) were higher in the preterm group. Vaginal pH was also elevated in preterm births (5.6 vs. 4.4, p < 0.001), with a higher prevalence of bacterial vaginosis (29.2% vs. 12.3%, p = 0.001) as indicated by the Nugent Score. The study noted a significant association of PTB with the presence of Candida spp. (OR = 1.84, p = 0.018), Gardnerella vaginalis (OR = 2.29, p = 0.003), Mycoplasma hominis (OR = 1.97, p = 0.007), and Ureaplasma urealyticum (OR = 2.43, p = 0.001). Conversely, a reduction in Lactobacillus spp. correlated with a decreased PTB risk (OR = 0.46, p = 0.001). The study provides compelling evidence that specific vaginal microbiota components, particularly certain pathogenic bacteria and an altered Lactobacillus profile, are significantly associated with PTB risk. These findings highlight the potential of targeting microbial factors in strategies aimed at reducing PTB rates. Further research is necessary to fully understand the complex interplay between microbial dynamics, host immunity, and PTB outcomes. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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16 pages, 3140 KiB

Open AccessArticle

Metronidazole Treatment Failure and Persistent BV Lead to Increased Frequencies of Activated T- and Dendritic-Cell Subsets

by Wenkosi Perez Qulu, Gugulethu Mzobe, Andile Mtshali, Marothi Peter Letsoalo, Farzana Osman, James Emmanuel San, Asavela Olona Kama, Nigel Garrett, Adrian Mindel, Anne Rompalo, Lenine J. P. Liebenberg, Derseree Archary, Aida Sivro and Sinaye Ngcapu

Microorganisms 2023, 11(11), 2643; https://doi.org/10.3390/microorganisms11112643 - 27 Oct 2023

Cited by 4 | Viewed by 2102

Abstract

Metronidazole (MDZ) treatment failure and bacterial vaginosis (BV) recurrence rates are high among African women. This cohort study identified genital immune parameters associated with treatment response by comparing vaginal microbiota and immune cell frequencies in endocervical cytobrushes obtained from 32 South African women with symptomatic BV pre- and post-metronidazole treatment. Cervical T- and dendritic-cell subsets were phenotyped using multiparameter flow cytometry and the composition of vaginal microbial communities was characterized using 16S rRNA gene sequencing. MDZ treatment led to a modest decrease in the relative abundance of BV-associated bacteria, but colonization with Lactobacillus species (other than L. iners) was rare. At 6 and 12 weeks, MDZ-treated women had a significant increase in the frequencies of CCR5+ CD4+ T cells and plasmacytoid dendritic cells compared to the pre-treatment timepoint. In addition, MDZ non-responders had significantly higher frequencies of activated CD4 T cells and monocytes compared to MDZ responders. We conclude that MDZ treatment failure was characterized by an increased expression of activated T- and dendritic-cell subsets that may enhance HIV susceptibility. These data suggest the need to further assess the long-term impact of MDZ treatment on mucosal immune response and the vaginal microbiota. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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14 pages, 2361 KiB

Open AccessArticle

Cervicovaginal Microbiota Profiles in Precancerous Lesions and Cervical Cancer among Ethiopian Women

by Brhanu Teka, Kyoko Yoshida-Court, Ededia Firdawoke, Zewditu Chanyalew, Muluken Gizaw, Adamu Addissie, Adane Mihret, Lauren E. Colbert, Tatiana Cisneros Napravnik, Molly B. El Alam, Erica J. Lynn, Melissa Mezzari, Jhingran Anuja, Eva Johanna Kantelhardt, Andreas M. Kaufmann, Ann H. Klopp and Tamrat Abebe

Microorganisms 2023, 11(4), 833; https://doi.org/10.3390/microorganisms11040833 - 24 Mar 2023

Cited by 14 | Viewed by 3404

Abstract

Although high-risk human papillomavirus infection is a well-established risk factor for cervical cancer, other co-factors within the local microenvironment may play an important role in the development of cervical cancer. The current study aimed to characterize the cervicovaginal microbiota in women with premalignant dysplasia or invasive cervical cancer compared with that of healthy women. The study comprised 120 Ethiopian women (60 cervical cancer patients who had not received any treatment, 25 patients with premalignant dysplasia, and 35 healthy women). Cervicovaginal specimens were collected using either an Isohelix DNA buccal swab or an Evalyn brush, and ribosomal RNA sequencing was used to characterize the cervicovaginal microbiota. Shannon and Simpson diversity indices were used to evaluate alpha diversity. Beta diversity was examined using principal coordinate analysis of weighted UniFrac distances. Alpha diversity was significantly higher in patients with cervical cancer than in patients with dysplasia and in healthy women (p < 0.01). Beta diversity was also significantly different in cervical cancer patients compared with the other groups (weighted UniFrac Bray-Curtis, p < 0.01). Microbiota composition differed between the dysplasia and cervical cancer groups. Lactobacillus iners was particularly enriched in patients with cancer, and a high relative abundance of Lactobacillus species was identified in the dysplasia and healthy groups, whereas Porphyromonas, Prevotella, Bacteroides, and Anaerococcus species predominated in the cervical cancer group. In summary, we identified differences in cervicovaginal microbiota diversity, composition, and relative abundance between women with cervical cancer, women with dysplasia, and healthy women. Additional studies need to be carried out in Ethiopia and other regions to control for variation in sample collection. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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18 pages, 2676 KiB

Open AccessArticle

Compositional Changes in the Vaginal Bacterial Microbiome of Healthy Pregnant Women across the Three Gestational Trimesters in Ismailia, Egypt

by Mariam E. Amin, Marwa Azab, Amro Hanora, Khaled Atwa and Sarah Shabayek

Microorganisms 2023, 11(1), 139; https://doi.org/10.3390/microorganisms11010139 - 5 Jan 2023

Cited by 3 | Viewed by 2754

Abstract

The composition of the vaginal microbiome may lead to adverse pregnancy outcomes. Normal pregnancy is associated with changes in the vaginal bacterial community composition, which tend to be more enriched with one or two Lactobacillus species promoting a healthy vagina and favorable birth outcomes. The aim of the current study was to determine compositional changes in the healthy vaginal microbiome composition during the three trimesters of pregnancy in Ismailia, Egypt using Illumina MiSeq sequencing of the V3–V4 region of the 16S rRNA. The phylum Firmicutes and the genus Lactobacillus dominated across the three trimesters of pregnancy. L. iners was the most abundant species. However, L. coleohominis and L. reuteri represented the least dominant vaginal lactobacilli. Core microbiome analyses showed the Lactobacillus genus and L. iners species to have the highest prevalence in all the samples of our study groups. The phylum Firmicutes was found to be negatively correlated with almost all other vaginal phyla during pregnancy. Likewise, a negative correlation between Lactobacillus and almost all other genera was detected, including significant negative correlations with Dialister and Prevotella. Furthermore, negative correlations of L. iners were detected with almost all other species, including a significant negative correlation with L. helveticus, G. vaginalis, S. anginosus, and S. agalactiae. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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Review

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14 pages, 302 KiB

Open AccessReview

Vaginal Microbiota and HPV in Latin America: A Narrative Review

by Eduardo Tosado-Rodríguez, Ian Alvarado-Vélez, Josefina Romaguera and Filipa Godoy-Vitorino

Microorganisms 2024, 12(3), 619; https://doi.org/10.3390/microorganisms12030619 - 20 Mar 2024

Cited by 3 | Viewed by 3780

Abstract

With the expansion of human microbiome studies in the last 15 years, we have realized the immense implications of microbes in human health. The human holobiont is now accepted, given the commensal relationships with bacteria, fungi, parasites, viruses, and human cells. The cervicovaginal microbiota is a specific case within the human microbiome where diversity is lower to maintain a chemical barrier of protection against infections. This narrative review focuses on the vaginal microbiome. It summarizes key findings on how native bacteria protect women from disease or predispose them to damaging inflammatory processes with an emphasis on the role of HPV infections in Latin America, one of the world’s regions with the highest cervical cancer prevalence. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

28 pages, 763 KiB

Open AccessReview

Current Updates on the Role of Microbiome in Endometriosis: A Narrative Review

by Hooi-Leng Ser, Siu-Jung Au Yong, Mohamad Nasir Shafiee, Norfilza Mohd Mokhtar and Raja Affendi Raja Ali

Microorganisms 2023, 11(2), 360; https://doi.org/10.3390/microorganisms11020360 - 31 Jan 2023

Cited by 19 | Viewed by 7405

Abstract

Endometriosis affects approximately 6 to 10% of reproductive-age women globally. Despite much effort invested, the pathogenesis that promotes the development, as well as the progression of this chronic inflammatory disease, is poorly understood. The imbalance in the microbiome or dysbiosis has been implicated in a variety of human diseases, especially the gut microbiome. In the case of endometriosis, emerging evidence suggests that there may be urogenital-gastrointestinal crosstalk that leads to the development of endometriosis. Researchers may now exploit important information from microbiome studies to design endometriosis treatment strategies and disease biomarkers with the use of advanced molecular technologies and increased computational capacity. Future studies into the functional profile of the microbiome would greatly assist in the development of microbiome-based therapies to alleviate endometriosis symptoms and improve the quality of life of women suffering from endometriosis. Full article

(This article belongs to the Special Issue Vaginal Microbiome in Women's Health)

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