Vaginal microbiome: considerations for reproductive health

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

• 1. Kumar A, Chordia N. Role of microbes in human health. Appl. Microbiol. Open Access 13, 1–3 (2017).
  Google Scholar
• 2. Lloyd-Price J, Abu-Ali G, Huttenhower C. The healthy human microbiome. Genome Med. 8(1), 1–11 (2016).
  MedlineGoogle Scholar
• 3. Kumar M, Murugesan S, Singh P et al. Vaginal microbiota and cytokine levels predict preterm delivery in Asian women. Front. Cell. Infect. Microbiol. 11, 639665 (2021).
  Medline CASGoogle Scholar
• 4. Kumar M, Singh P, Murugesan S et al. Microbiome as an immunological modifier. Methods Mol. Biol. 2055, 595–638 (2020).
  Medline CASGoogle Scholar
• 5. Ogunrinola GA, Oyewale JO, Oshamika OO, Olasehinde GI. The human microbiome and its impacts on health. Int. J. Microbiol. 2020, 8045646 (2020).
  MedlineGoogle Scholar
• 6. Dunlop AL, Mulle JG, Ferranti EP, Edwards S, Dunn AB, Corwin EJ. Maternal microbiome and pregnancy outcomes that impact infant health: a review. Adv. Neonatal. Care 15(6), 377–385 (2015).
  MedlineGoogle Scholar
• 7. Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the human microbiome. Nutr. Rev. 70(Suppl. 1), S38–S44 (2012).
  MedlineGoogle Scholar
• 8. Ogunrinola GA, Oyewale JO, Oshamika OO, Olasehinde GI. The human microbiome and its impacts on health. Int. J. Microbiol. 2020, 8045646 (2020).
  MedlineGoogle Scholar
• 9. Saraf VS, Sheikh SA, Ahmad A, Gillevet PM, Bokhari H, Javed S. Vaginal microbiome: normalcy vs dysbiosis. Arch. Microbiol. 203(7), 3793–3802 (2021).
  Medline CASGoogle Scholar
• 10. Gilbert JA, Blaser MJ, Caporaso JG, Jansson JK, Lynch SV, Knight R. Current understanding of the human microbiome. Nat. Med. 24(4), 392–400 (2018).
  Medline CASGoogle Scholar
• 11. Witkin SS, Linhares IM, Giraldo P. Bacterial flora of the female genital tract: function and immune regulation. Best Pract. Res. Clin. Obstet. Gynaecol. 21(3), 347–354 (2007).
  MedlineGoogle Scholar
• 12. Sharma M, Chopra C, Mehta M et al. An insight into vaginal microbiome techniques. Life 11(11), 1229 (2021).
  Medline CASGoogle Scholar
• 13. Gupta S, Kakkar V, Bhushan I. Crosstalk between vaginal microbiome and female health: a review. Microb. Pathog. 136, 103696 (2019). •• The vaginal microbiota in women with relation to several conditions is highlighted in great detail in this article.
  Medline CASGoogle Scholar
• 14. Ravel J, Gajer P, Abdo Z et al. Vaginal microbiome of reproductive-age women. Proc. Natl Acad. Sci. USA 108(Suppl. 1), 4680 (2011).
  Medline CASGoogle Scholar
• 15. Farage MA, Miller KW, Sobel JD. Dynamics of the vaginal ecosystem – hormonal influences. Infect. Dis. (Auckl.) 3, S3903 (2010).
  Google Scholar
• 16. Lamont R, Sobel J, Akins R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 118(5), 533–549 (2011). • The article describes the role of the Lactobacillus in preventing various infections in females.
  Medline CASGoogle Scholar
• 17. Ravel J, Brotman RM. Translating the vaginal microbiome: gaps and challenges. Genome Med. 8(1), 1–3 (2016).
  MedlineGoogle Scholar
• 18. Kaur H, Merchant M, Haque MM, Mande SS. Crosstalk between female gonadal hormones and vaginal microbiota across various phases of women's gynecological lifecycle. Front. Microbiol. 11, 551 (2020).
  MedlineGoogle Scholar
• 19. Bayar E, Bennett PR, Chan D, Sykes L, Macintyre DA. The pregnancy microbiome and preterm birth. Semin. Immunopathol. 42(4), 487–499 (2020).
  MedlineGoogle Scholar
• 20. Mancabelli L, Tarracchini C, Milani C et al. Vaginotypes of the human vaginal microbiome. Environ. Microbiol. 23(3), 1780–1792 (2021).
  Medline CASGoogle Scholar
• 21. Lewis FM, Bernstein KT, Aral SO. Vaginal microbiome and its relationship to behavior, sexual health, and sexually transmitted diseases. Obstet. Gynecol. 129(4), 643 (2017).
  MedlineGoogle Scholar
• 22. Selle K, Klaenhammer TR. Genomic and phenotypic evidence for probiotic influences of Lactobacillus gasseri on human health. FEMS Microbiol. Rev. 37(6), 915–935 (2013).
  Medline CASGoogle Scholar
• 23. Auriemma RS, Scairati R, Del Vecchio G et al. The vaginal microbiome: a long urogenital colonization throughout woman life. Front. Cell. Infect. Microbiol. 11, 686167 (2021).
  MedlineGoogle Scholar
• 24. Reid G. Has knowledge of the vaginal microbiome altered approaches to health and disease? F1000Research 7, 460 (2018).
  MedlineGoogle Scholar
• 25. Mesa MD, Loureiro B, Iglesia I et al. The evolving microbiome from pregnancy to early infancy: a comprehensive review. Nutrients 12(1), 133 (2020). •• The microbiota in pregnancy and newborns is highlighted in this research.
  Google Scholar
• 26. Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu. Rev. Microbiol. 66, 371–389 (2012).
  Medline CASGoogle Scholar
• 27. Marconi C, El-Zein M, Ravel J et al. Characterization of the vaginal microbiome in women of reproductive age from 5 regions in Brazil. Sex. Transm. Dis. 47(8), 562–569 (2020).
  Medline CASGoogle Scholar
• 28. Chaban B, Links MG, Jayaprakash TP et al. Characterization of the vaginal microbiota of healthy Canadian women through the menstrual cycle. Microbiome 2(1), 1–12 (2014).
  MedlineGoogle Scholar
• 29. Xiao B, Liao Q. [Analysis of diversity of vaginal microbiota in healthy Chinese women by using DNA-fingerprinting.] Beijing Da Xue Xue Bao Yi Xue Ban 44(2), 281–287 (2012).
  Medline CASGoogle Scholar
• 30. Jespers V, Menten J, Smet H et al. Quantification of bacterial species of the vaginal microbiome in different groups of women, using nucleic acid amplification tests. BMC Microbiol. 12(1), 1–10 (2012).
  MedlineGoogle Scholar
• 31. Anukam KC, Osazuwa EO, Ahonkhai I, Reid G. Lactobacillus vaginal microbiota of women attending a reproductive health care service in Benin city, Nigeria. Sex. Transm. Dis. 33(1), 59–62 (2006).
  MedlineGoogle Scholar
• 32. Fettweis JM, Brooks JP, Serrano MG et al. Differences in vaginal microbiome in African American women versus women of European ancestry. Microbiology 160(Pt 10), 2272 (2014).
  Medline CASGoogle Scholar
• 33. Zhou X, Brown CJ, Abdo Z et al. Differences in the composition of vaginal microbial communities found in healthy Caucasian and Black women. ISME J. 1(2), 121–133 (2007).
  Medline CASGoogle Scholar
• 34. Mändar R, Mikelsaar M. Transmission of mother's microflora to the newborn at birth. Neonatology 69(1), 30–35 (1996).
  CASGoogle Scholar
• 35. Dunn AB, Jordan S, Baker BJ, Carlson NS. The maternal infant microbiome: considerations for labor and birth. MCN Am. J. Matern. Child Nurs. 42(6), 318 (2017).
  MedlineGoogle Scholar
• 36. Prince AL, Chu DM, Seferovic MD, Antony KM, Ma J, Aagaard KM. The perinatal microbiome and pregnancy: moving beyond the vaginal microbiome. Cold Spring Harb. Perspect. Med. 5(6), a023051 (2015).
  MedlineGoogle Scholar
• 37. Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. The neonatal microbiome and its partial role in mediating the association between birth by cesarean section and adverse pediatric outcomes. Neonatology 114(2), 103–111 (2018).
  MedlineGoogle Scholar
• 38. Huang B, Fettweis JM, Brooks JP, Jefferson KK, Buck GA. The changing landscape of the vaginal microbiome. Clin. Lab. Med. 34(4), 747–761 (2014).
  MedlineGoogle Scholar
• 39. Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J, Versalovic J. The placenta harbors a unique microbiome. Sci. Transl. Med. 6(237), 237ra265 (2014).
  Google Scholar
• 40. Chu DM, Ma J, Prince AL, Antony KM, Seferovic MD, Aagaard KM. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nat. Med. 23(3), 314–326 (2017).
  Medline CASGoogle Scholar
• 41. Vaginal microbiota. https://evolmedwomenshealth.weebly.com/vaginal-microbiota.html (Accessed 25 May 2022).
  Google Scholar
• 42. Hammerschlag MR, Alpert S, Rosner I et al. Microbiology of the vagina in children: normal and potentially pathogenic organisms. Pediatrics 62(1), 57–62 (1978).
  Medline CASGoogle Scholar
• 43. Hammerschlag MR, Alpert S, Onderdonk AB et al. Anaerobic microflora of the vagina in children. Am. J. Obstet. Gynecol. 131(8), 853–856 (1978).
  Medline CASGoogle Scholar
• 44. Ceccarani C, Foschi C, Parolin C et al. Diversity of vaginal microbiome and metabolome during genital infections. Sci. Rep. 9(1), 1–12 (2019).
  Medline CASGoogle Scholar
• 45. Buchta V. Vaginal microbiome. Ceska Gynekol. 83(5), 371–379 (2018).
  Medline CASGoogle Scholar
• 46. Farage MA, Maibach HI, Deliveliotou A, Creatsas G. Changes in the vulva and vagina throughout life. The Vulva, Taylor and Francis, UK, 14–21 (2017).
  Google Scholar
• 47. Morison L, Ekpo G, West B et al. Bacterial vaginosis in relation to menstrual cycle, menstrual protection method, and sexual intercourse in rural Gambian women. Sex. Transm. Infect. 81(3), 242–247 (2005).
  Medline CASGoogle Scholar
• 48. Eschenbach DA, Thwin SS, Patton DL et al. Influence of the normal menstrual cycle on vaginal tissue, discharge, and microflora. Clin. Infect. Dis. 30(6), 901–907 (2000).
  Medline CASGoogle Scholar
• 49. MSD. Gynecology and Obstetrics MSD Manual Professional Edition. www.msdmanuals.com/en-in/professional/gynecology-and-obstetrics/female-reproductive-endocrinology/female-reproductive-endocrinology (Accessed 19 May 2022).
  Google Scholar
• 50. Onderdonk AB, Delaney ML, Fichorova RN. The human microbiome during bacterial vaginosis. Clin. Microbiol. Rev. 29(2), 223–238 (2016). • The alterations in the vaginal microbiota that occur during bacterial vaginosis are described in this research.
  Medline CASGoogle Scholar
• 51. Hickey R, Abdo Z, Zhou X et al. Effects of tampons and menses on the composition and diversity of vaginal microbial communities over time. BJOG 120(6), 695–706 (2013).
  Medline CASGoogle Scholar
• 52. Yockey LJ, Iwasaki A. Interferons and proinflammatory cytokines in pregnancy and fetal development. Immunity 49(3), 397–412 (2018).
  Medline CASGoogle Scholar
• 53. Gajer P, Brotman RM, Bai G et al. Temporal dynamics of the human vaginal microbiota. Sci. Transl. Med. 4(132), 132ra152 (2012).
  Google Scholar
• 54. Kumar M, Saadaoui M, Elhag DA et al. Omouma: a prospective mother and child cohort aiming to identify early biomarkers of pregnancy complications in women living in Qatar. BMC Pregnancy Childbirth 21(1), 570 (2021).
  MedlineGoogle Scholar
• 55. Tulchinsky D, Hobel CJ, Yeager E, Marshall JR. Plasma estrone, estradiol, estriol, progesterone, and 17-hydroxyprogesterone in human pregnancy: I. Normal pregnancy. Am. J. Obstet. Gynecol. 112(8), 1095–1100 (1972).
  Medline CASGoogle Scholar
• 56. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am. J. Reprod. Immunol. 63(6), 425–433 (2010).
  Medline CASGoogle Scholar
• 57. House M, Kaplan DL, Socrate S. Relationships between mechanical properties and extracellular matrix constituents of the cervical stroma during pregnancy. In: Semin. Perinatol. 33(5), 300–307 (2009).
  MedlineGoogle Scholar
• 58. Soma-Pillay P, Catherine N-P, Tolppanen H, Mebazaa A, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc. J. Af. 27(2), 89 (2016).
  MedlineGoogle Scholar
• 59. Gupta P, Singh MP, Goyal K. Diversity of vaginal microbiome in pregnancy: deciphering the obscurity. Front. Public Health 8, 326 (2020).
  MedlineGoogle Scholar
• 60. Lash GE. Molecular cross-talk at the feto–maternal interface. Cold Spring Harb. Perspect. Med. 5(12), 1–14 (2015).
  Google Scholar
• 61. Kumar M, Saadaoui M, Al Khodor S. Infections and pregnancy: effects on maternal and child health. Front. Cell. Infect. Microbiol. 12, 873253 (2022).
  Medline CASGoogle Scholar
• 62. Kumar P, Magon N. Hormones in pregnancy. Niger. Med. J. 53(4), 179–183 (2012).
  MedlineGoogle Scholar
• 63. Schock H, Zeleniuch-Jacquotte A, Lundin E et al. Hormone concentrations throughout uncomplicated pregnancies: a longitudinal study. BMC Pregnancy Childbirth 16(1), 1–11 (2016).
  MedlineGoogle Scholar
• 64. Kumar P, Magon N. Hormones in pregnancy. Niger. Med. J. 53(4), 179 (2012).
  MedlineGoogle Scholar
• 65. Haque MM, Merchant M, Kumar PN, Dutta A, Mande SS. First-trimester vaginal microbiome diversity: a potential indicator of preterm delivery risk. Sci. Rep. 7(1), 1–10 (2017).
  MedlineGoogle Scholar
• 66. Laghi L, Zagonari S, Patuelli G et al. Vaginal metabolic profiles during pregnancy: changes between first and second trimester. PLOS ONE 16(4), e0249925 (2021).
  Medline CASGoogle Scholar
• 67. Nuriel-Ohayon M, Neuman H, Koren O. Microbial changes during pregnancy, birth, and infancy. Front. Microbiol. 7, 1031 (2016).
  MedlineGoogle Scholar
• 68. Romero R, Hassan SS, Gajer P et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome 2(1), 1–19 (2014).
  MedlineGoogle Scholar
• 69. Saadaoui M, Kumar M, Al Khodor S. COVID-19 infection during pregnancy: risk of vertical transmission, fetal, and neonatal outcomes. J. Pers. Med. 11(6), 1–11 (2021).
  Google Scholar
• 70. Vinturache AE, Gyamfi-Bannerman C, Hwang J, Mysorekar IU, Jacobsson B, Collaborative TPBI. Maternal microbiome – a pathway to preterm birth. Semin. Fetal Neonatal Med. 21(2), 94–99 (2016).
  MedlineGoogle Scholar
• 71. Macintyre DA, Chandiramani M, Lee YS et al. The vaginal microbiome during pregnancy and the postpartum period in a European population. Sci. Rep. 5(1), 1–9 (2015).
  Google Scholar
• 72. Hendrick V, Altshuler LL, Suri R. Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics 39(2), 93–101 (1998).
  Medline CASGoogle Scholar
• 73. DiGiulio DB, Callahan BJ, Mcmurdie PJ et al. Temporal and spatial variation of the human microbiota during pregnancy. Proc. Natl Acad. Sci. USA 112(35), 11060–11065 (2015).
  Medline CASGoogle Scholar
• 74. Severgnini M, Morselli S, Camboni T et al. A deep look at the vaginal environment during pregnancy and puerperium. Front. Cell. Infect. Microbiol. 12, 838405 (2022).
  Medline CASGoogle Scholar
• 75. Gomez-Lopez N, Stlouis D, Lehr MA, Sanchez-Rodriguez EN, Arenas-Hernandez M. Immune cells in term and preterm labor. Cell. Mol. Immunol. 11(6), 571–581 (2014).
  Medline CASGoogle Scholar
• 76. Taylor KR, Trowbridge JM, Rudisill JA, Termeer CC, Simon JC, Gallo RL. Hyaluronan fragments stimulate endothelial recognition of injury through TLR4. J. Biol. Chem. 279(17), 17079–17084 (2004).
  Medline CASGoogle Scholar
• 77. Hong Y, Kim YK, Kim GB et al. Degradation of tumour stromal hyaluronan by small extracellular vesicle-PH20 stimulates CD103+ dendritic cells and in combination with PD-L1 blockade boosts anti-tumour immunity. J. Extracell. Vesicles 8(1), 1670893 (2019).
  Medline CASGoogle Scholar
• 78. Nunn KL, Witkin SS, Schneider GM et al. Changes in the vaginal microbiome during the pregnancy to postpartum transition. Reprod. Sci. 28(7), 1996–2005 (2021). •• The paper highlights the changes that occur in the vaginal microbiota in females during their postpartum period.
  Medline CASGoogle Scholar
• 79. Stout MJ, Zhou Y, Wylie KM, Tarr PI, Macones GA, Tuuli MG. Early pregnancy vaginal microbiome trends and preterm birth. Am. J. Obstet. Gynecol. 217(3), 356.e1–356.e18 (2017).
  Google Scholar
• 80. Gudnadottir U, Debelius JW, Du J et al. The vaginal microbiome and the risk of preterm birth: a systematic review and network meta-analysis. Sci. Rep. 12(1), 1–8 (2022).
  MedlineGoogle Scholar
• 81. Chu DM, Seferovic M, Pace RM, Aagaard KM. The microbiome in preterm birth. Best Pract. Res. Clin. Obstet. Gynaecol. 52, 103–113 (2018).
  MedlineGoogle Scholar
• 82. Sun S, Serrano MG, Fettweis JM et al. Race, the vaginal microbiome, and spontaneous preterm birth. mSystems 7(3), e0001722 (2022).
  MedlineGoogle Scholar
• 83. Kumar M, Murugesan S, Singh P et al. Vaginal microbiota and cytokine levels predict preterm delivery in Asian women. Front. Cell. Infect. Microbiol. 11, 639665 (2021).
  Medline CASGoogle Scholar
• 84. Mohamed I, Zakeer S, Azab M, Hanora A. Changes in vaginal microbiome in pregnant and nonpregnant women with bacterial vaginosis: toward microbiome diagnostics? OMICS 24(10), 602–614 (2020).
  Medline CASGoogle Scholar
• 85. Dall'Asta M, Laghi L, Morselli S et al. Pre-pregnancy diet and vaginal environment in Caucasian pregnant women: an exploratory study. Front. Mol. Biosci. 8, 702370 (2021).
  MedlineGoogle Scholar
• 86. Jefferson KK, Parikh HI, Garcia EM et al. Relationship between vitamin D status and the vaginal microbiome during pregnancy. J. Perinatol. 39(6), 824–836 (2019). • The paper highlights the role of vitamin D in maintaining a health vaginal microbiota.
  Medline CASGoogle Scholar
• 87. Zhou SS, Tao YH, Huang K, Zhu BB, Tao FB. Vitamin D and risk of preterm birth: up-to-date meta-analysis of randomized controlled trials and observational studies. J. Obstet. Gynaecol. Res. 43(2), 247–256 (2017).
  Medline CASGoogle Scholar
• 88. Tabatabaei N, Eren A, Barreiro L et al. Vaginal microbiome in early pregnancy and subsequent risk of spontaneous preterm birth: a case-control study. BJOG 126(3), 349–358 (2019).
  Medline CASGoogle Scholar
• 89. Wee BA, Thomas M, Sweeney EL et al. A retrospective pilot study to determine whether the reproductive tract microbiota differs between women with a history of infertility and fertile women. Aust. N. Z. J. Obstet. Gynaecol. 58(3), 341–348 (2018).
  MedlineGoogle Scholar
• 90. Wright VC, Schieve LA, Reynolds MA, Jeng G. Assisted reproductive technology surveillance – United States, 2002. MMWR Surveill. Summ. 54(2), 1–24 (2005).
  MedlineGoogle Scholar
• 91. Campisciano G, Florian F, D'eustacchio A et al. Subclinical alteration of the cervical-vaginal microbiome in women with idiopathic infertility. J. Cell. Physiol. 232(7), 1681–1688 (2017).
  Medline CASGoogle Scholar
• 92. Lledo B, Fuentes A, Lozano F et al. Identification of vaginal microbiome associated with IVF pregnancy. Sci. Rep. 12(1), 1–10 (2022).
  MedlineGoogle Scholar
• 93. Moreno I, Simon C. Deciphering the effect of reproductive tract microbiota on human reproduction. Reprod. Med. Biol. 18(1), 40–50 (2019).
  MedlineGoogle Scholar
• 94. Azpiroz MA, Orguilia L, Palacio MI et al. Potential biomarkers of infertility associated with microbiome imbalances. Am. J. Reprod. Immunol. 86(4), e13438 (2021).
  Medline CASGoogle Scholar
• 95. University of California Los Angeles Health Menopause. www.uclahealth.org/obgyn/menopause
  Google Scholar
• 96. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J. Psychiatry 57(Suppl. 2), S222 (2015).
  MedlineGoogle Scholar
• 97. Gupta S, Kumar N, Singhal N, Kaur R, Manektala U. Vaginal microflora in postmenopausal women on hormone replacement therapy. Indian J. Pathol. Microbiol. 49(3), 457–461 (2006).
  MedlineGoogle Scholar
• 98. Brotman RM, Shardell MD, Gajer P et al. Association between the vaginal microbiota, menopause status and signs of vulvovaginal atrophy. Menopause 21(5), 450 (2014).
  MedlineGoogle Scholar
• 99. Gliniewicz K, Schneider GM, Ridenhour BJ et al. Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Front. Microbiol. 10, 193 (2019).
  MedlineGoogle Scholar
• 100. Abdi F, Mobedi H, Roozbeh N. Hops for menopausal vasomotor symptoms: mechanisms of action. J. Menopausal Med. 22(2), 62–64 (2016).
  MedlineGoogle Scholar
• 101. Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas 91, 42–50 (2016). •• The paper highlights the vaginal microbiome present in the postmenopausal women.
  MedlineGoogle Scholar
• 102. Vitali D, Wessels JM, Kaushic C. Role of sex hormones and the vaginal microbiome in susceptibility and mucosal immunity to HIV-1 in the female genital tract. AIDS Res. Ther. 14(1), 1–5 (2017).
  MedlineGoogle Scholar
• 103. Pabich WL, Fihn SD, Stamm WE, Scholes D, Boyko EJ, Gupta K. Prevalence and determinants of vaginal flora alterations in postmenopausal women. J. Infect. Dis. 188(7), 1054–1058 (2003).
  MedlineGoogle Scholar
• 104. Bank NK. Menopausal hormone replacement therapy. Nicole K Banks. https://emedicine.medscape.com/article/276104-overview (Accessed 24 May 2022).
  Google Scholar
• 105. Bisanz JE, Seney S, Mcmillan A et al. A systems biology approach investigating the effect of probiotics on the vaginal microbiome and host responses in a double blind, placebo-controlled clinical trial of post-menopausal women. PLOS ONE 9(8), e104511 (2014).
  MedlineGoogle Scholar
• 106. Kim J-M, Park YJ. Probiotics in the prevention and treatment of postmenopausal vaginal infections. J. Menopausal Med. 23(3), 139 (2017).
  MedlineGoogle Scholar
• 107. Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu. Rev. Microbiol. 66, 371–389 (2012).
  Medline CASGoogle Scholar