Book contents
- Context, Principles, and Practice of Transgynecology
- Context, Principles, and Practice of Transgynecology
- Copyright page
- Dedication
- Contents
- Foreword
- Preface
- Contributors
- Abbreviations
- Section A Contextual Transgynecology
- Section B Practicing Transgynecology
- Section C Gynecological Surgery for Transgender Males
- Section D Sexuality and Contraception
- Section E Fertility and Reproduction
- Section F Impact of Gender-affirming Hormonal Therapy on Genital Organs
- Chapter 31 Changes to the Uterus from Supraphysiological Androgens
- Chapter 32 The Ovaries under Supraphysiological Androgen Exposure
- Chapter 33 The Vaginal and Neovaginal Microbiome under Androgen or Estrogen Exposure Respectively
- Section G Screening and Prophylaxis
- Transgynecology Index
- References
Chapter 33 - The Vaginal and Neovaginal Microbiome under Androgen or Estrogen Exposure Respectively
from Section F - Impact of Gender-affirming Hormonal Therapy on Genital Organs
Published online by Cambridge University Press: 22 December 2022
Book contents
- Context, Principles, and Practice of Transgynecology
- Context, Principles, and Practice of Transgynecology
- Copyright page
- Dedication
- Contents
- Foreword
- Preface
- Contributors
- Abbreviations
- Section A Contextual Transgynecology
- Section B Practicing Transgynecology
- Section C Gynecological Surgery for Transgender Males
- Section D Sexuality and Contraception
- Section E Fertility and Reproduction
- Section F Impact of Gender-affirming Hormonal Therapy on Genital Organs
- Chapter 31 Changes to the Uterus from Supraphysiological Androgens
- Chapter 32 The Ovaries under Supraphysiological Androgen Exposure
- Chapter 33 The Vaginal and Neovaginal Microbiome under Androgen or Estrogen Exposure Respectively
- Section G Screening and Prophylaxis
- Transgynecology Index
- References
Summary
A particularly important, yet largely underappreciated, aspect of transgender health relates to the creation of novel microbiome niches with gender-confirmation surgery. In transwomen specifically, gender-confirming surgery may involve the creation of a vault through vaginoplasty [1], open to microbial colonization. In ciswomen, it is rather well established that the vaginal microbiome tends to be dominated by niche-specific Lactobacillus taxa, an ecology understood as central to human reproductive health [2,3]. Perturbations of this community ecology in turn are known to predispose to an array of adverse health conditions, including an overall increased acquisition risk of sexually transmitted infections (STIs). Apart from surgical interventions, transwomen as well as transmen will most often receive gender-affirming hormonal treatment, which may also affect the structure and function of the vaginal as well as of the neovaginal microbiome. In this chapter, we will review what is known of the neovaginal microbiome, as well as the effects of estrogen and androgen exposure on the vaginal and neovaginal microbiome, respectively.
- Type
- Chapter
- Information
- Context, Principles and Practice of TransGynecologyManaging Transgender Patients in ObGyn Practice, pp. 243 - 249Publisher: Cambridge University PressPrint publication year: 2022
References
Hadj-Moussa, M, Ohl, DA, Kuzon, WM Jr. Feminizing genital gender-confirmation surgery. Sex Med Rev 2018;6(3):457–468.e2. https://doi.org/10.1016/j.sxmr.2017.11.005.Google Scholar
van de Wijgert, JH, Borgdorff, H, Verhelst, R et al. The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One 2014;9(8):e105998. https://doi.org/10.1371/journal.pone.0105998.Google Scholar
Charbonneau, MR, Blanton, LV, DiGiulio, DB, et al. A microbial perspective of human developmental biology. Nature 2016;535(7610):48–55. https://doi.org/10.1038/nature18845.Google Scholar
Anahtar, MN, Byrne, EH, Doherty, KE, et al. Cervicovaginal bacteria are a major modulator of host inflammatory responses in the female genital tract. Immunity 2015;42(5):965–976. https://doi.org/10.1016/j.immuni.2015.04.019Google Scholar
Mendes-Soares, H, Suzuki, H, Hickey, RJ, Forney, LJ. Comparative functional genomics of Lactobacillus spp. reveals possible mechanisms for specialization of vaginal lactobacilli to their environment. J Bacteriol 2014;196(7):1458–1470. https://doi.org/10.1128/JB.01439-13CrossRefGoogle ScholarPubMed
Reid, G, Brigidi, P, Burton, JP, et al. Microbes central to human reproduction. Am J Reprod Immunol 2015;73(1):1–11. https://doi.org/10.1111/aji.12319Google Scholar
Koedooder, R, Mackens, S, Budding, A, et al. Identification and evaluation of the microbiome in the female and male reproductive tracts. Hum Reprod Update 2019;25(3):298–325. https://doi.org/10.1093/humupd/dmy048Google Scholar
Jašarević, E, Bale, TL. Prenatal and postnatal contributions of the maternal microbiome on offspring programming. Front Neuroendocrinol 2019;55:100797. https://doi.org/10.1016/j.yfrne.2019.100797Google Scholar
Verstraelen, H, Vilchez-Vargas, R, Desimpel, F, et al. Characterisation of the human uterine microbiome in non-pregnant women through deep sequencing of the V1–2 region of the 16S rRNA gene. Peer J 2016;4:e1602. https://doi.org/10.7717/peerj.1602Google Scholar
Jones, BP, Saso, S, L’Heveder, A, et al. The vaginal microbiome in uterine transplantation. BJOG 2020;127(2):230–238. https://doi.org/10.1111/1471-0528.15881Google Scholar
Borgdorff, H, Gautam, R, Armstrong, SD, et al. Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier. Mucosal Immunol 2016;9(3):621–633. https://doi.org/10.1038/mi.2015.86Google Scholar
Verstraelen, H, Swidsinski, A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment: 2018 update. Curr Opin Infect Dis 2019;32(1):38–42. https://doi.org/10.1097/QCO.0000000000000516Google Scholar
Swidsinski, A, Guschin, A, Tang, Q, et al. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol 2019;220(1):91.e1–91.e8. https://doi.org/10.1016/j.ajog.2018.10.023Google Scholar
Willems, HME, Ahmed, SS, Liu, J, Xu, Z, Peters, BM. Vulvovaginal candidiasis: a current understanding and burning questions. J Fungi 2020;6(1):27. https://doi.org/10.3390/jof6010027CrossRefGoogle ScholarPubMed
Mirmonsef, P, Hotton, AL, Gilbert, D, et al. Free glycogen in vaginal fluids is associated with Lactobacillus colonization and low vaginal pH. PLoS One 2014;9(7):e102467. https://doi.org/10.1371/journal.pone.0102467Google Scholar
Mirmonsef, P, Hotton, AL, Gilbert, D, et al. Glycogen levels in undiluted genital fluid and their relationship to vaginal pH, estrogen, and progesterone. PLoS One 2016;11(4):e0153553. https://doi.org/10.1371/journal.pone.0153553Google Scholar
Verstraelen, H, Vervaet, C, Remon, JP. Rationale and safety assessment of a novel intravaginal drug-delivery system with sustained dl-lactic acid release, intended for long-term protection of the vaginal microbiome. PLoS One 2016;11(4):e0153441. https://doi.org/10.1371/journal.pone.0153441Google Scholar
van de Wijgert, JH, Verwijs, MC, Turner, AN, Morrison, CS. Hormonal contraception decreases bacterial vaginosis but oral contraception may increase candidiasis: implications for HIV transmission. AIDS 2013;27(13):2141–2153. https://doi.org/10.1097/QAD.0b013e32836290b6Google Scholar
Vodstrcil, LA, Hocking, JS, Law, M, et al. Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and meta-analysis. PLoS One 2013;8(9):e73055. https://doi.org/10.1371/journal.pone.0073055Google Scholar
Wessels, JM, Felker, AM, Dupont, HA, Kaushic, C. The relationship between sex hormones, the vaginal microbiome and immunity in HIV-1 susceptibility in women. Dis Model Mech 2018;11(9):dmm035147. https://doi.org/10.1242/dmm.035147Google Scholar
Baldassarre, M, Giannone, FA, Foschini, MP, et al. Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women. Int J Impot Res 2013;25(5):172–177. https://doi.org/10.1038/ijir.2013.9Google Scholar
Winston McPherson, G, Long, T, Salipante, SJ, et al. The vaginal microbiome of transgender men. Clin Chem 2019;65(1):199–207. https://doi.org/10.1373/clinchem.2018.293654Google Scholar
Litvak, Y, Bäumler, AJ. The founder hypothesis: a basis for microbiota resistance, diversity in taxa carriage, and colonization resistance against pathogens. PLoS Pathog 2019;15(2):e1007563. https://doi.org/10.1371/journal.ppat.1007563Google Scholar
Thomas-White, K, Forster, SC, Kumar, N, et al. Culturing of female bladder bacteria reveals an interconnected urogenital microbiota. Nat Commun 2018;9(1):1557. https://doi.org/10.1038/s41467-018-03968-5Google Scholar
Bauer, MA, Kainz, K, Carmona-Gutierrez, D, Madeo, F. Microbial wars: competition in ecological niches and within the microbiome. Microb Cell 2018;5(5):215–219. https://doi.org/10.15698/mic2018.05.628Google Scholar
Toolenaar, TA, Freundt, I, Wagenvoort, JH, et al. Bacterial flora of the sigmoid neovagina. J Clin Microbiol 1993;31(12):3314–3316. https://doi.org/10.1128/JCM.31.12.3314-3316.1993Google Scholar
van der Sluis, WB, Bouman, MB, Mullender, MG, et al. The effect of surgical fecal stream diversion of the healthy colon on the colonic microbiota. Eur J Gastroenterol Hepatol 2019;31(4):451–457. https://doi.org/10.1097/MEG.0000000000001330Google Scholar
Weyers, S, Verstraelen, H, Gerris, J, et al. Microflora of the penile skin-lined neovagina of transsexual women. BMC Microbiol 2009;9:102. https://doi.org/10.1186/1471-2180-9-102Google Scholar
Birse, KD, Kratzer, K, Zuend, CF, et al. The neovaginal microbiome of transgender women post-gender reassignment surgery. Microbiome 2020;8(1):61. https://doi.org/10.1186/s40168-020-00804-1Google Scholar
Petricevic, L, Kaufmann, U, Domig, KJ, et al. Molecular detection of Lactobacillus species in the neovagina of male-to-female transsexual women. Sci Rep 2014a;4:3746. https://doi.org/10.1038/srep03746Google Scholar
Petricevic, L, Kaufmann, U, Domig, KJ, et al. Rectal Lactobacillus species and their influence on the vaginal microflora: a model of male-to-female transsexual women. J Sex Med 2014b;11(11):2738–2743.CrossRefGoogle Scholar
Jain, A, Bradbeer, C. A case of successful management of recurrent bacterial vaginosis of neovagina after male to female gender reassignment surgery. Int J STD AIDS 2007;18(2):140–141. https://doi.org/10.1258/095646207779949790CrossRefGoogle ScholarPubMed
de Haseth, KB, Buncamper, ME, Özer, M, et al. Symptomatic neovaginal candidiasis in transgender women after penile inversion vaginoplasty: a clinical case series of five consecutive patients. Transgend Health 2018;3(1):105–108. https://doi.org/10.1089/trgh.2017.0045Google Scholar
van der Sluis, WB, Neefjes-Borst, EA, Bouman, MB, et al. Morphological spectrum of neovaginitis in autologous sigmoid transplant patients. Histopathology 2016;68(7):1004–1012. https://doi.org/10.1111/his.12894Google Scholar
Tominaga, K, Kamimura, K, Takahashi, K, et al. Diversion colitis and pouchitis: a mini-review. World J Gastroenterol 2018;24(16):1734–1747. https://doi.org/10.3748/wjg.v24.i16.1734Google Scholar
van der Sluis, WB, Bouman, MB, Meijerink, WJHJ, et al. Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics. Fertil Steril 2016;105(3):834–839.e1. https://doi.org/10.1016/j.fertnstert.2015.11.013CrossRefGoogle ScholarPubMed