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Systematic Review: The Neovaginal Microbiome.

Richard Mateo Mora1, Preeya Mehta2, Ryan Ziltzer2

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The neovaginal microbiome is typically polymicrobial, often resembling native vaginal flora. Optimizing this environment may improve surgical outcomes by reducing inflammation and infection.

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Area of Science:

  • Gynecologic Surgery
  • Microbiome Research
  • Vaginal Reconstruction

Background:

  • Neovaginal construction is performed using various graft types, including penile/scrotal skin, sigmoid segments, and peritoneal grafts.
  • The neovaginal microbiome's composition and its association with inflammatory patterns are not fully understood.

Purpose of the Study:

  • To systematically review the neovaginal microbiome and inflammatory patterns.
  • To identify factors influencing the neovaginal microenvironment.
  • To inform strategies for improving surgical outcomes in neovaginal reconstruction.

Main Methods:

  • Systematic review of 13 articles published up to October 2021, following PRISMA guidelines.
  • Analysis of data from 458 patients undergoing neovaginal construction.
  • Review of studies reporting on neovaginal microflora and inflammatory markers.

Main Results:

  • Neovaginal microflora were generally polymicrobial, with similarities to native vaginal tissue.
  • Lactobacillus was identified in studies using penile skin, sigmoid, peritoneal, and other graft types.
  • A bacterial vaginosis-like environment was present in 9 studies, and inflammatory markers were noted in several graft types.

Conclusions:

  • The neovagina can support Lactobacillus, potentially through various mechanisms.
  • A polymicrobial, dysbiotic environment is common in neovaginas.
  • Further research is needed to standardize testing and develop treatments for neovaginal dysbiosis to enhance surgical results.