Vaginal Microbiota and Pelvic Floor Dysfunction: Mechanistic Insights and Therapeutic Implications

Pelvic floor dysfunction (PFD) encompasses a spectrum of prevalent chronic conditions, including urinary incontinence, pelvic organ prolapse, and female sexual dysfunction, arising from the impaired integrity of the pelvic floor muscles, ligaments, and connective tissues. The vaginal microbiota (VM) plays a critical role in maintaining mucosal barrier function and homeostasis within the lower reproductive tract. The integrity of the levator hiatus and urogenital hiatus maintains the closure of the pelvic floor and the stability of the VM. Emerging evidence indicates a bidirectional relationship between PFD and the VM, mediated through anatomical, hormonal-metabolic, and immunological pathways. Recent studies indicate that some of these interventions are associated with shifts in VM composition. Emerging evidence suggests that microbiota-targeted approaches, including probiotics and VM transplantation, demonstrate potential in restoring microbial balance and modulating local inflammatory responses in the lower genital tract. Although large-scale clinical trials are lacking, several studies have demonstrated that microbiota-targeted interventions, including probiotics, VM transplantation, and estriol-containing pessaries, can improve vaginal dysbiosis and modulate local inflammatory responses, with potential implications for PFD management. This review synthesizes current evidence on the interaction among the VM, pelvic floor supports, and PFD development, with a focus on underlying mechanisms and clinical associations, and discusses the potential role of microbiome-based diagnostics and therapeutics in PFD management. This article aims to review the roles and therapeutic implications of the VM and VM dysbiosis in PFD.