The role of probiotics in restoring and maintaining vaginal microbiome health: a review

ABSTRACT The vaginal microbiome is an important aspect of female reproductive health. The dominant microbial species of this ecosystem, Lactobacillus , offers protection from vaginal infections by maintaining lower pH levels and reducing potential pathogen colonization. Dysbiosis, or imbalance of the vaginal microbial ecosystem, has been associated with both common infections, such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and urinary tract infections (UTIs), and obstetric complications, including gestational diabetes, preterm labor, and obstetric anemia. This review provides an overview of the composition and function of the vaginal microbiota, emphasizing the role of Lactobacillus and other beneficial microbes and their mechanisms of action, including lactic acid and hydrogen peroxide production, competitive adherence, and immune modulation. Evidence from clinical trials supports the efficacy of these strains in reducing recurrence of BV, VVC, and UTIs. Additionally, emerging research shows promise for probiotic use in managing reproductive conditions such as gestational diabetes mellitus, preterm labor, and obstetric anemia. The review also discusses safety considerations, particularly in immunocompromised individuals, and the expanding interest in non- Lactobacillus genera like Bifidobacterium and Bacillus . Targeted probiotic interventions have great potential for restoring and maintaining a healthy vaginal microbiome, preventing recurrent infections, and helping improve reproductive outcomes. However, in order to incorporate these approaches in clinical practice, probiotic strains, delivery method, and dosage all need standardization.