National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100005, Beijing, China.
BGI-Research, Shenzhen, 518083, China.
Nat Commun. 2024 Sep 6;15(1):7808. doi: 10.1038/s41467-024-52102-1.
Neovaginas are surgically constructed to correct uterovaginal agenesis in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or as part of gender-affirming surgery for transfeminine individuals. Understanding the assembly of the neovaginal microbiota is crucial for guiding its management. To address this, we conducted a longitudinal study on MRKH patients following laparoscopic peritoneal vaginoplasty. Our findings reveal that the early microbial assemblage exhibited stochastic characteristics, accompanied with a notable bloom of Enterococcus faecalis and genital Mycoplasmas. While both the pre-surgery dimple microbiota and the fecal microbiota constituted the primary species pool, the neovaginal microbiota developed into a microbiota that resembled that of a normal vagina at 6-12 months post-surgery, albeit with a bacterial vaginosis (BV)-like structure. By 2-4 years post-surgery, the neovaginal microbiota had further evolved into a structure closely resembling with the homeostatic pre-surgery dimple microbiota. This concords with the development of the squamous epithelium in the neovagina and highlights the pivotal roles of progressive selective forces imposed by the evolving neovaginal environment and the colonization tropism of vaginal species. Notably, we observed that strains of Lactobacillus crispatus colonizing the neovagina primarily originated from the dimple. Since L. crispatus is generally associated with vaginal health, this finding suggests potential avenues for future research to promote its colonization.
阴道是通过手术构建的，用于纠正患有 Mayer-Rokitansky-Küster-Hauser（MRKH）综合征的女性的子宫阴道发育不全，或作为跨性别女性进行性别肯定手术的一部分。了解新阴道微生物群的组装对于指导其管理至关重要。为了解决这个问题，我们对接受腹腔镜腹膜阴道成形术的 MRKH 患者进行了一项纵向研究。我们的研究结果表明，早期微生物组合具有随机特征，同时伴随着粪肠球菌和生殖道支原体的明显增多。虽然术前酒窝菌群和粪便菌群构成了主要的物种库，但新阴道菌群在术后 6-12 个月内发展成为类似于正常阴道的菌群，尽管具有细菌性阴道病（BV）样结构。术后 2-4 年内，新阴道菌群进一步演变为与术前酒窝稳态菌群结构非常相似的结构。这与新阴道鳞状上皮的发育一致，并强调了不断变化的新阴道环境和阴道物种定植倾向施加的渐进选择性力量的关键作用。值得注意的是，我们观察到定植在新阴道中的乳酸杆菌 crispatus 菌株主要来源于酒窝。由于 L. crispatus 通常与阴道健康相关，这一发现为未来促进其定植的研究提供了潜在途径。
