Vaginal microbiome: modern approaches for correction and/or restoration

Today, women’s health is a separate issue for doctors of many specialties, including obstetricians and gynecologists, family doctors, etc. There is a wide range of treatment options for managing diseases of the reproductive system in women. But despite this, many of these strategies do not work for our patients. Therefore, we need the latest personalized approaches to therapy. One of the newest trends in women’s health is the correction or restoration of the vaginal microbiome. In our previous publications, we have covered the issue of the normal composition of the vaginal microbiome and its changes in various pathological conditions. Modification of the vaginal microbiome can be a useful strategy in the treatment of sexually transmitted infections, bacterial vaginosis, candidiasis, benign, precancerous and even malignant diseases of the female reproductive system, miscarriage, preterm birth and other pregnancy complications.The concept of using exogenous microorganisms as a treatment has been known for centuries. Possible mechanisms by which exogenous strains of lactobacilli can affect vaginal microbiome include vaginal recolonization, increased production or release of lactic acid and other antimicrobial compounds, and modulation of the local mucosal immune response. From a microbiome perspective, “prebiotics” are nutraceutical compounds that induce bacterial growth or the activity of probiotics or beneficial endogenous microorganisms. One of the limitations of prebiotics is their dependence on the presence of lactobacilli, which are absent or almost absent in dysbiosis. Symbiotics are combinations of prebiotics and probiotics based on the concept that the first nutraceutical can improve the bacterial growth and function of the other. This review highlights the latest views on correction and/or restoration of the vaginal microbiome using not only probiotics, prebiotics, and symbiotic, but also phage-altering agents, phage therapy, vaginal microbiome transplantation, etc. Such methods of correction and/or restoration are currently relevant in the reproductive medicine, gynecology and obstetrics all over the world. Despite the fact that these are the newest methods of correction and/or restoration, they are developing every day and require more detailed coverage of this issue.