The Vulvar Microbiome in Children and Adolescents: Developmental Dynamics, Dysbiosis, and Clinical Implications

Given the proliferation of direct-to-consumer marketing of vulvar hygiene products, this review addresses best practices influenced by new understanding of the vulvar biome. It also provides new understanding of the how alterations in the vulvar biome can adversely affect health. The vulvar microbiome represents a distinct ecological niche that differs fundamentally from the vaginal microbiome in composition, function, and hormonal responsiveness. Unlike the vagina, the vulva is a keratinized cutaneous surface characterized by higher microbial diversity and lower biomass, rendering it particularly vulnerable to mechanical, chemical, and antibiotic-induced disruption. The vulvar biome evolves with the hormonal and structural changes of puberty. Emerging evidence suggests that many recurrent vulvar conditions, including folliculitis, methicillin-resistant Staphylococcus aureus (MRSA) abscesses, and early-onset hidradenitis suppurativa, may represent manifestations of microbiome dysbiosis rather than primary infection. Current evidence suggests that to effectively restore health, it is important to assess the ecosystem, normalize the physiologic pH, restore protective barriers, and rebalance the flora.