V-RAD (Vaginal Radar Assessment Diagram): A Conceptual Framework for the Standardized Multidimensional Representation of the Vaginal Ecosystem

Molecular diagnostics and next-generation sequencing have greatly expanded our ability to identify and characterize microorganisms within the vaginal environment. However, identifying which microorganisms are present does not fully describe the ecological state in which they interact with the host. Routine vaginal microscopy provides complementary information by simultaneously revealing microbial morphology and abundance, epithelial status, microbial organization, cytolytic changes, and the host inflammatory response. Yet, while disease-specific diagnostic systems standardize selected microscopic findings, no common framework exists to represent this broader ecological information as a whole. To address this gap, we developed the Vaginal Radar Assessment Diagram (V-RAD), a conceptual framework that translates routine microscopic observations into a standardized graphical representation of the vaginal ecosystem. V-RAD integrates six independently assessed dimensions covering microbial composition and abundance, epithelial status, microbial spatial organization, host–microbiota interaction, and inflammatory response, preserving their individual contribution without reducing them to a composite score. Representative profiles illustrate how the framework can describe physiological conditions, classical dysbiotic syndromes, mixed presentations, and transitional states within the same graphical language. By making the multidimensional information generated during microscopy explicit and comparable, V-RAD may provide a common framework for documenting vaginal ecology, following its changes over time, and integrating microscopic findings with current and emerging diagnostic technologies.