(129) WOMEN WHO REPORT PAIN WITH SEX HAVE VARYING MICROBIOME PROFILES BASED ON AGE
Authors: Thomas-White K , Navarro P , Weaver F 
Published: June 2024

Abstract

Introduction
Even though the vaginal microbiome (VM) is a known contributor to vaginal epithelial health, the VM of women who report pain with sex has not been characterized. It is known that the VM shifts during menopause, therefore we segmented out analysis based on menopausal status.

Objective
An observational analysis comparing the vaginal microbiome composition and symptom profiles in individuals of both menopausal and reproductive age who experience moderate to severe pain with sex and those that do not report pain with sex.

Methods
This study involved the collection of self-reported health profiles and shotgun metagenomic analysis of vaginal samples from two distinct demographic groups: menopausal women and women of reproductive age (defined as non-pregnant, non-menopausal, and aged under 40 years). The focus was on identifying the microbial composition in individuals experiencing moderate to severe sexual intercourse pain and those without any reported pain, excluding samples from individuals with mild pain. An additional criterion for inclusion was a reported history of sexual activity within the preceding 30 days. The menopausal group comprised 157 individuals reporting pain and 367 individuals without pain. In the reproductive age cohort, there were 968 participants with pain and 968 age-matched controls without pain. Statistical analysis between the pain and control groups in both cohorts revealed no significant differences in body mass index (BMI, menopause p = 0.74, reproductive p = 0.19), reported hormone use (menopause p = 0.2, reproductive p = 0.24), or history of previous infections (menopause p = 0.29, reproductive p = 0.09).

Results
In both the menopausal and reproductive-aged cohorts, individuals experiencing pain during sexual intercourse exhibited a higher prevalence of symptomatic conditions, as illustrated in Figure 1 A & B. Reported symptoms included increased severity of burning, itchiness, vaginal and vulvar pain, erythema, dysuria, and vaginal dryness. A significant correlation was observed between these enhanced symptomatology and variations in vaginal microbiome compositions among the menopausal group, as depicted in Figure 2 A & B. Specifically, pain during sexual intercourse in menopausal women was linked to elevated vaginal microbiota (VM) diversity (p=0.047) and a reduction in lactobacilli levels (p=0.06). Conversely, in the reproductive-aged cohort, a higher VM diversity was noted in the control group (p=0.014), with no significant differences in Lactobacillus or Gardnerella concentrations between those experiencing pain and the control group.

Conclusions
Preliminary examination of the vaginal microbiome in women who self-report moderate to severe pain with sex reveals significant differences, particularly in menopausal women experiencing pain. These individuals exhibited a more diverse vaginal microbiome and lower levels of Lactobacillus. This study underscores the need for further research to explore the potential of targeted microbiome modifications as a therapeutic approach to alleviate pain symptoms in this demographic.

Disclosure
Yes, this is sponsored by industry/sponsor: Evvy.
Clarification: Industry initiated, executed and funded study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Evvy.