Assessment of the vaginal microbiota before and after use of hyperosmolal lubricant during transvaginal ultrasound

Sarah E Brown; Xin He; Laurence Magder; Christina A Stennett; Sarah J Robbins; Elizabeth D Johnston; Daniel Morgan; Khalil Ghanem; Jacques Ravel; Katrina Mark; Rebecca M Brotman

doi:10.1016/j.ajog.2024.12.016

Assessment of the vaginal microbiota before and after use of hyperosmolal lubricant during transvaginal ultrasound

Am J Obstet Gynecol. 2024 Dec 16:S0002-9378(24)01193-1. doi: 10.1016/j.ajog.2024.12.016. Online ahead of print.

Authors

Affiliations

¹ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
² Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA.
³ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
⁴ University of Maryland, Faculty Physicians Inc., Baltimore, MD, USA.
⁵ Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁷ Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁸ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: rbrotman@som.umaryland.edu.

PMID: 39694166
DOI: 10.1016/j.ajog.2024.12.016

Abstract

Background: Vaginal lubricants are commonly used during sexual activity and clinical procedures such as transvaginal ultrasound (TVUS). Epidemiologic and laboratory studies indicate hyperosmolal water-based lubricants may disrupt the vaginal microbiota, particularly the beneficial Lactobacillus spp. These bacteria play a critical role in protecting against sexually transmitted infection acquisition and other adverse gynecologic and obstetric outcomes.

Objective: We sought to evaluate changes in the composition of the vaginal microbiota before and after a single exposure to lubricant over a 10-week period among pre-, peri-, and postmenopausal patients referred for TVUS.

Study design: 104 participants self-collected mid-vaginal swabs daily between baseline and TVUS (∼one week), immediately before TVUS ("pre-TVUS"), and 6-12 hours after TVUS ("post-TVUS"). Participants attended a follow-up visit ∼2-5 days after TVUS ("post-TVUS follow-up"), continued to self-sample twice-weekly for 9 weeks, and attended a final clinical visit in week 10. Microbiota composition was characterized by 16S rRNA gene amplicon sequencing (V3-V4) and assigned to community state types (low-Lactobacillus vs Lactobacillus-dominated). Yue-Clayton theta indices defined similarity between daily successive samples between baseline and TVUS, and overall stability of the vaginal microbiota before and after TVUS. Analysis of Compositions of Microbiomes II determined differentially abundant taxa in post-TVUS samples versus pre-TVUS samples. Generalized linear mixed models evaluated the odds of having a low-Lactobacillus microbiota after TVUS with samples before TVUS as the reference for each participant.

Results: A majority of the cohort was pre-menopausal (85/104, 82%) and self-reported Black race (65/104, 62%). Over the short-term (one week), there was no immediate changes in the composition of the microbiota of daily successive samples following TVUS. In contrast, over the longer-term (participants followed for 10 weeks), the vaginal microbiota was less stable within intervals after TVUS versus the interval before. There were no changes in the odds of a low-Lactobacillus microbiota after TVUS among all participants in this 10-week longitudinal study. However, in specific groups such as peri/postmenopausal participants (N=19, aOR: 3.22, 95% CI:1.16-8.98) and those with a history of bacterial vaginosis (N=58, aOR: 1.73, 95% CI:1.10-2.72), there was a higher likelihood of persisting in a low-Lactobacillus state throughout the follow-up period.

Conclusions: Peri- and postmenopausal individuals and those with a history of bacterial vaginosis show a sustained decrease in protective Lactobacillus spp. after a single exposure to hyperosmolal vaginal lubricant. Reformulating water-based lubricants to reduce osmolality and toxicity may be beneficial.

Keywords: bacterial vaginosis; lubricant; postmenopausal; transvaginal ultrasound; vaginal microbiota.