Down there: Women respond enthusiastically to vagina study

Summary

The number of women who have responded to a citizen science project at UAntwerp shows just how important research into vaginal health really is

Swab for science

When Sarah Ahannach and her colleagues at the University of Antwerp announced their citizen’s science project at the end of last month during the middle of the corona pandemic, they quietly hoped 500 women might respond to their call to take a series of vaginal swabs in the name of research.

The notice on their website went live around 9.00. Two hours later, they’d clocked 300 participants. In the end, more than 5,500 women signed up in the space of 10 days.

“That shows how necessary a project like this is,” says Ahannach, a microbiologist. “We received so many messages from women who wanted to share their stories, who’d never had an outlet for them and who now had the feeling that a group of researchers cared about how they were doing.”

There were messages “from women who’d had infections for years, women who didn’t receive adequate care, women who had had one or multiple miscarriages”.

Isala

The study is called Isala – named after Belgium’s first female doctor – and is headed by microbiology professor Sarah Lebeer. It is the first large-scale study in Western Europe to map the vaginal microbiome – that is, the mixture of bacteria, viruses and fungi that are active in the vagina.

Although similar projects have been undertaken in the US and Sweden, it’s important to study the vaginal microbiome of local women specifically, Ahannach explains. “Our microbiome is influenced by several lifestyle and environmental factors. And our eating patterns in Belgium, for instance, are completely different to those in the US. So the conclusions of those other studies might not dovetail with our local lifestyle.”

We don’t know much about the vaginal microbiome beyond the fact that it has a huge impact on women’s lives. For instance, a lack of beneficial types of bacteria collectively known as lactobacilli appears to be a leading cause of vaginal infections, fertility problems and pregnancy complications.

At least, we think it is, says Ahannach: “These are all associations rather than proven causal relationships.”

‘Women aren’t comfortable talking about it’: UAntwerp researchers Eline Oerlemans, Sarah Ahannach and Sarah Lebeer (l-r)

The Isala research team opted for a citizen’s science approach because most clinical studies until now have tended to focus on samples from women who’ve come into hospitals with various complaints. This creates a biased sample pool.

“With our study, we want to look at the average woman in Flanders,” explains Ahannach, both those with and without vaginal health problems.

Over the next few months, 200 women will send in vaginal, saliva and skin swabs they take at home at different intervals during their menstrual cycle and also complete a detailed questionnaire about their lifestyle.

If you don’t have a diverse research team, you’re not going to be able to ask diverse questions

- Researcher Sarah Ahannach

The Isala research team will test the more than 1,000 swabs submitted by participants and extract their microbial DNA using a method known as sequencing so they can identify the micro-organisms present. They then hope to tie the results to certain lifestyle factors so they can formulate health recommendations based on evidence.

They also hope to identify and grow the strongest, best-performing beneficial bacteria, which could then in the future be made into a probiotic to treat microbiome imbalances. “The probiotics currently being used are based on micro-organisms that were isolated from the gut,” says Ahannach, “so it could well be that they’re not able to perform to their best capacity because they weren’t isolated from the vagina.”

The extensive studies that have been performed into gut microbiome stand in shrill contrast to the limited advances in the study of the vaginal microbiome. As more women are entering the highest levels of academia as PhD students, postdocs and professors, research interests are also shifting, says Ahannach.

Taboo

“If you don’t have a diverse research team, you’re not going to be able to ask diverse questions that are innovative or that can have an impact on your own life.” The fact that we generally aren’t too eager to talk about vaginas has also made it difficult to attract funding for such research, she adds.

That taboo is one Ahannach and her fellow researchers hope to smash with the Isala project. Because it comes at a high cost.

“Women who have a problem aren’t comfortable talking about it, whether in a private or public setting. They are sometimes afraid to share with their doctor how big or small their problem is, and then don’t get the treatment they need.”

Because we don’t discuss it like an everyday topic, “it seems less relevant,” she says. “When, in fact, this is something that is extremely relevant and something that has a really big impact on women, their partners and their children.”

Photo, top: Flemish singer and TV host Evi Hanssen is helping spread the word about Isala
©Courtesy Isala/Twitter