From metagenomics to metadata: understanding the social context of vaginal microbiome health across the life course

Humans carry millions of micro-organisms, including bacteria, viruses, and fungi, in the body and on the surface of the skin. The vaginal microbiome, specifically, has been understudied, but preliminary research indicates that the micro-organisms in the vagina are influenced by a variety of factors and play a role in fertility, birth outcomes, and protection against vaginal infection. Nevertheless, preliminary research on the vaginal microbiome is dominated by a biomedical perspective, and fails to consider how social and contextual factors may play a role in the associations documented thus far. My PhD seeks to change this by using data from the newest wave of the National Survey of Sexual Attitudes and Lifestyles (Natsal-4), a partially ESRC-funded social survey, to further our understanding of the vaginal microbiome on a population level in the UK. Using ~2,000 vaginal swabs, and centring sociodemographic and behavioural factors including socioeconomic position, ethnicity, sexual behaviour, contraceptive choices, and life stage, my project will map the composition of the vaginal microbiome in women of different age groups in the UK. My PhD is comprised of several sub-studies, including a systematic review on the associations between contraceptive choice and vaginal microbiome composition, an exploration of vaginal microbiome composition in the population through the lens of a theoretical framework envisioning the reproductive life course, an exploration into how social factors affect the associations between sexual behaviour and contraception and the vaginal microbiome, and ultimately, a qualitative study into public knowledge of and curiosity surrounding the vaginal microbiome which will be used to inform a planned interactive science communication exhibition mixing science and art to share the research findings with the public. The project places social factors at its centre, and takes a biosocial perspective- vastly different from existing work into the vaginal microbiome. The project is expected to make an impact on the field of vaginal microbiome research by emphasising the importance of considering holistic, social factors, and will support the growing body of evidence that clinicians can use to counsel patients.