Palabras clave
Transgender Persons
Microbiota
Microbiome
Human
Cómo citar
Resumen
The vaginal microbiota is a complex ecosystem, influenced by genetic, environmental, and hormonal factors. It is plausible that changes in the vaginal/neovaginal microbiota of transgender people have implications for their health. This review aims to characterize the vaginal microbiota of trans men using testosterone and the neovagina of trans women. This systematic narrative review was conducted in January 2025, in accordance with the PRISMA protocol. The search was conducted in PubMed, the Biblioteca Virtual de Saúde, Scopus, Periódicos CAPES, and the Scientific Electronic Library Online, using Health Sciences Descriptors and the Medical Subject Headings vocabulary. Studies involving cisgender populations or other populations were considered when comparing or contextualizing the findings. Results showed that the neovagina with penile/scrotal grafts may contain Actinobacteria, Bacteroidetes, Lactobacillus, Staphylococcus, and Streptococcus. The sigmoid/rectal flap may contain Bacteroidaceae and Enterobacteriaceae. Trans men may harbor Atopobium, Prevotella, Gardnerella, and Lactobacillus. The use of estrogen, surgical technique, and graft origin may impact the neovaginal microbiota of trans women. The findings should be interpreted with caution due to the heterogeneity among populations, samples, and microbiological identification methods used in the included studies.
Citas
1. Silva CC, Miron AC, Silva LFM. Laerte-se: transgeneridade e gestalt-terapia. Periódicos Fórum Regional de Pesquisa e Intervenção (FOR-PEI). 2019;(1):21. Available from: https://periodicosfacesf.com.br/index.php/FOR-PEI/article/view/68
2. Sociedade Brasileira de Endocrinologia e Metabologia – SBEM. Transgênero: posicionamento conjunto. 2021. Available from: https://www.endocrino.org.br/transgenero-posicionamento-conjunto/
3. Secretaria Municipal da Saúde de São Paulo. Protocolo para o atendimento de pessoas transexuais e travestis no município de São Paulo. 2020;133p. Available from: https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/Protocolo_Saude_de_Transexuais_e_Travestis_SMS_Sao_Paulo_3_de_Julho_2020.pdf
4. Tachedjian G, Aldunate M, Bradshaw CS, Cone RA. The role of lactic acid production by probiotic Lactobacillus species in vaginal health. Res Microbiol. 2017;168:782-92. https://doi.org/10.1016/j.resmic.2017.04.001
5. Graver MA, Wade JJ. The role of acidification in the inhibition of Neisseria gonorrhoeae by vaginal lactobacilli during anaerobic growth. Ann Clin Microbiol Antimicrob. 2011;10:8. https://doi.org/10.1186/1476-0711-10-8
6. Nunn KL, Wang YY, Harit D, Humphrys MS, Ma B, Cone R et al. Enhanced trapping of HIV-1 by human cervicovaginal mucus is associated with Lactobacillus crispatus-dominant microbiota. MBio. 2015;6. https://doi.org/10.1128/mbio.01084-15
7. Coudray MS, Madhivanan P. Bacterial vaginosis – a brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol. 2020;245:143-48. https://doi.org/10.1016/j.ejogrb.2019.12.035
8. Chacra LA, Fenollar F, Diop K. Bacterial vaginosis: what do we currently know? Front Cell Infect Microbiol. 2021;11:672429. https://doi.org/10.3389/fcimb.2021.672429
9. Shouldice A, Hallarn J. Genital microbiome research for transgender populations [Internet]. American Society for Microbiology; 2023 [cited 2026 Sep 8]. Available from: https://asm.org/articles/2023/june/geital-microbiome-research-for-transgender-popula
10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n71
11. Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-am Enfermagem. 2007;15(3). Available from: https://www.redalyc.org/articulo.oa?id=281421874023
12. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing and healthcare: a guide to best practice. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2015.
13. Birse KD, Kratzer K, Zuend CF, Mutch S, Noël-Romas L, Lamont A et al. The neovaginal microbiome of transgender women post gender reassignment surgery. Microbiome. 2020;8. https://doi.org/10.1186/s40168-020-00804-1
14. McPherson GW, Long T, Salipante SJ, Rongitsch JA, Hoffman NG, Stephens K et al. The vaginal microbiome of transgender men. Clin Chem. 2019;65(1):199-207. https://doi.org/10.1373/clinchem.2018.293654
15. Lin LH, Zhou F, Elishaev E, Khader S, Hernandez A, Marcus A et al. Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone. Diagn Cytopathol. 2022;50:518-24. https://doi.org/10.1002/dc.25030
16. Petricevic L, Kaufmann U, Domig KJ, Kraler M, Marschalek J, Kneifel W et al. Molecular detection of Lactobacillus species in the neovagina of male-to-female transsexual women. Sci Rep. 2014;4. https://doi.org/10.1038/srep03746
17. Petricevic L, Kaufmann U, Domig KJ, Kraler M, Marschalek J, Kneifel W et al. Rectal Lactobacillus species and their influence on the vaginal microflora: a model of male-to-female transsexual women. J Sex Med. 2014;11(11):2738-43. https://doi.org/10.1111/jsm.12671
18. Kaufmann U, Domig KJ, Lippitsch CI, Kraler M, Marschalek J, Kneifel W et al. Ability of an orally administered lactobacilli preparation to improve the quality of the neovaginal microflora in male to female transsexual women. Eur J Obstet Gynecol Reprod Biol. 2014;172:102-5. https://doi.org/10.1016/j.ejogrb.2013.10.019
19. Kim SK, Jeong JO, Kwon YS, Lee KC, Park KJ, Jung G. Laparoscopic rectosigmoid flap vaginoplasty. J Plast Surg Hand Surg. 2011;45:226-31. https://doi.org/10.3109/2000656x.2011.613649
20. Van der Sluis WB, Bouman MB, Mullender MG, Degen MC, Savelkoul PHM, Meijerink WJHJ et al. The effect of surgical fecal stream diversion of the healthy colon on the colonic microbiota. Eur J Gastroenterol Hepatol. 2019;31(4):451-7. https://doi.org/10.1097/meg.0000000000001330
21. Weyers S, Verstraelen H, Gerris J, Monstrey S, Santiago GSL, Saerens B et al. Microflora of the penile skin-lined neovagina of transsexual women. BMC Microbiol. 2009;9:102. https://doi.org/10.1186/1471-2180-9-102
22. Grosse A, Grosse C, Lenggenhager D, Bode B, Camenisch U, Bode P. Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina. Cytopathology. 2017;28:184-91. https://doi.org/10.1111/cyt.12417
23. Haseth KB, Buncamper ME, Özer M, Elfering L, Smit JM, Bouman MB et al. Symptomatic neovaginal candidiasis in transgender women after penile inversion vaginoplasty: a clinical case series of five consecutive patients. Transgend Health. 2018;3(1):105-8. https://doi.org/10.1089/trgh.2017.0045
24. Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905-27. https://doi.org/10.3109/1040841X.2015.1091805
25. Sun Z, Ge X, Qiu B, Xiang Z, Jiang C, Wu J et al Vulvovaginal candidiasis and vaginal microflora interaction: microflora changes and probiotic therapy. Front Cell Infect Microbiol. 2023;13:1123026. https://doi.org/10.3389/fcimb.2023.1123026
26. Krakowsky Y, Potter E, Hallarn J, Monari B, Wilcox H, Bauer G et al. The effect of gender-affirming medical care on the vaginal and neovaginal microbiomes of transgender and gender-diverse people. Front Cell Infect Microbiol. 2022;11. https://doi.org/10.3389/fcimb.2021.769950
27. Panichaya P, Panyakhamlerd K, Suwan A, Ariyasriwatana C, Visedthorn S, Chanchaem P et al. Characteristics of vaginal microbiome comparing before and after testosterone treatment in transgender men. Transgend Health. 2024;11(1):55-64. https://doi.org/10.1089/trgh.2023.0249
28. Muzny CA, Van Gerwen OT, Schroeder JA, Kay-Duncan ES, Siwakoti K, Aaron KJ et al. Impact of testosterone use on the vaginal microbiota of transgender men, including susceptibility to bacterial vaginosis: study protocol for a prospective, observational study. BMJ Open. 2023;13(3):e073068. https://doi.org/10.1136/bmjopen-2023-073068
29. Liu CM, Hungate BA, Tobian AAR, Ravel J, Prodger JL, Serwadda D et al. Penile microbiota and female partner bacterial vaginosis in Rakai, Uganda. MBio. 2015;6(3). https://doi.org/10.1128/mbio.00589-15
30. Liu CM, Hungate BA, Tobian AAR, Serwadda D, Ravel J, Lester R et al. Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria. MBio. 2013;4(2). https://doi.org/10.1128/mbio.00076-13
31. Kiss H, Kögler B, Petricevic L, Sauerzapf I, Klayraung S, Domig K et al. Vaginal Lactobacillus microbiota of healthy women in the late first trimester of pregnancy. BJOG. 2007;114:1402-7. https://doi.org/10.1111/j.1471-0528.2007.01412.x
32. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK, McCulle SL et al. Vaginal microbiome of reproductive-age women. PNAS. 2011;108(1):4680-7. https://doi.org/10.1073/pnas.1002611107
33. Stoehr JR, Moss C, Jahromi H. The microbiome of the neovagina: a systematic review and comparison of surgical techniques. Int J Transgend Health. 2024;25(4):623-33. https://doi.org/10.1080/26895269.2024.2316623
34. Hayashida SA, Soares-Jr JM, Costa EMF, Fonseca AM, Maciel GAR, Mendonça BB et al. The clinical, structural, and biological features of neovaginas: a comparison of the Frank and the McIndoe techniques. Eur J Obstet Gynecol Reprod Biol. 2015;186:12-6. https://doi.org/10.1016/j.ejogrb.2014.12.025
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2026 Narciso DiLorenzo Machado Dias, Jeferson Bastos Santos, Michelli Christina Magalhães Novais, Nilo Manoel Pereira Vieira Barreto