Wednesday, June 1, 2011

Written by Joni Kirk

He acknowledges the public's general reluctance to talk about it, and admits freely that it's not a polite dinner conversation topic.

But Larry Forney, professor of biological sciences and director of the Initiative for Bioinformatics and Evolutionary Studies (IBEST), also knows that silence on a topic that affects 3 billion people globally is detrimental to women's health. Brace yourself: it involves the "V" word!

Forney's research is helping to increase understanding about normal vaginal microbiota – or bacteria – so that physicians can better identify conditions that make women prone to infections and other diseases, and avoid the development of health problems.

"For example, approximately 75 percent of women experience at least one yeast infection during their lives, and some 40 to 50 percent of these women experience a recurrence," says Forney.

"Nobody dies from yeast infections, and they have no long-term consequences. But they cause misery with such frequency that it deserves our attention."

His hope is to encourage a "vagina dialogue" of sorts. "Because of the taboo nature of the topic, many women suffer in silence," he notes. "Women feel uncomfortable asking a health provider about things like odor or why they have recurring yeast infections. They may talk to a few close friends, but they may not have reliable sources of information."

And the bacteria, or microbiota, actually can help keep pathogens at bay – "they're beneficial to us," he explains. "The acidity created by bacteria in the vagina precludes the growth of pathogens and keeps them from causing a problem. But at times things run amuck and are disturbed in the vagina."

Those disturbances can lead to bacterial vaginosis, and increase the risk of yeast infections, sexually transmitted diseases, and HIV.

Currently, not much is understood about what causes these disturbances or how to really treat them. However, Forney notes that the "one size fits all" approach to preventing diseases probably doesn't work.

His research centers on understanding the distinctive composition and ecology of the vaginal microbial ecosystem. "We're looking at the differences between humans to try and understand the risk of disease," Forney says.

In a paper just published in the Proceedings of the National Academy of Sciences (PNAS), Forney and his colleagues from the University of Maryland and Emory University detail some astounding news related to the human vagina and ecology of the vagina microbial ecosystem.

Common wisdom readily accepts that lactic acid-producing bacteria lower the pH – the measure of acidity – in a woman's vagina, which aids in the prevention of disease. Research has held for years that this pH should consistently be low. But Forney's research, as published in the PNAS, shows that the pH varies considerably among women.

Taking it one step further, due to inherent differences among individuals and their personal habits and practices, vaginal communities are likely to vary over time even among women who have the same fundamental type of bacterial community.

Forney's research suggests that differences in vaginal bacteria community composition is what may ultimately determine risk factors.

Though still undergoing extensive testing, which is funded through the National Institutes of Health, Forney's research could be the first step toward personalized medicine for women's reproductive health. Under such a model, differences in the makeup of the vaginal microbiomes of individuals would be taken into account for risk assessment and disease diagnosis and treatment.

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