Investigating the Link Between Intimate Health, Hygiene and Sexual Practices and the Vaginal Microbiome-The INTIMATE Study

PURPOSE: To explore how intimate hygiene practices and related products-such as feminine washes, wipes, and lubricants-affect the vaginal microbiome.

METHODS: Vaginal bacterial communities of 96 non-pregnant Western Australian women were characterised via full-length 16S rRNA gene sequencing. Participants completed an online questionnaire capturing demographics, intimate health, hygiene and sexual practices, to compare these with microbial composition.

RESULTS: Beta diversity varied significantly across multiple variables, particularly in relation to Lactobacillus spp. abundance. Compared to women with no partners or two or more sexual partners, monogamous women had lower L. crispatus ( p  = 0.002 and p  = 0.04, respectively), higher L. iners ( p  = 0.017 and p  = 0.044, respectively), and were least likely to cluster into CST I ( p  < 0.001). Postmenopausal women showed reduced L. crispatus ( p  = 0.009), increased levels of L. iners ( p  = 0.037), and were most likely to cluster into CST IV ( p  = 0.029) compared with women who did not report menopause. Regular perineal washing was associated with fewer reported infections ( p  = 0.029), whereas internal washing correlated with recurrent thrush ( p  = 0.017).

CONCLUSIONS: Sexual practices and menopause status are key factors influencing L. crispatus and L. iners colonisation. Most hygiene practices had minimal impact on Lactobacillus dominance, although behaviours associated with significant microbiome disruption were uncommon in this cohort.