Caring for the Vaginal Ecosystem: How KEMRI and University of Cape Town (UCT) Scientists Are Advancing Women’s Health.

The vagina has its own natural community of bacteria that make up the vaginal ecosystem (or scientifically, the vaginal microbiome). When in balance, this ecosystem is dominated by “good” bacteria like Lactobacillus, which help maintain a healthy pH and prevent harmful bacteria from taking over.

But when that balance is disturbed—whether by infections, hygiene habits, or hormonal changes—harmful bacteria can multiply. This can lead to bacterial vaginosis (BV), a common condition that causes unusual discharge, odor, itching, or burning. BV is more than just uncomfortable—it also increases the risk of sexually transmitted infections, poor pregnancy outcomes, and even sub-fertility.

Caring for the vaginal ecosystem means protecting the good bacteria. Simple practices—like not washing the inside of the vagina, avoiding harsh soaps, choosing breathable cotton underwear, and eating a balanced diet that includes fermented foods—can make a difference.

For the past three years, scientists from KEMRI and the University of Cape Town, led by Prof. Jo-Ann Passmore, Prof. Elizabeth Bukusi, Dr. Serah Gitome, and Dr. Katherine Gill, have been working to better understand what keeps the vagina healthy among women in Kenya and South Africa. Their collaborative effort, the Vaginal Microbiome Research Consortium for Africa (VMRC4A), is investigating the role of vaginal microbes—both helpful and harmful—and how these microbial communities shift following BV treatment.

One of VMRC4A’s major goals is to build an African-led vaginal microbiome biorepository, a valuable resource for developing new vaginal probiotics (known as live biotherapeutic products) to treat BV and prevent its recurrence. These products aim to harness the beneficial effects of Lactobacillus species found in women with consistently healthy vaginal microbiota.

So far, the VMRC4A researchers have collected hundreds of vaginal samples and made exciting progress:

• 704 bacterial isolates identified
• 127 bacterial genomes sequenced
• 71 bacterial species characterized

The findings from this work reveal that despite the high burden of BV, many women in these two African countries have stable, Lactobacillus-dominated microbiomes over a 10-week period.

These women provide a strong foundation for isolating regionally-representative probiotic strains that could be used to improve vaginal health for many others.

Menstruation is one of the key factors that naturally alters the vaginal environment, including its pH and hormone levels. While menstrual products and hygiene practices are essential for comfort and cleanliness, they may also impact the vaginal microbiome in ways we’re just beginning to understand.

To explore this further, VMRC4A has launched a new study: the Menstruation and Menstrual Hygiene Management (MMHM) Study. This research will follow 100 women—50 in Kenya and 50 in South Africa—over 10 weeks, closely monitoring how menstrual cycles, hygiene products, and dietary habits influence the bacteria and immune responses in the vagina.

By collecting simple samples such as vaginal swabs and cervicovaginal fluid using softcups, the team hopes to identify early signs—whether microbial or immune—that predict who is more likely to maintain a healthy vaginal environment versus those at risk for BV. The goal? To build smarter, earlier, and more effective interventions that support women’s health in Africa and beyond.

The VMRC4A-MMHM study in Kenya officially kicked off on 22^nd – 24^th July 2025 with a vibrant and insightful site initiation training held at Pine Cone Hotel and CMR-KEMRI CIS site at Lumumba Hospital in Kisumu—a promising start to this exciting new chapter in women’s health research!