Volume 29, Issue 160, June 2025

Effects of contraceptive choice on vaginal microbiome: current evidence and perspectives

Justyna Kuciel^1♦, Dominik Tomczak¹, Maria Mroczka², Kinga Erazmus³, Roksana Hrapkowicz³, Agnieszka Czernecka⁴, Kinga Świtała², Patrycja Pysz², Marek Borecki⁵, Karolina Jałocha⁵

¹Chrzanów District Hospital, Topolowa 16, 32-500 Chrzanów, Poland
²V Military Hospital with Polyclinic, Wrocławska 1-3, 30-901 Kraków, Poland
³Ludwik Rydygier Specialist Hospital, Os. Złotej Jesieni 1, 31-820 Kraków, Poland
⁴Hospital of the Ministry of Internal Affairs and Administration, Kronikarza Galla 25, 30-053 Kraków, Poland
⁵Karol Marcinkowski University Hospital, Zyty 26, 65-046 Zielona Góra, Poland

^♦Corresponding author
Justyna Kuciel, Chrzanów District Hospital, Topolowa 16, 32-500 Chrzanów, Poland

ABSTRACT

Lactobacillus species are the most significant bacteria present in the vaginal microbiome, as they protect the female reproductive system against infections by, for example, releasing protective substances and regulating vaginal pH. The disrupted vaginal ecosystem may lead to bacterial vaginosis, which is the term for inflammation of the vagina because of the overgrowth of naturally present bacteria. Many factors may influence the microbial ecosystem of the vagina, not only the contraceptive methods but also lifestyle and diet. Evaluation and summing up of the current knowledge of the influence of different contraceptive methods on the vaginal ecosystem and reproductive health is the aim of this review article. Combined oral contraceptives may be linked to the stability of the vaginal microbiota and lead to a lower risk of bacterial vaginosis (BV). Progesterone-only methods, such as depot medroxyprogesterone acetate, may increase microbial diversity and cause shifts in the Lactobacillus dominant ecosystem. Some older contraceptive methods, such as copper intrauterine devices, are known to increase the risk of BV and other bacterial infections, for instance, Actinomycosis. Condoms are shown not to influence the vaginal ecosystem and keep it stable. It is crucial to say that the use of different hormonal and non-hormonal contraceptive methods is not indifferent to sexually transmitted infections (also HIV), as they alter vaginal mucosa, leading to being prone to infections. As the interactions between contraceptive use and the vaginal microbiota are complex, it is essential to conduct long-term, multi-center studies, which may allow doctors in personalized contraceptive counseling.

Keywords: vaginal microbiome, hormonal contraception, bacterial vaginosis, Lactobacillus species

Medical Science, 2025, 29, e78ms3577

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DOI: https://doi.org/10.54905/disssi.v29i160.e78ms3577

Published: 03 June 2025