Skip to main content


Front. Reprod. Health
Sec. Gynecology
Volume 6 - 2024 | doi: 10.3389/frph.2024.1345294

Vaginal Microecology and Endometriosis: A Systematic Review and Meta-analysis Provisionally Accepted

 Xuemei Qing1, 2  Min Xie1, 3 Ping Liu1 Ou Feng1 Hong Leng1 Hongying Guo1 Yong Zhang2, 4* Ying Ma4, 5*
  • 1People's Hospital of Qingbaijiang District, China
  • 2Southwest Medical University, China
  • 3West China Second University Hospital, Sichuan University, China
  • 4Mianyang Central Hospital, China
  • 5Chengdu Medical College, China

The final, formatted version of the article will be published soon.

Receive an email when it is updated
You just subscribed to receive the final version of the article

Background: Endometriosis, a complex gynecological condition, involves inflammation and immune dysregulation. The vaginal microbiota, characterized by its diversity, is an integral part of the vaginal microecologyinteracting with vaginal anatomy, the endocrine system, and local mucosal immunity. Imbalances in this microecology are known to precipitate various inflammatory diseases. Despite extensive research, the connection between vaginal microbiota dysbiosis and endometriosis remains a subject of debate.Our study assesses the association between vaginal microecology dysbiosis and endometriosis.: We systematically searched major electronic databases in English, including Embase, PubMed, The Cochrane Library, MEDLINE (Ovid), BIOSIS (Ovid), China National Knowledge Infrastructure (CNKI), and Wanfang, up to August 15, 2023. Selected articles underwent screening based on predefined inclusion and exclusion criteria. Normal vaginal microecology was defined as a negative Amsel/Spiegel test or Nugent score of 0-3, or Lactobacillus predominance determined by 16S rRNA gene amplification sequencing. Deviations from this norm were classified as dysbiosis, further categorized into bacterial vaginosis (BV) and intermediate BV. Data analysis utilized Revman 5.4, with effect sizes presented as Odds Ratios (OR) and 95% Confidence Intervals (CI).Results: Out of 1081 articles, eight met the inclusion criteria. Utilizing fixedeffect models due to low heterogeneity, the analysis revealed a positive association between dysbiosis and endometriosis (OR=1.17, 95% CI 0.81-1.70; I² = 0%). Normal vaginal microecology showed a slight negative association (OR=0.90, 95% CI 0.55-1.46; I² =29%). However, the association is not significant. Subgroup and sensitivity analyses corroborated the stability of these associations.A positive correlation exists between vaginal microecology dysbiosis and endometriosis, notably with intermediate BV. However, the mechanisms underpinning this relationship remain elusive, highlighting the need for further research to overcome limitations.

Keywords: Endometriosis, Vaginal microecology, Dysbiosis, bacterial vaginosis, Correlation, Meta-analysis

Received: 27 Nov 2023; Accepted: 01 Apr 2024.

Copyright: © 2024 Qing, Xie, Liu, Feng, Leng, Guo, Zhang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Yong Zhang, Southwest Medical University, Luzhou, Sichuan, China
Prof. Ying Ma, Mianyang Central Hospital, Mianyang, 621000, Sichuan Province, China