International Microbiota Observatory with a focus on Women Health

If the gut microbiota remains the best known, it’s not the only one...  The vaginal microbiota also plays an essential role in our health. But what do women know today about the role of the vaginal microbiota? What do they know about how to take care of their microbiota? What role do healthcare professionals play in informing patients? To answer these questions, the Biocodex Microbiota Institute commissioned Ipsos to conduct a major international survey on the subject: the International Microbiota Observatory. To carry out this survey, Ipsos questioned 6,500 people in 7 countries (France, Portugal, Spain, USA, Brazil, Mexico and China). For each country, the sample questioned was representative of the country's population aged 18 and over, in terms of gender, age, profession, region and urban area.

The survey was conducted over the Internet from March 21^st to April 7^th, 2023. This exclusive survey reveals a general lack of understanding of the vaginal microbiota’s contribution to health, and underlines the essential role of healthcare professionals in teaching patients, in particular senior patients, about the role of the vaginal microbiota and the behaviors they should adopt to preserve it as well as possible.

Vaginal microbiota: a little-known organ 

• The level of knowledge of vaginal microbiota is fairly low: only 1 in 5 women say they know exactly the meaning of the term “vaginal microbiota” (21%, vs 18% among overall results). 53% of women say they have never heard about it (vs 55% overall). 
• Questioning about the term “vaginal flora”, notions remain superficial: only 1 in 2 women know what the vaginal flora is exactly (49%), a proportion slightly higher than overall results (40%). 
• Regarding the role and importance of microbiota in health, a large majority of women is aware that the vaginal microbiota acts as a barrier, protecting women from pathogenic microorganisms (67%) and that every woman has a vaginal microbiota that is different from any other woman’s (60%). 
• However, only 1 in 2 women know that the vagina is self-cleaning (52%) and that from childhood to menopause, a woman’s vaginal microbiota is not remaining the same (52%). 
• When it comes to specific knowledge regarding delivery, bacterial diversity or unbalanced microbiota, the level of knowledge plummets: only 1 in 3 women know that the vaginal microbiota bacteria are safe for the vagina of women (37%) and that bacterial vaginosis is associated with an imbalance in the vaginal microbiota (35%). 1 in 3 women are also aware that delivery (vaginally or cesarean section) has an impact on the newborn’s gut microbiota (30%). Only 27% say they know that the vaginal microbiota is balanced when its bacterial diversity is low.

Inappropriate behaviors to protect their vaginal microbiota 

• Faced with questions designed to assess their knowledge of the right behaviors to adopt in order to protect the health of their vaginal microbiota, the interviewees gave a relatively low average score of 2,8/5.
• In detail, and except the cotton underwear, where the correct behavior was adopted by 85% of women, a moderate proportion of women have adopted specific behaviors to protect the health of their vaginal microbiota.
• Almost 1 in 2 women say they take vaginal douches (45%) whereas it's bad for their vaginal microbiota. 
• Only 41% say they have taken probiotics and/or prebiotics (either orally or vaginally). 

Information provided by healthcare professionals is still too rare but is needed! 

• Fewer than 1 in 2 women say that their doctor has ever explained to them how to maintain a balanced vaginal microbiota (42%, but only 20% have had this explained to them more than once) or educated on the importance of preserving as much as possible the balance of their vaginal microbiota (40%, but only 18% say they have done so several times). 

• Finally, only 1 in 3 said their doctor had ever taught them what the vaginal microbiota was and what it was used for (35%, and only 14% had had this explained to them several times). 

• Microbiota information is still too rarely provided by physicians, but women need it! 86% of women surveyed said they would like to have more information about the importance of the vaginal microbiota and its impact on health.

Real differences depending on the profile of the people surveyed: women aged 60 and over are the least aware in terms of knowledge 

• Even though they are at an age when health problems linked to aging will, for many of them, become increasingly present, women aged 60 and over are the least aware in terms of knowledge. Only 40% of them know what vaginal microbiota is (vs 47% among all women). 
• Women aged 60 and over are the least likely to know about the vaginal microbiota, with an average score of knowledge of 3,3/8 (vs 3,6/8 overall).  For instance, less than 1 of 4 women aged 60 and over (23%) know that the vaginal microbiota is balanced when its bacterial diversity is low (vs 27% overall). 
• Regarding the adoption of appropriate behaviors to keep their vaginal microbiota balanced, women aged 60 and are (along with the less than 25 yo age group) the ones that have adopted the least correct behaviors. Less than 1 in 2 women aged 60 and over is using a soap-free cleansing solution (49%, vs 52% overall). 
• At the same time, the 60+ age group is the least likely to discuss the subject with their doctor. Only 1 in 4 women aged 60 and over said their doctor had ever taught them what vaginal microbiota was and what it was used for (29% vs. 35% overall).
• Whereas 90% of the 35-44 years old group said they would like to have more information from their healthcare professionals about the importance of the vaginal microbiota and its impact on health, only 79% of the 60+ age group would like to have more information (vs 86% overall).
• On the other hand, the 25-34 and 35-44 age groups have the highest levels of knowledge about what people need to know and do to preserve their vaginal microbiota.
• For example, the 35-44 age group is much more familiar than others with the term "vaginal flora" (47% know exactly what it is vs. 40% overall). 
• The 25-34 age group is the best informed by their physicians. Almost 1 in 2 women were explained by their doctor what the vaginal microbiota is and what its purpose is (48% vs. 35% overall). A large majority of the 25-34 age group women (56% vs. 42% overall) said they received from their physician information about the good behaviors to adopt in order to maintain a good balanced vaginal microbiota. 

The International Microbiota Observatory has also revealed striking contrasts between countries in terms of knowledge, behaviors, and information provided by healthcare professionals.

About the Biocodex Microbiota Institute

The Biocodex Microbiota Institute is an international hub of knowledge that aims to foster better health by spreading information about human microbiota. To do so, the Institute addresses both healthcare professionals and the general public to raise awareness about the central role of this little-known organ.

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