Effects of tampons and menses on the composition and diversity of vaginal microbial communities over time

Objective To investigate the influence of menses on the vaginal microbiota and determine whether tampons that differ in material composition influence these bacterial communities in different ways. Design A single-centre trial with randomised, complete block design. Setting Procter & Gamble facility. Sample Seven self-declared healthy, female volunteers of reproductive age. Methods Volunteers used a pad and two types of tampons during the study, one product exclusively each month for three sequential menstrual cycles. During menses and once each mid-cycle, vaginal bacterial community composition was characterised by cultivation-independent methods based on pyrosequencing of V1V2 variable regions of 16S ribosomal RNA genes. Main outcome measures Changes in the species composition, abundance and diversity in vaginal bacterial communities over time and between treatments. Results The vaginal microbiotas of all seven women were dominated by Lactobacillus spp. at mid-cycle, and the compositions of those communities were largely consistent between cycles. Community dynamic patterns during menses varied considerably and were more or less individualised. In three of the seven women the community diversity during pad use was significantly different from at least one tampon cycle. Conclusions Changes in the composition of the vaginal microbiota during menses were common, but the magnitude of change varied between women. Despite these changes, most communities were capable of resuming a composition similar to previous mid-cycle sampling times following menstruation. Overall we conclude that the two tampons tested do not significantly impact the vaginal microbiota in different ways; however, larger studies should be performed to confirm these findings.