Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

Nicole Jimenez, Nicole R. Jimenez, Taylor Norton, Gurbeen Diadala, Emerald Bell, Michelle Valenti, Leslie V Farland, Nichole D. Mahnert, Nichole Mahnert, Melissa M. Herbst‐Kralovetz, Melissa M Herbst-Kralovetz
BMC medicine · 2024 · vol. 22(1) , pp. 283 · doi:10.1186/s12916-024-03500-1 · PMID:38972981 · PMC11229265 · W4400402967
article OA: gold CC0 ⤵ 8 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This pilot study found that chronic pelvic pain with endometriosis is associated with distinct vaginal and rectal microbiome profiles and immune responses compared to chronic pelvic pain without endometriosis or controls.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This pilot study investigated whether vaginal and rectal microbiomes and cervicovaginal immune microenvironments differ among women undergoing gynecologic laparoscopy with chronic pelvic pain and confirmed endometriosis (CPP-Endo), chronic pelvic pain without endometriosis (CPP alone), or surgical controls without CPP/endometriosis, using 16S rRNA sequencing of vaginal and rectal swabs and multiplex quantification of soluble immune mediators from cervicovaginal lavages. Significant differences between groups included lower rectal microbiome alpha diversity in both CPP groups versus controls and enrichment of irritable bowel syndrome–associated bacteria in both CPP alone and CPP-Endo, while CPP-Endo showed increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus; patients with endometrioma(s) had increased vaginal Streptococcus, Lactobacillus, and Prevotella, and abnormal uterine bleeding was linked to increased bacterial vaginosis–associated bacteria. Immune/proteomic profiles clustered distinctly by CPP alone versus CPP-Endo, with CPP-Endo enriched in TNFα, MDC, and IL-1α; the study also reports potential confounding by co-occurring conditions (e.g., AUB/fibroids) and notes exclusions due to missed specimen collection and endometriosis found in controls. This paper is centrally about endometriosis — it compares vaginal/rectal microbiome and cervicovaginal immune mediators between chronic pelvic pain patients with confirmed endometriosis versus chronic pelvic pain without endometriosis.

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Abstract

BACKGROUND: Chronic pelvic pain (CPP) is a multifactorial syndrome that can substantially affect a patient's quality of life. Endometriosis is one cause of CPP, and alterations of the immune and microbiome profiles have been observed in patients with endometriosis. The objective of this pilot study was to investigate differences in the vaginal and gastrointestinal microbiomes and cervicovaginal immune microenvironment in patients with CPP and endometriosis diagnosis compared to those with CPP without endometriosis and no CPP. METHODS: Vaginal swabs, rectal swabs, and cervicovaginal lavages (CVL) were collected among individuals undergoing gynecologic laparoscopy. Participants were grouped based on patients seeking care for chronic pain and/or pathology results: CPP and endometriosis (CPP-Endo) (n = 35), CPP without endometriosis (n = 23), or patients without CPP or endometriosis (controls) (n = 15). Sensitivity analyses were performed on CPP with endometriosis location, stage, and co-occurring gynecologic conditions (abnormal uterine bleeding, fibroids). 16S rRNA sequencing was performed to profile the microbiome, and a panel of soluble immune mediators was quantified using a multiplex assay. Statistical analysis was conducted with SAS, R, MicrobiomeAnalyst, MetaboAnalyst, and QIIME 2. RESULTS: Significant differences were observed between participants with CPP alone, CPP-Endo, and surgical controls for body mass index, ethnicity, diagnosis of ovarian cysts, and diagnosis of fibroids. In rectal microbiome analysis, both CPP alone and CPP-Endo exhibited lower alpha diversity than controls, and both CPP groups revealed enrichment of irritable bowel syndrome-associated bacteria. CPP-Endo exhibited an increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus. Patients with CPP and endometrioma (s) demonstrated increased vaginal Streptococcus, Lactobacillus, and Prevotella compared to other endometriosis sites. Further, abnormal uterine bleeding was associated with an increased abundance of bacterial vaginosis-associated bacteria. Immunoproteomic profiles were distinctly clustered by CPP alone and CPP-Endo compared to controls. CPP-Endo was enriched in TNF⍺, MDC, and IL-1⍺. CONCLUSIONS: Vaginal and rectal microbiomes were observed to differ between patients with CPP alone and CPP with endometriosis, which may be useful in personalized treatment for individuals with CPP and endometriosis from those with other causes of CPP. Further investigation is warranted in patients with additional co-occurring conditions, such as AUB/fibroids, which add additional complexity to these conditions and reveal the enrichment of distinct pathogenic bacteria in both mucosal sites. This study provides foundational microbiome-immunoproteomic knowledge related to chronic pelvic pain, endometriosis, and co-occurring gynecologic conditions that can help improve the treatment of patients seeking care for pain.

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Condition tags

endometriosischronic_pelvic_painendometriomairritable_bowel_syndrome

MeSH descriptors

Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Chronic Pain Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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