Stress and microbiocenosis of the female reproductive tract

Aim: to systematically evaluate the evidence on psychosocial stress impacting on the microbiocenosis of the female reproductive tract and to delineate the underlying pathogenetic mechanisms.

Materials and Methods. A comprehensive literature review was conducted across PubMed/MEDLINE, Google Academy, and eLibrary databases covering a 25-year period. Search terms for query included "stress," "vaginal microbiome/microbiocenosis/microflora," "cervical microbiome," and "uterine microbiome" in both Russian and English. Original studies, systematic reviews, and meta-analyses were included; animal experiments, conference abstracts, non-full-text publications, and off-topic articles were excluded.

Results. Chronic psychosocial stress activates the hypothalamic-pituitary-adrenal axis and the sympathoadrenal system, leading to hypercortisolemia and elevated catecholamine levels. Key pathogenetic mechanisms include Th1-to-Th2 (T-helpers 1/T-helpers 2) immune shift followed by consequently suppressed cell-mediated immunity, estrogen deficiency-driven reduction of vaginal epithelial glycogen, impaired glucose metabolism, and direct catecholamine-mediated enhancement of bacterial virulence and proliferation. In the lower reproductive tract, stress is an independent predictor of bacterial vaginosis, recurrent vulvovaginal candidiasis, genital herpes reactivation, and high-risk human papillomavirus (HPV) persistence with increased risk of cervical intraepithelial neoplasia and invasive cervical cancer. Stress also elevates susceptibility to sexually transmitted infections. In the upper reproductive tract, depression and anxiety are associated with increased incidence of pelvic inflammatory disease and reduced implantation success in assisted reproductive technology programs.

Conclusion. Psychosocial stress is an independent, modifiable risk factor for reproductive tract dysbiosis. Assessing psychosocial status should be integrated into clinical evaluation of women with inflammatory and dysbiotic conditions of the reproductive tract, and psychological intervention should be considered a component of comprehensive treatment strategies.

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