The Impact of Lifestyle and Socioeconomic Factors on the Vaginal Microbiome in Üsküdar, Istanbul, Türkiye

The vaginal microbiome plays a critical role in women’s health by maintaining vaginal acidity and preventing pathogenic overgrowth. This cross-sectional study investigated the impact of lifestyle and socioeconomic factors on vaginal microbiome composition among women in Kad?köy District, Istanbul, Türkiye. A total of 200 women were recruited from Central Kad?köy (urban), Üsküdar, and Beykoz (peri-urban/suburban districts). After excluding pregnant women and cases of non-bacterial infections, a final analytical cohort of 110 women (50 healthy, 60 with bacterial vaginosis) was analyzed using a polyphasic approach that included culture, phenotypic characterization, and multiplex PCR targeting Lactobacillus species. Vaginal infections were significantly more prevalent in peri-urban/suburban areas (70%) compared with the urban center (50%) (p < 0.05), with bacterial vaginosis accounting for 50% of diagnosed infections. Molecular analysis of the 100 most vigorous isolates revealed that Lactobacillus crispatus (40%) was predominantly isolated from healthy women, whereas Lactobacillus iners (30%) was found exclusively in women with bacterial vaginosis. Multivariable analysis identified high psychological stress (AOR = 3.48), low monthly income (AOR = 2.82), and sharing of personal hygiene items (AOR = 1.98) as significant independent predictors of bacterial vaginosis. Regular probiotic yogurt consumption and physical activity were associated with lower BV prevalence in univariate analyses. These findings demonstrate that psychological, economic, and behavioral factors substantially influence vaginal microbial balance and dysbiosis, highlighting the need for integrated public health interventions that address mental health, economic constraints, and hygiene education to promote vaginal health in this population.