Environmental Pollution and the Female Genital Microbiome: Implications for Reproductive Health

Environmental pollution is increasingly recognized as an important determinant of human reproductive health. Women are exposed throughout life to a wide range of environmental contaminants, including particulate matter, heavy metals, pesticides, plastic-associated chemicals, endocrine-disrupting compounds, and microplastics. At the same time, the female genital tract contains a dynamic microbial ecosystem that contributes to epithelial protection, immune regulation, maintenance of an acidic environment, and resistance to pathogen colonization. Lactobacillus species frequently predominate in the reproductive-age vagina and contribute to microbial stability through production of lactic acid and other antimicrobial metabolites. Disruption of this ecological balance, commonly referred to as dysbiosis, has been associated with bacterial vaginosis, genital infections, adverse pregnancy outcomes, and altered reproductive potential. Emerging evidence suggests that environmental exposures may influence the genital microbiome directly or indirectly through changes in epithelial integrity, hormonal signalling, oxidative stress, immune responses, nutrient availability, and microbial metabolism. However, the evidence linking individual pollutants to specific changes in the female genital microbiome remains considerably less developed than the evidence linking environmental exposure to reproductive toxicity. Air pollution has been associated with impaired fertility and adverse pregnancy outcomes, while experimental and emerging human evidence indicates that microplastics and endocrine- disrupting chemicals may affect ovarian, endometrial, and placental function. The potential interaction between pollutants and the genital microbiome therefore represents an important area of investigation. This review discusses the structure and function of the female genital microbiome, major environmental pollutants relevant to reproductive health, possible mechanisms linking environmental exposure with microbial dysbiosis, and potential consequences for infertility, pregnancy, and gynaecological health. The review also highlights research gaps and proposes a One Health and exposome-based framework for future investigations.