Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Microbiology and Immunology


Prodger, Jessica


Transfeminine individuals are assigned male at birth but do not identify as male. Some transfeminine individuals may choose to undergo the gender affirming surgery vaginoplasty to create a neovagina. There is a paucity of data on the neovaginal microenvironment to inform best gynecological practices. Vaginal and penile inflammation is modulated by local microbiota, but drivers of inflammation in the neovagina are poorly understood. The compositions of the neovaginal microbiota and immune milieu were elucidated from neovaginal swabs, using 16s rRNA gene sequencing and multiplex immunoassay, respectively. Immune data reduction and clustering was performed, and six unique immune profile types (IPTs) were found. Associations between IPTs and bacterial taxa were assessed using regression models. Streptococcus, Atopobium deltea, and Prevotella buccalis all trended toward significant associations with a proinflammatory IPT, however these associations were not statistically significant. Understanding the unique interplay between the neovaginal immune milieu and microbiota will inform trans-specific healthcare.

Summary for Lay Audience

Transfeminine individuals are those who are assigned male at birth but who do not have a male gender identity. Some transfeminine individuals may seek gender affirming care, such as hormone therapy and surgeries, to produce a physical appearance better aligned with their gender identity. Gender affirming surgery for transfeminine individuals can include vaginoplasty, which is the surgical creation of a neovagina, usually using penile and scrotal tissue. Many transfeminine individuals who have undergone vaginoplasty report gynecological symptoms such as odour, discharge, and bleeding. However, the underlying cause of these concerns is unknown. In the cisgender female vagina, these symptoms are often caused by disturbances in the vaginal microbiota (e.g., bacteria) that cause inflammation and increase susceptibility to sexually transmitted infections. Because the causes of vaginal symptoms are often known for cisgender females, targeted treatments are available; however, the relationship between bacteria and inflammation has not been researched in transfeminine people and thus no appropriate treatments are available.

Bacteria and immune factors in the neovagina were measured. Clustering analyses were performed to group the immune data into low, medium and high inflammation groups. Associations between bacteria and low, medium and high inflammation groups were then assessed using clustering tools and regression analyses. Three bacterial taxa trended toward being associated with a high inflammation group, however the association was not statistically significant. These taxa were Streptococcus, Atopobium deltea, and Prevotella buccalis. These findings are a critical step in developing a better understanding of the relationship between bacteria and inflammation. However, much more research is needed to inform developments of targeted treatments for gynecological healthcare for transfeminine individuals.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.