# The Role of the Vaginal Microbiota in Urgency Urinary Incontinence in Older Women

> **NIH NIH R03** · CEDARS-SINAI MEDICAL CENTER · 2020 · $167,000

## Abstract

PROJECT SUMMARY
Urgency Urinary Incontinence (UUI), the hallmark of overactive bladder (OAB), is a prevalent, chronic condition
disproportionately affecting postmenopausal women. The debilitating symptoms substantially degrade physical
activity and quality of life, yet despite the heavy burden on public health, little is understood of the
pathophysiology of UUI. Multiple epidemiologic factors implicate a microbial influence in this disease. New
detection methods have revealed microbial communities within the urinary tract, once thought to be sterile, and
implicated changes in these communities in UUI. The role of these alterations in the urine is unclear, but in the
vagina, loss of protective Lactobacilli after menopause leads to increased vaginal pH, increased local
inflammation, and impaired resistance to both vaginal and urinary infections. Early data suggest free exchange
of urinary and vaginal bacteria; thus, vaginal microbiota may promote UUI via transmission of this loss of
protective Lactobacilli in the urine, promoting similar changes in bladder function as seen in the vagina. In
postmenopausal women, vaginal estrogen supplementation can improve UUI symptoms, but the mechanism of
this improvement is unknown. As vaginal estrogen can also alter vaginal bacteria, increasing the abundance of
Lactobacilli, we hypothesize that vaginal estrogen will impact urinary microbiota in a similar way to ameliorate
UUI symptoms. To examine the relation between vaginal and urinary microbiota and UUI symptoms, we will
conduct a pre-post pilot study in postmenopausal women with UUI, who are <10 years from menopause and
estrogen-naïve. We will use next-generation sequencing to define the baseline urinary and vaginal microbiota,
validated OAB-specific patient-reported measures to assess the severity and impact of UUI symptoms, and
vaginal cytologic indices to define vaginal epithelial quality. After a 3-month trial of standard-dose vaginal
estrogen, these measures will be repeated. This proposal seeks to describe baseline vaginal features of
postmenopausal women with UUI by characterizing vaginal microbiota of postmenopausal women with UUI and
its concordance with urinary microbiota, and assessing vaginal epithelial quality at baseline in women with UUI.
After the intervention, we will explore the effect of vaginal estrogen administration on: a) vaginal and urinary
microbiota and b) vaginal quality indices in postmenopausal women with UUI and their relation to improvements
in UUI symptom severity, allowing an exploration of the baseline participant characteristics positively associated
with improvements in vaginal and urinary microbiota as well as the amelioration of UUI symptoms. We expect
this will confirm the association of a loss of protective vaginal microbial communities and decreased vaginal
epithelial quality with worsening UUI symptoms and provide evidence that local estrogen supplementation
promotes symptomatic resolution by modifying vaginal microb...

## Key facts

- **NIH application ID:** 10028090
- **Project number:** 1R03AG067993-01
- **Recipient organization:** CEDARS-SINAI MEDICAL CENTER
- **Principal Investigator:** A. Lenore Ackerman
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $167,000
- **Award type:** 1
- **Project period:** 2020-09-15 → 2020-09-16

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10028090

## Citation

> US National Institutes of Health, RePORTER application 10028090, The Role of the Vaginal Microbiota in Urgency Urinary Incontinence in Older Women (1R03AG067993-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10028090. Licensed CC0.

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