Abstract
BACKGROUND: The human microbiome includes trillions of microorganisms, with the vaginal microbiota playing a vital role in women's reproductive health. Concurrently, interest in vulvovaginal esthetic procedures (VVEP) is increasing. This study aimed to compare single and married or previously married women in terms of their knowledge of the human microbiome, particularly the vaginal microbiota, and their perceptions of VVEP. It also examined associations between microbiota awareness, attitudes toward VVEP, and sociodemographic factors. METHODS: A cross-sectional, online survey was distributed to women aged 18 years and older in Saudi Arabia. A total of 1019 responses were collected. Chi-square tests compared knowledge responses between marital groups, while linear regression was used to explore associations between microbiota knowledge and participant characteristics. RESULTS: Single women showed greater awareness of general microbiome concepts, with 42% correctly identifying the term "microbiome" compared to 29.89% of married or previously married women. In contrast, married or previously married women demonstrated better knowledge of vaginal microbiota and the effects of antibiotic misuse. Of the participants, 6.6% had undergone one or more VVEP. Furthermore, 19.7% of single women and 18.3% of married or previously married women expressed future interest in undergoing such procedures. Marital status influenced perceptions of specific procedures, with married or previously married women more likely to justify interventions such as augmentation of the labia minora/"G-spot" augmentation and vaginal rejuvenation. Justification for augmentation of the labia minora/"G-spot" augmentation in this group was associated with lower vaginal microbiota knowledge. Healthcare professionals exhibited significantly higher microbiota awareness. CONCLUSION: Enhancing women's knowledge of vaginal microbiota can enhance informed decision-making and reduce unnecessary esthetic interventions among Saudi women, thereby supporting better reproductive health outcomes.