Narrative review explores vaginal microbiota transplantation for dysbiosis and sexual quality of life

Dysbiosis of the female genital tract microbiota represents a key pathological basis underlying clinical symptoms such as vaginal dryness and dyspareunia, which subsequently contribute to diminished sexual quality of life (QoL) in women. Although conventional antimicrobial therapies may provide short-term relief from infectious symptoms, they often fail to restore vaginal microbial homeostasis—thereby exhibiting inherent limitations, including high recurrence rates and increased risks of antimicrobial resistance. Vaginal microbiota transplantation (VMT), an emerging ecological restoration strategy, aims to reconstitute the recipient’s vaginal microbiota by transferring a complete, functionally intact microbial community from a rigorously screened healthy donor. This review systematically delineates the multidimensional mechanistic links between genital tract dysbiosis and impaired female sexual quality of life; elucidates the core clinical value of VMT; comprehensively summarizes recent advances in both preclinical research and clinical trials; and critically examines major challenges currently facing the field—including the lack of standardized donor screening criteria, variability in procedural protocols, insufficient long-term safety data, and evolving ethical and regulatory considerations. Furthermore, we propose forward-looking perspectives on future directions, such as the development of individualized, precision-based VMT approaches; the establishment of standardized, evidence-based technical frameworks; and the acceleration of clinical translation and implementation. This review is intended to provide a robust theoretical foundation and practical guidance for the scientifically sound promotion, standardized application, and further investigation of VMT—ultimately advancing women’s reproductive health and holistic sexual well-being.