You are wrong to state there is no selfcleaning of a neo-vagina as in fact it is subject to the movement of hard stools down the lower colon and especially so when on the toilet. Most post-ops would notice that passing a stool does in fact make them leak some fluid from their neo-vaginas.
Only a post-op would know this.

I've found a lovely new prescription, recommended by my post-op MTF friend's OB-GYN. It is vaginal estradiol. Since using it, we both now self-lubricate (though not as much as a cisgender), our odor is more cisgenderish, and her OB-GYN told her that her vaginal tissue looks exactly like cisgender vaginal tissue.
The report isn't very informative. There needs to be a comparison to cisgender bacteria. And the study needs to be way more extensive. I also wonder how varied each cisgender vagina is.

And?

One thing that strikes me, is that "50" (or is it only "30"? The authors' numbers seem to be inconsistent) TS... especially with no indication of how far post op they are... is a rather small study. The study also does not seem to have paid any attention to what "post SRS" initial care protocols were followed, which might be very relevant. Still, despite those flaws... the study is interesting.
Another thing that strikes me, is that while a lot of my previous comments about vaginal flora on other web sites were largely based on my observations of my own vagina... I can see that I seem to be somewhat atypical, as far as the "care and feeding" of a neo-vagina are concerned. That lactobacilli (found in a health vagina, they help control or prevent other vaginal microorganisms from multiplying...) were only found in one of the "30" ("30"??!! Two paragraphs above that number, they talk about "50" TS... something odd with their data here...) women, suggests to me that many TS are not really taking care of their vaginas properly. Out of 30 women, 30 should have had lactobacilli present... not just one.
That Candida cells were not seen does not seem statistically relevant to me. Too small a population group -- those cells are found with "yeast infections", and it *is* known that TS sometimes get candidiasis. [I have had a yeast infection myself]. But normally most women do not have a yeast infection every day... so the fact that none of their small sample group had one *at the time of the study* is moot. Perhaps a tiny bit surprising, since there are often a few candida cells present even if full blown candidiasis is not present... about 19% of a typical "apparently healthy" female population usually has this... but not really all that statistically significant, given the small sample population size.
Given the very low incidence of lactobacilli (which would otherwise prevent this), the presence of high populations of skin, intestinal, or bacterial vaginosis microflora is not at all surprising to me. In the absence of healthy flora, opportunistic populations will inevitably colonize vaginal tissues... and the closest sources for those opportunistic microflora would be the surrounding skin, and the intestines (via the close by anal opening...). The reported high prevalence of Bacterial Vaginosis (BV, an imbalance of naturally occurring vaginal flora) is only to be expected, given that there is not enough healthy lactobacilli present...
A few things this suggest to me, (assuming this tiny study's numbers are accurate for the general population), is that early post op's need to pay more attention to this aspect of their initial recovery. A well established flora population is hard to displace -- meaning, exactly which populations establish themselves (after the vaginoplasty is sufficiently healed for daily douching to be discontinued), is rather important... and based on this study, something not enough TS give enough thought to.
Whether they colonize the neo-vagina early on, or acquire a foothold later... the types of bacteria this study reports are hard to get rid of, but not impossible. Any woman who has had a yeast infection pretty much knows the drill. Get rid of the "nasties", or "level the playing field" of the bacteria imbalance causing BV, with a course of antibiotics (the quick way), or with a LOT of probiotic yogurt applications (the "natural", but slow way). Then encourage the colonization of the area with healthy, normal vaginal flora with probiotics. [Acidophilus... available either as a vaginal suppository capsule, or it can be obtained from "plain unsweetened yogurt with live cultures". For the later method, insert at least two tablespoons daily. You will probably want to wear a pad if you use the yogurt method... the stuff will leak out again...].
One thing to keep in mind, is that a post op TS is medically equivalent to a post hysterectomy woman. Like a hysterectomy woman, vaginal dryness is an issue... and from that, there is not the "self cleaning" aspects of a "normal" vagina, where normal vaginal discharges tend to flush out the vagina regularly. This translates as, those who are heterosexually sexually active may need to "wash out" our vaginas (not really douching, but similar) after sex, to avoid unpleasant odours. I suppose the same could also be said of just dilating, depending on what one is using for lube. Regardless, that washing tends to weaken the normal vaginal defences (the reason excessive douching is not recommended), which can make the sort of vaginal flora imbalances reported in this study more likely to occur.
I suppose it boils down to, this study seems to say that post op's need to pay more attention to their vaginal health, than it appears most of us do...
Just my two cents worth, mostly offered as I was asked to comment by another medical professional who read this...

"It reveals a mixed microflora of aerobe and anaerobe species usually found either on the skin, in the intestinal microflora or in a BV microflora."
In other words, they didn't find the microflora usually found in cisgender vaginas. Instead, they found microflora that resembles skin, intestinal, and BV (pathological) microflora.
This is an awesome pilot study! At the very least, it will lead to the reduction of inappropriate treatment of 'BV' in post-operative MTFs. But the fact that this kind of study is being done bodes well for the improvement of treatment and management of post-operative MTFs and transsexuals in general. Kudos to the authors!

I'm curious as to how this compares to the microflora found in cisgender vaginas?