The vaginal microbiota represents a dynamic microbial ecosystem that contributes to mucosal homeostasis and protection against potentially pathogenic microorganisms. Vaginal dysbiosis, characterized by alterations in microbial composition and function, has increasingly been associated with gynecological, reproductive, obstetric, and puerperal conditions. This review summarizes current evidence on the composition and determinants of the vaginal microbiota, with an emphasis on Community State Types and major forms of dysbiosis, including bacterial vaginosis, vulvovaginal candidiasis, aerobic vaginitis, and viral infections. The associations between dysbiosis and sexually transmitted infections are discussed, with particular attention to the distinction between colonization, dysbiosis, and clinically relevant infection. Potential relationships between dysbiosis and infertility are examined, including tubal, cervical, and endometrial factors, as well as outcomes following assisted reproductive technologies. Evidence regarding obstetric and puerperal complications is critically evaluated. Finally, current therapeutic strategies are reviewed, ranging from etiological antimicrobial treatment to probiotics, defined live biotherapeutics, and emerging approaches such as vaginal microbiota transplantation. Although microbiota restoration represents a promising therapeutic concept, uncertainties remain regarding optimal strains, timing, diagnostic criteria, and clinically meaningful outcomes. Overall, vaginal dysbiosis should be regarded not simply as a local microbial imbalance but as a condition capable of modifying mucosal host-pathogen interactions throughout the female reproductive tract.