Female genital tract (FGT) inflammation is an important risk factor for HIV acquisition. Previous studies have identified the FGT microbiota as a major determinant of altered inflammatory cytokine profiles, however, the relative importance of microbial activities and functions is unknown. Liquid chromatography-tandem mass spectrometry was used to evaluate the FGT metaproteomic profiles of 113 young South African women. FGT inflammation was defined by inflammatory cytokine concentration profile. A total of 3,186 microbial and human proteins were identified and both were analyzed for the functional and the former also for taxonomic distributions. The functional annotations of bacterial proteins predicted genital inflammation more accurately than bacterial relative abundance determined by 16S rRNA analysis (p<0.0001). The majority of microbial biological pathways were underrepresented in women with inflammation, including a signature of reduced cell wall organization and peptidoglycan biosynthesis. This signature remained associated with FGT inflammatory profiles after adjusting for Lactobacillus relative abundance and potential confounders. These biological pathways were also associated with inflammatory cytokine responses to Lactobacillus isolates from the same women in a vaginal epithelial cell model. Comparison of metaproteomics taxonomic assignment with 16S rRNA gene survey analysis revealed differences in bacterial relative abundance between the methods, however both approaches showed increased non-optimal bacteria and decreased lactobacilli in women with FGT inflammation. These findings suggest that microbial function is a critical determinant of FGT inflammation, and that specific microbial properties may be harnessed for biotherapeutic development.