Ah, the vagina. A magical, mystical, wonderful place that has much more going on than meets the eye. In fact, the vagina is home to its very own community of microbes, and they can give us insight into what’s going on in our bodies. But, like most things when it comes to healthcare pertaining to women and people with vulvas, the research is lacking. So, let us introduce you: meet the vaginal microbiome.
The vaginal microbiome is an ecosystem of microorganisms that live inside the vagina and has a handful of functions, including protecting the sensitive area from infections, STDs, and during pregnancy, and keeping the PH at an optimal level for your body. “We live symbiotically with microorganisms in various places in our body, not just the gut and the mouth,” says Kirti Patel, MD, OB/GYN at UMass Memorial Health and chief medical officer at POV, an online provider directory. “The vagina is no different.”
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While the gut microbiome has become a clicky wellness trend on the internet — and a far more popular discussion in the health space — there aren’t many conversations floating around about our vaginal microbiome (also known as our vaginal flora). “It's an area that really should be explored more,” Dr. Patel says. “There's a lot of potential in learning about what makes good vaginal and reproductive health for women.”
Some people are trying to make that happen. Evvy is a company that sells at-home vaginal microbiome tests. For $130, you’ll order a test, swab your vagina, send the sample off to their lab, and in 8-10 business days, you’ll have a comprehensive look at exactly what kinds of bacteria and fungi are hanging out in your vagina what they mean, and what you can do about them if they’re causing you discomfort. Laine Bruzek, CMO and co-founder of Evvy, tells Refinery29 their tests also come with a custom plan of next steps, which can include a prescription treatment program. If that’s needed, Evvy can connect you with a provider, and all tests come with one-on-one coaching calls to walk you through results.
The goal of Evvy, according to Priyanka Jain, CEO and co-founder of the brand, is to help people be more proactive about their health. “If you're somebody who doesn't have symptoms, [it may be] something you check in on once or twice a year to better understand if your vaginal microbe is in a protective state, [or] so you can catch imbalances before they become full-on infections,” she says. “I always say we shouldn't be waiting until it smells the way we do something about it.” Jain goes on to say that people with vulvas are more likely to be misdiagnosed or have a missed diagnosis at the doctor. Although that number is difficult to track down since mis- and missed diagnoses aren’t exactly reported, there’s plenty of anecdotal evidence out there to have people feeling frustrated.
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And Evvy isn’t the only test on the market — there’s Daye, Juno, Ombrelab (and more), all of which fall between the prices of around $70 to $150 per test. If you want to learn more about your health and what goes on inside of your body, this information can be incredibly interesting to have on hand. But doctors aren’t so sure that it’s entirely helpful. “It is probably more interesting to know what your vaginal microbiome composition is if you are prone to frequent vaginal infections, however, has that been clinically validated? No,” says Dr. Patel. “I really can't justify the expense of these tests, given that you don't know yet what you do with the information.”
While we know what the vaginal microbiome is, Dr. Patel says there’s not enough sufficient evidence to take advantage of the ins and outs of our own microbe make-up in regards to our overall health. “You don't really need to be aware of [your vaginal microbiome] if you don't have any issues,” says Jacques Ravel, PhD, professor of microbiology and immunology at the University of Maryland. “Women who have issues, usually what they do is they go to their doctor and their doctor can do a clinical examination. It is true that some of the medicine we have [isn’t] optimal, they don't solve all the problems, and sometimes those problems persist.”
Dr. Patel says there are a lot of factors that can influence your vaginal microbiome from hormones to antibiotics, birth control use to sex, and even stress to smoking. And although at-home vaginal microbiome tests may not be totally necessary right now, Dr. Patel sees a future where we may be able to use this technology more often — that is, once we have more answers.
“We don't fund enough research in women's health and things like the vaginal microbiome, which we should,” she says. “I think going forward, there's a lot of potential. What if we find that a certain type of vaginal microbiome profile causes pre-term labor? That would be a game-changer.”