How to Choose a Vaginal Microbiome Test

When it comes to wellness products, we all want the best results, whether it's finding skincare with the most effective ingredients, running shoes with the best support, or supplements that are scientifically proven to work. So why should it be any different when you're buying a vaginal microbiome test?

The vaginal microbiome has been getting more attention lately, and many female health companies now offer tests that you can do at home. If you search for at-home vaginal microbiome tests online, you'll find tons of options, all with seemingly different technologies and price points. 

But here's the thing: not all vaginal microbiome tests are the same. It can be tough to navigate all the jargon and figure out which one will give you the most bang for your buck. So, we've put together a little guide on how to choose a vaginal microbiome test.

What to look out for in a vaginal microbiome test

If you’re wondering how to choose a vaginal microbiome test, start by comparing what each one actually detects — and how it helps you act on results. There are six main things to look out for when choosing a vaginal microbiome test: 

1. Technology: What sequencing technology does it use? 
2. Comprehensiveness: Which microbes does it test for, and how many?
3. Accuracy: How well does it distinguish between microbes?
4. Speed: How fast can you get results?
5. Certifications: How legit are the labs they use to analyze your test?
6. Care: After you receive your results, does the test offer options for follow-up clinical care, prescription treatment, and coaching with a healthcare provider?

Why sequencing methods matter when choosing a vaginal microbiome test

The sequencing method a test uses determines how much information you get. Some only look for a few common bacteria, while others analyze hundreds of microbes, including ones linked to BV or yeast infections. 

There are different technologies used to analyze the vaginal microbiome, and the type of technology will directly affect how comprehensive and accurate the test will be. 

The type of technology the test uses determines how many bacteria and fungi you can look for at one time and what kinds of bacteria or fungi you can accurately test for.

The three main types of sequencing technology for vaginal microbiome tests are PCR, 16s, and metagenomics. 

• PCR: Thanks to COVID, you’re probably familiar with polymerase chain reaction (PCR) tests. PCR tests are incredibly effective at identifying the specific microbe you’re looking for (for example, COVID-19) even at the lowest levels, but they’re not particularly comprehensive. In the context of vaginal health, this means they can be very accurate in finding one or two specific fungi or bacteria. Still, they won’t tell you what else is present in your vaginal microbiome. There are thousands of different species living in your vaginal microbiome, and it’s worth keeping in mind that just because a bacterium is present doesn’t mean it’s the cause of your symptoms!‍
• 16s: This type of test is more comprehensive than PCR, but the downside is that it can only pick up bacteria, not the fungi that cause yeast infections. 16s tests also only look at one part of the genome (rather than all of the DNA), so it can’t accurately distinguish between microbes. And when it comes to vaginal health, the species of bacteria present in your microbiome can make a whole lot of difference.  
• ‍Metagenomics: Shotgun metagenomics is the most comprehensive technology available for analyzing the vaginal microbiome. It can accurately pick up and categorize all bacteria and fungi present. It can even discover new microbes that weren't explicitly being searched for (including ones missed by traditional testing).

How effective a technology is also depends on why you’re testing your microbiome. If you want to know if a single specific bacteria is present in your vagina (for example, Mycoplasma genitalium), even at the lowest amounts, PCR is a good choice. But if you’re interested in looking at your vaginal microbiome as a whole, a test that uses metagenomics is the better option as it can give you a more complete picture.

Speed of results: How quickly will you get answers?

The type of sequencing technology also affects how long you have to wait before getting your results, which means there may be trade-offs based on what you’re looking to find out. 

Comprehensive tests like 16s and metagenomics take longer than PCR, which only looks for a few individual microbes instead of the entire microbial community (It has less work to do, so it'll take less time).

If you're only looking to test for a few bacteria — like common STIs such as chlamydia and gonorrhea — a PCR test is a great option because it can return results in just 1-3 days. This can be especially helpful if you're dealing with uncomfortable symptoms and want an answer ASAP. 

That's also why Evvy offers an Expanded PCR Panel add-on to our metagenomic Vaginal Microbiome Test. This panel includes PCR testing for four STIs, ten antibiotic resistances, and 11 common microbes; all delivered back to patients in just 1-3 days. Meanwhile, our Vaginal Microbiome Test returns results on 700+ bacteria and fungi in 7-10 days.

Certifications

When it comes to lab testing, it's important to not just think about the type of technology used but also about the certifications of the lab that processes and analyzes your tests. 

The quality of lab and clinical testing is crucial for adequately diagnosing, treating, and managing health conditions. Certifications are a good indication of quality standards and compliance with regulations. Choosing a lab with proper certifications ensures that your tests are handled properly and accurately. 

Certifications can tell you how the tests are handled, whether the machines are up to code, lab personnel are properly trained, and whether your medical data is safe. It might sound over the top, but it's worth it to ensure the accuracy and reliability of your test results. 

By law, labs that perform testing on human specimens — so, lab-developed tests (LDTs), much like vaginal microbiome tests — must have something called a CLIA certificate. 

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 is a federal law that ensures the accuracy, reliability, and timeliness of patient test results processed in a laboratory. This means you can have peace of mind knowing you're receiving the best possible care. 

Whether you’re seeking a diagnosis, treatment, or disease prevention, all facilities in the U.S. that test human specimens (including the results from your vaginal microbiome test) have to meet these standards.

Interestingly, LDTs don't need approval from the U.S. Food and Drug Administration (FDA). The FDA is mainly responsible for classifying diagnostic tests based on their complexity and making sure that companies market them truthfully. “FDA-approved” is a label most of us are familiar with and comfortable with, and we often seek it to make sure the wellness products we’re consuming are safe and legit. But when it comes to vaginal microbiome tests, CLIA validation is far more important. 

Evvy's Vaginal Microbiome Test is the world’s first and only CLIA-validated metagenomic vaginal microbiome test performed at a lab certified not only by the CLIA but by the College of American Pathologists (CAP) and Clinical Laboratory Evaluation Program (CLEP), too.  

A physician also reviews our tests, so you can be sure that a doctor has seen and OK’d your results before you receive them.

Follow-up care and treatment 

The last (but not least) thing to look for when you're shopping for a vaginal microbiome test is whether the company offers any follow-up steps. 

Sometimes, it's frustrating when test results come in, but you're unsure what to do next. After all, testing your vaginal microbiome is only helpful if the data is actionable. Look out for a platform that offers

• Clinical care by connecting you with providers who can help you with treatment options.
• A clear plan of action customized to your results.
• Access to health coaches who can guide you through the process. 

Evvy provides end-to-end clinical care, including physician-reviewed results, a personalized plan of action, and a free 1:1 coaching session to understand your results better.

For eligible users, we also offer comprehensive prescription treatment programs. Our healthcare providers will create a custom treatment program just for you, which may consist of prescription medication and research-backed supplements. Plus, our partner pharmacy specially formulates each prescription with top-quality medical-grade ingredients you can't find over the counter.