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Meet Your Microbiome

Every day, your vagina performs the equivalent of modern health miracles.

It can fight off infections, defend against cancers, and protect a pregnancy. And the quality of its defense is determined by the composition of your vaginal microbiome — a complex ecosystem of bacteria, fungi, viruses, and more.

How does my microbial defense actually work?
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Given that the vagina is the structural connection between the outside world and some of our most important reproductive organs, the local microbiome has evolved to serve as a critical layer of protection against pathogens entering our bodies.

While there is a variety of bacteria and fungi that can exist in the vagina, Lactobacillus are the local heroes. Lactobacilli ensure that the vaginal environment is inhospitable for potential pathogens in a variety of ways:

1) Producing lactic acid that helps keep the pH low and healthy (ideally between 3.8 and 4.5)
2) Taking up space on the vaginal wall, preventing other pathogens from being able to thrive
3) Producing bacteriocins, which further inhibit pathogens
4) Keeping inflammation down in the genital tract.

When this environment is in an optimal state, it can do amazing things. A balanced vaginal microbiome can lower your risk for:

  • STIs like chlamydia, gonorrhea, trich, herpes, HPV, and HIV
  • Pelvic Inflammatory Disease
  • Fertility complications like infertility and failed IVF
  • Pregnancy complications like miscarriage, preterm birth, neonatal problems, and preeclampsia
  • Gynecological cancers like ovarian cancer and cervical cancer
  • Cervicitis
  • Toxic Shock Syndrome
Are my frequent vaginal infections related to my microbiome?
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Yes! The viruses, fungi, and bacteria that cause vaginal infections are all part of your microbiome. When your microbiome is imbalanced, it creates opportunity for these bad microbes to thrive.

If you’re one of the ~30% of people with vaginas that will get BV this year, that means your vaginal microbiome has a wide variety of bacteria (called dysbiosis) instead of a Lactobacillus bacteria playing the main role in creating that all-important lactic acid environment.

On top of that, 84% of BV cases are asymptomatic, meaning that you might not even know if your vaginal microbiome is imbalanced — but you might still be at risk for infection or other complications.

Dysbiosis of the vaginal microbiome can catalyze other types of infections as well, such as aerobic vaginitis, yeast infections, cytolytic vaginosis (CV), UTIs, all of which can have frustrating (and confusingly similar) side effects, such as itchiness, abnormal discharge, and burning.

One important thing to note: research shows that dysbiosis is more prevalent in Black and Hispanic women, but there is a disappointing lack of research explaining why that is or how we can change it. More broadly, it’s incredibly frustrating that research on this topic has not been more highly prioritized in medicine overall, given the prevalence of vaginal dysbiosis and its impact on our quality of life.

…Go on…  

We know, we know — we could talk about this for hours. But let us point out a few more things —   the current methods for treating vaginal infections are as archaic as diagnosing them.

Antibiotics and antifungals are widely used treatments which have high rates of success in the short term. However, in the long term, they’re not as great of a solution as you might think.  

While antibiotics and antifungals kill off the bad bacteria, they also kill off the good ones, rendering the vagina defenseless and highly susceptible to reinfection. In fact, vaginal infections have some of the highest rates of reinfection, with 80% of BV patients having a reinfection within 3 months and 60-70% of patients taking long term yeast infection treatment having a recurrence within 6 months afterwards.

There have been almost no advancements to improve cure rates for vaginal infections for decades. There is a pressing need for better, more sustainable solutions — and demystifying the microbiome to patients, doctors, and researchers can drastically improve treatment options in this space.

If my vaginal microbiome is so powerful, why haven’t I heard of it?
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Microbiome research is a relatively new field, and lots of resources have been invested in understanding other human microbiomes like the one in your gut or on your skin. But when it comes to your vagina, the microbiome has been overlooked.

We wish the reason why wasn’t yet another gender gap… but that’s why we’re here! Evvy exists to use cutting-edge research techniques to elevate the vaginal microbiome to its rightful place in research and clinical care, all while providing you with critical insights into your health.

How can I check in on my own microbiome?
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Well — that’s the other reason why we exist.

Evvy’s first product willbe the only at-home test that leverages metagenomic sequencing, an advanced form of next-gen sequencing that analyzes the entire genome. This allows us to pick up on all bacteria present at an extremely specific level.

In addition, Evvy won't just return a table of numbers. Evvy results come with actionable recommendations and curated insights on how your vaginal microbiome is related to your holistic health — customized to you based on your specific microbes, symptoms, and experiences.

You’ve convinced me my microbiome is important...how can I take care of it?
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Here’s the thing about vaginas: they’re pretty great at taking care of themselves. They’re self-cleaning and normally self-protecting, as long as the vaginal microbiome is in balance.

However, many of the things we enjoy — sex and sugar, for example — are good at throwing off this balance.

Plus our bodies naturally change over time, and trying new birth control, medications, sexual partners, period products, and more can add chaos to this balancing act.

There are some all-around great things you can do to take care of your vaginal microbiome — and we’re pretty sure you’ve heard them before: Drink water, never douche, wear cotton underwear, pee after sex, cut down on sugar, change out of wet swimsuits as soon as you can, the list goes on.

But surprise! Not all vaginas are the same. What works for you might not work for your sister or your friend. So the best way to care for your unique microbiome is to first understand what your microbiome looks like (what bacteria are present) and whether or not it is optimally balanced (psst...that’s what we made the Evvy vaginal microbiome test for!)

And when you do intervene (try a new probiotic, change your diet, etc.),  Evvy will take the guesswork out of figuring out which solution is working for you. By retesting, you can see how changes you’re making in your diet, life, and supplements are impacting your vaginal microbiome’s defense.

We envision a world where everyone with a vagina is in control of their own health through personal data, accessible research, and empathetic care.
Scientific accuracy is important to us.
See what we're reading and citing here.

What's my vaginal microbiome?

Your vaginal microbiome is associated with everything from recurrent infections to fertility challenges to STI acquisition. Don't worry if you've never heard of it — we'll introduce you.

Every day, your vagina performs the equivalent of modern health miracles.

Every day, your vagina performs the equivalent of modern health miracles. 

It can fight off infections, bolster fertility, protect a pregnancy, and possibly even defend against cancers. 

The key to all of it? The complex ecosystem of bacteria & fungi known as the vaginal microbiome. It’s similar to the microbiomes that exist in your gut or on your skin, but when it comes to your vagina, the microbiome has been overlooked -- despite ample research showing its importance to overall female health. Evvy exists to change that.

 Research has shown that most vaginal microbiomes fall into one of 5 general categories¹, sometimes called "Community State Types” (CSTs). While research on the types is evolving, they can be a helpful way to get a sense of the symptoms and health outcomes that may be associated with your results. You can read more about the types in our overview here.

Vaginal Microbiome 101

Given that the vagina is the structural connection between the outside world and some of our most important reproductive organs, the local microbiome has evolved to serve as a critical layer of protection against pathogens entering our bodies.

While there is a variety of bacteria and fungi that can exist in the vagina, Lactobacillus are the local heroes. Lactobacilli ensure that the vaginal environment is inhospitable for potential pathogens in a variety of ways:

  1. Producing lactic acid that helps keep the pH low and healthy (ideally between 3.8 and 4.5)
  2. Taking up space on the vaginal wall, preventing other pathogens from being able to thrive
  3. Producing bacteriocins, which further inhibit pathogens
  4. Keeping inflammation down in the genital tract

The DL on dysbiosis 

When Lactobacilli are not present, pathogens can start to colonize the vaginal microbiome, which is referred to as dysbiosis. In a state of dysbiosis, there is a higher diversity of bacteria, which can allow disruptive microbes like Gardnerella, E.coli, or Ureaplasma to flourish. These bacteria can cause unwanted symptoms like itching, burning, irritation, or pain, as well as catalyze vaginal infections like bacterial vaginosis, yeast infections, and urinary tract infections (UTIs).

The most common vaginal infection is bacterial vaginosis (BV),which is defined by high bacterial diversity and an abundance of disruptive bacteria. Research shows that over 30% of women will have this condition every year, and up to 84% of these cases can be asymptomatic. You can read more about BV in our article here.

Dysbiosis of the vaginal microbiome can catalyze other types of infections as well, such as aerobic vaginitis, yeast infections, cytolytic vaginosis (CV), UTIs, all of which can have frustrating (and confusingly similar) side effects, such as itchiness, abnormal discharge, and burning.

One important thing to note: research shows that dysbiosis is more prevalent in Black and Hispanic women, but there is a disappointing lack of research explaining why that is or how we can change it. More broadly, it’s incredibly frustrating that research on this topic has not been more highly prioritized in medicine overall, given the prevalence of vaginal dysbiosis and its impact on our quality of life.

Considering the larger picture

To add to the many reasons the vaginal microbiome deserves more attention: on top of being the primary actor in the prevalent and often debilitating conditions listed above, recent research is starting to uncover groundbreaking insights on the vaginal microbiome’s critical role in female health far beyond the vagina.
When the vaginal microbiome is in an optimal state, it can do amazing things. It turns out that having protective bacteria like Lactobacillus in your vaginal microbiome can protect you from a variety of other potential health outcomes.

On the flip side, disruptive microbes can create a favorable environment for other infectious microorganisms, increase inflammation, and inhibit your immune response.

Research has shown that the composition of your vaginal microbiome is associated with your risk for the following conditions:

  • STIs such as chlamydia, gonorrhea, trich, herpes, HPV, and HIV
  • Pelvic inflammatory disease
  • Fertility issues or failed IVF cycles
  • Pregnancy complications such as miscarriage, preterm birth, neonatal problems, and preeclampsia
  • Gynecological cancers such as ovarian, cervical, or endometrial cancer
  • Cervicitis
  • Toxic shock syndrome

An evolving ecosystem

While the vaginal microbiome is critically important to female health, it is also always changing. Unlike genetic results, which are static, microbiomes are dynamic and can reflect progression towards or away from disease. They can shift not only across years, but even from one week to the next.

There are multiple reasons that the vaginal microbiome changes over time. Your day to day behaviors -- such as trying new birth control, medications, supplements, sexual partners, smoking, or vaginal products -- can influence its composition. The vaginal microbiome is also affected by hormones, shifting when someone gets their first period, pregnancy, and menopause.

Given its dynamic nature, if your vaginal microbiome isn’t in an ideal state, it might be cause for consideration -- and possible care -- but not concern.

Decoding your vaginal defense

When it comes to the vaginal microbiome, knowledge is power. By keeping tabs on its composition, you can catch potential imbalances early, giving you the chance to proactively take action to promote the protective bacteria and prevent the disruptive bacteria from taking hold. 


Referenced in this article:

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