Farrah was fed with her vagina.
For the past two years, the 29-year-old dancer from Ohio suffered from severe pelvic pain and vaginal odor. “It was like 8/10, horrible central pain,” she said. “I couldn’t lie down. I couldn’t even work office work. It was bad. »
When she visited doctors, she told them what she thought was the culprit: an allergic reaction to soybean oil in a vat of water she had swam in at a pirate-themed dinner theater. But they didn’t believe her. “They tried to fix it with antibiotics,” she said. “And they just didn’t do anything.”
So Farrah (who asked that we withhold her full name so she could speak freely about health issues) started Googling her symptoms. This is how she came across Neueve, a vaginal health company which provides supplements, suppositories and at-home vaginal microbiome testing kits.
She ordered a test from the company for $150, and it came back with a diagnosis: aerobic vaginitis (AV), a bacterial infection caused by an overgrowth of E. coli. coli or streptococcus. She ordered supplements recommended by the company and says the pain subsided almost immediately. “I was so happy to know what was wrong,” she said.
Farrah is one of a growing number of women who have used at-home tests to self-diagnose issues related to the vaginal microbiome, an ecosystem of bacteria growing inside the vagina; the presence of “good” bacteria correlates with a lower risk of STIs and other types of infections, according to numerous studies. The industry received praise when Silicon Valley entrepreneur Bryan Johnson recently job on X that he had just performed oral sex on his girlfriend, Kate Tolo, then followed up with a screenshot of his TinyHealth vaginal microbiome report. He proclaimed that she scored “100/100” and that hers was in the “top 1% of all vaginas” due to the predominance of vaginas. Lactobacillus curlatusa type of “good” bacteria found in the vagina.
Johnson’s thread sparked widespread mockery, with many wondering why Johnson would publicly quantify her partner’s vaginal health in this way. But he also received responses from women online who monitor their own vaginal microbiome to treat their bacterial infections, to increase their fertility, or simply out of interest. Some have even published their results.
The market for at-home vaginal microbiome testing is growing — TinyHealth, the startup Tolo uses, says sales of vaginal health tests soared 2,000% in the first 48 hours after Johnson’s post — and similar companies include Juno Bio, which is partnering with Neueve; UK-based Daye and Evvy. But some experts say there isn’t yet enough research to support the long-term validity of such tests. None of the at-home kits available on the market are FDA approved. There are also questions about whether they empower women to take charge of their health care or simply create more anxiety for them.
Samantha, 28 (she also requested a pseudonym given the sensitive nature of this topic) developed an interest in vaginal microbiome testing after experiencing a bout of bacterial vaginosis, or BV. She ordered a test kit from Evvy on the recommendation of the Facebook group Beyond BV, which offers support to women with recurrent vaginal infections and where they often post their own results.
Samantha found her test results helpful, but she also noticed some paranoia within the group. For example, when many women receive their results, they tend to wonder if they have enough Lactobacillus curlatusor “good” bacteria, in the vagina. “I read articles where women panic if they have about 97 percent crispatus, and then they take the test again and they’ll get about 60 percent and be really disappointed and scared,” she says. The opposite is also true. “Women will post about having 100% crispatus and other women in the comments will just say, ‘Oh, I’m so jealous, I have so many problems, I hope to be you one day.'”
In Internet communities like the subreddit r/healthyhoohah, which has more than 100,000 members, women regularly discuss their ratios of “protective” and “destructive” vaginal bacteria, often trying to optimize the former. Some perform several vaginal microbiome tests, as a preventative measure, to avoid future infections. Research indicates that 50 to 80 percent of women who get BV once will get it again.
Longevity researcher Kayla Barnes-Lentz tests her vaginal microbiome about twice a year and publicly publishes her results. (She also uses Evvy and serves as a paid advisor for the brand.) She started testing it not because she has any underlying health conditions, but because she wants to do everything in her power to try to boost her numbers. For example, she says she got a bacterial protection score of 97 percent up to 100 percent while taking vaginal probiotics.
“We know that decline happens with age, and I want to be as protected against that as possible,” she says. “I’m always striving and always competing with myself.”
Evvy founder and CEO Priyanka Jain says the company has served more than 100,000 patients since its launch in 2020. She says that while the vast majority of her customers struggle with pre-existing vaginal health issues, 10% of them take the test out of “curiosity” and more than 50% are regular subscribers, taking the test every three months, either to track their fertility or to prevent recurrence.
There is little research on the vaginal microbiome compared to the much better known gut microbiome. This is partly due to gender bias within the scientific research community, says Hana Janebdar, founder and CEO of vaginal microbiome testing startup Juno Bio. Historically, “there has been a tremendous amount of research and commercialization on every aspect of the microbiome except its connection to women’s health,” she says.
But even though recurrent BV infections in women are a legitimate problem, some researchers say the usefulness of doing an at-home vaginal microbiome test is questionable, especially when one is asymptomatic, as Barnes-Lentz and Tolo were.
The vaginal microbiome is constantly fluctuating and can vary based on factors like diet, sexual activity, and whether a person is pregnant or menstruating, says Jacques Ravel, a vaginal microbiome researcher at the University of Maryland. (Ravel is also listed as scientific advisor at probiotic company Seed.) “It’s a very dynamic system,” he says. “Knowing what happened at one point in your life won’t tell you much about what’s going to happen, even two weeks from now.”
The diversity of the vaginal microbiome also varies by race and ethnicity: Black women, for example, are statistically more likely to have fewer bacteria. Lactobacillus curlatusthe protective bacteria, than white women of European descent, but this does not necessarily indicate a vaginal health problem. And some women can have little or no lactobacilli and be perfectly healthy.
The tests also usually suggest treatment protocols such as antibiotics or probiotics, which can disrupt the vagina’s bacterial ecosystem if introduced unnecessarily. “You may end up with something that may not be optimal for you, and all of a sudden you’ll start having problems,” such as worsening irritation or discomfort, Ravel says. “I think it’s dangerous.”
Asked about such criticism, the CEOs I spoke with dispute the idea that the tests provide no insight into long-term vaginal health, arguing that results fluctuate much less than Ravel suggests. Although Kimberley Sukhum, TinyHealth’s chief scientific officer, acknowledges that unnecessary treatment such as antibiotic intervention “can be harmful,” she says biomarkers such as lactobacillus dominance are “not ephemeral signals. They reflect the underlying character of a woman’s vaginal community at any given time and are associated with real health outcomes.”
Regardless of the long-term usefulness of the tests — or, at the very least, the ridiculous idea of a woman having a “top 1%” vagina — their popularity undoubtedly indicates a larger problem in women’s health. Until 1993, researchers were not legally required to include women in clinical trials, contributing to a huge gender gap in data. Women who regularly test their vaginal microbiome are trying to find their own answers within a medical system that has largely failed them.
“We haven’t done extensive research or funded enough in-depth research to find new drugs to solve this problem,” says Ravel. “For almost 50 years, we have not found a solution to help women. And I find that very, very sad.”
