How to Choose a Vaginal Microbiome Test

When it comes to vaginal health, we all want the best results, whether it's finding a great OB-GYN or vaginal health 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 there are now a few different tests that you can do at home. But here's the thing: not all vaginal microbiome tests are made equal. It can be tough to navigate all the jargon and figure out which one will give you the most accurate and useful results. 

So, we've put together a guide on what to look out for when you're looking for an at-home vaginal microbiome test.

What to look out for

There are six main things to look out for when choosing a vaginal microbiome test: 

1. Technology: What technology does it use to analyze the vaginal microbiome? 
2. Comprehensiveness: How many microbes does it test for, and which ones?
3. Accuracy: How accurate is the test in reporting the microbes that are actually present?
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/or coaching?

Technology, comprehensiveness, and accuracy

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. That’s because the technology determines how many bacteria and fungi you can look for at one time, and which 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. 16s and metagenomics are both forms of next-gen sequencing (NGS), but as you’ll see below, there are key differences that make metagenomics the better method for accurate and comprehensive microbiome reporting.

There’s a lot to say about different testing methods (we have a comprehensive guide elsewhere on our blog!) but here’s the TLDR on the difference between the three: 

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 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 if the test wasn’t specifically looking for it, or tell you how much of one microbe there is compared to another. There are hundreds of different kinds of bacteria that can live 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, Gardnerella vaginalis or Ureaplasma parvum), 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. 

You don’t always need to choose between the two however! For instance, Evvy offers the option to add an Expanded PCR Panel to our metagenomic Vaginal Health Test — so you can get the best of both worlds with just one swab. 

Note that most doctor’s offices use either PCR tests that look for 3-5 pathogens or symptoms-based diagnostics like Amsel criteria. If you want to learn more about Amsel and how your doctor’s office tests are different than an at-home vaginal microbiome test, check out our comprehensive testing methods article!

Speed

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 takes 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. 

Evvy’s Expanded PCR Panel add-on 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 Health Test leverages metagenomics and 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 the lab and clinical testing is crucial for adequately diagnosing, treating, and managing health conditions. 

Certifications are a great 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. 

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. If your at-home test is CLIA-certified, this means you can have peace of mind knowing it achieves the these high federal standards. 

The Evvy Vaginal Health Test is the world’s first and only CLIA-validated metagenomic vaginal microbiome test. It’s 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.  The test results are also reviewed by both the lab director and a provider.

Some at-home vaginal microbiome tests are designed for research use only (not clinical use), and are typically marketed as "wellness" products. If you want to use test results for treatment or other clinical follow ups, make sure to order a test that is CLIA/CAP certified and designed for clinical use! 

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 and/or you don’t have a provider who can help you with next steps. 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. 

Need more help finding an at-home vaginal microbiome test?

We know evaluating different vaginal microbiome tests can be time-consuming and even confusing at times! If you need any more information or clarification, or just want to talk to someone who gets it, our certified health coaches would love to answer your questions. Just reach out to hello@evvy.com!