Females in focus: The vaginal microbiome

Despite the proliferation of the gut microbiome, the skin microbiome and even the soil microbiome, the vaginal microbiome had been largely ignored. 

Women are half the population, and at least 30% of them suffer each year from imbalances in the vaginal microbiome, manifesting as yeast infections, recurrent UTIs, bacterial vaginosis (BV) and other infections.

Femtech is tackling these challenges head on with new technologies such as wearables, artificial intelligence, apps, and at-home test kits to bring awareness to female health.

One femtech company is Evvy, a female-founded startup that aims to build a new  understanding of the female body. The new company’s focus is on a critical but often overlooked biomarker: the vaginal microbiome.

Evvy's at-home vaginal microbiome test leverages metagenomic sequencing to help bring more insight to the vaginal microbiome's newly discovered role in fertility and overall female health.

The home vaginal microbiome test provides details like what bacteria are present, why it matters, and what can be done about it. Evvy CEO and co-founder Priyanka Jain said that users also add to the dataset, leading to more insight on predicting risk and supporting the female body.

Too complicated for research 

"Women weren't required to be in clinical research in the US until 1993, meaning we are decades behind in understanding how to best care for women and people with vaginas,"​ said Jain.

Indeed, the Food and Drug Administration (FDA) excluded females of ‘child-bearing potential’ from clinical trials from 1977-1993 — including mice. Yes, even female mice were deemed too complicated for research. 

Despite the extreme physiological differences between the male and female body, health and medicine has historically used the male body as the standard. The decision to exclude women was rationalized by asserting that men and women are the same—except for women’s hormonal fluctuations. 

Women want more natural options

A recent study​ revealed that women with recurrent urinary tract infections (UTIs) experience frustration related to their treatment and seek more natural options, according to a focus group study in The Journal of Urology. 

The researchers conducted focus groups with 29 women with recurrent UTIs — defined as two infections in six months or three in a year. Participants were asked about their knowledge of UTIs and prevention strategies and about the impact of treatment on their quality of life. These discussions highlighted  two common themes: fear and frustration. 

Many participants voiced frustration and resentment toward their medical providers for ‘throwing antibiotics’ at them without presenting alternative options for treatment and prevention. 

“Since there’s already a common treatment for UTIs — antibiotics — many doctors don’t see a need to do anything differently,”​ said senior author Dr. Ja-Hong Kim, an associate professor of urology and assistant fellowship director for female pelvic medicine and reconstructive surgery at UCLA Health. 

"There are exciting research developments underway, including the utilization of point-of-care rapid diagnostic assays to accurately and selectively treat UTIs as well as studies to understand the impact of vaginal microbiome on voiding dysfunction. We hope these efforts will pave the way to improved patient experience,”​ said Kim. 

While antibiotics are often used to treat vaginal infections, these medications can also kill off good as well as bad bacteria.

Ingredients 

Beyond cranberry supplements, brands are coming out with a variety of formulas for women. For instance, Cambridge Diagnostic Imaging, also known as CaDi, launched Lycovary Daily, an ovarian health supplement in the family of oxygenation products. The patented complex of DHA omega-3 with the carotenoid molecules lutein and zeaxanthin provide clinically-validated ingredients that aim to promote hormonal balance. 

Many women are also turning to probiotics to restore the pH level of vaginal acid and to help with issues like bacterial vaginosis, urinary tract infections, and yeast infections. Lactobacillus is the most frequently isolated microorganism from the healthy human vagina, this includes Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners​, and Lactobacillus jensenii​, which is used to support vaginal pH and to help maintain the normal balance of bacteria. 

And as interest and anecdotal evidence of CBD increases, so does research into the vagina’s endocannabinoid system and how CBD affects things like reproductive, sexual, and overall vaginal health. There is still much to learn, but burgeoning sector has caught a lot of women's attention.

With more women and women-related health topics being researched, more products for the vaginal microbiome—​whether it be apps, formulations, personalized health, or other innovations—​can expect to hit the market. 

For Evvy, the vaginal microbiome is just the beginning. The company said it is already planning to expand into new biomarkers, datasets, and products that can transform female health.