Vaginal microbiome – vaginal flora test at home

In a large study of almost 400 women without complaints, the vaginal flora was usually dominated by one lactobacillus species. Lactobacilli produce lactic acid and thereby keep the environment acidic (PubMed 20534435). In bacterial vaginosis, lactobacilli decline and anaerobic bacteria, especially Gardnerella, increase sharply (PubMed 37097068).

A low proportion of lactobacilli is not automatically a disease, however: in the same study, some women without complaints also had a flora with few lactobacilli (PubMed 20534435). What the value means for you is clarified in the results consultation.

The most common vaginal lactobacilli are Lactobacillus crispatus, iners, gasseri and jensenii; vaginal types I, II, III and V are named after the respective dominant species (PubMed 20534435).

Lactobacillus iners plays a special role: it is common in healthy women but is also often found in large amounts in bacterial vaginosis. A systematic review describes it as a transitional species that offers less protection against a disturbed flora than L. crispatus (PubMed 34881196). These are group observations; they do not predict what will happen in your case.

Gardnerella vaginalis is the key bacterium of bacterial vaginosis: in it, Gardnerella forms a coating (biofilm) on the vaginal lining together with other bacteria (PubMed 37097068). The report lists Gardnerella together with other BV-associated bacteria such as Fannyhessea (formerly Atopobium) vaginae, Prevotella, Megasphaera and Mobiluncus.

Detection alone is not a diagnosis: Gardnerella and other anaerobic bacteria also occur in smaller amounts in women without complaints (PubMed 20534435). Bacterial vaginosis is diagnosed by a doctor based on examination and a swab (PubMed 35118003).

Lactobacilli keep the vaginal environment acidic with lactic acid. When they decline, the pH rises. A raised pH is described in bacterial vaginosis and even more markedly in aerobic vaginitis (PubMed 28502874).

pH also differs between healthy women, however; in one study, the average in women without complaints was between 4.2 and 5.0 depending on the ethnic group (PubMed 20534435). A single pH value therefore does not show what lies behind it. You measure it with the enclosed test strip and enter it on the request form.

The vaginal type (community state type, CST) assigns the flora to one of five basic patterns: four each dominated by one lactobacillus species, and type IV with few lactobacilli and more anaerobic bacteria (PubMed 20534435).

Unlike in the gut, low species diversity is the usual state in the vagina; higher diversity can go along with a disturbed flora such as bacterial vaginosis (PubMed 35118003). The BV score is the laboratory's rating based on lactobacilli, the anaerobic accompanying flora and BV-associated bacteria. It is not the same as the clinical Amsel criteria or the Nugent score (PubMed 35118003).

The report checks seven Candida species by qPCR, including Candida albicans and Candida glabrata. Detection is not the same as a yeast infection: in a study from Portugal, 64% of women without complaints carried Candida in the vagina (PubMed 35482711). A yeast infection is only present when complaints and examination fit.

With recurrent yeast infections, the exact Candida species matters for medical treatment (PubMed 26164695). That belongs in a gynaecology practice.

In bacterial vaginosis, the balance of the vaginal flora is shifted: protective lactobacilli decline and anaerobic bacteria such as Gardnerella increase sharply. It is the most common intimate-area disorder in women of reproductive age and affects about one in four women (PubMed 37097068, PubMed 40537474).

The exact cause has not been clarified (PubMed 40537474). Bacterial vaginosis is diagnosed by a doctor, classically through examination, pH and microscopy (PubMed 35118003), and treated medically.

After the usual treatment, bacterial vaginosis returns in more than half of women within 3–6 months (PubMed 40537474). The biofilm on the mucosa, resistance and a failure of protective lactobacilli to recolonise are discussed as reasons; newer data also point to sexual transmission (PubMed 40537474, PubMed 37097068).

With recurring complaints, a gynaecology practice is the right place to discuss causes and treatment.

A pH test strip only shows whether the environment is more or less acidic. Sequencing shows which bacterial species are present in what proportion, including those that are hard to grow on standard culture media, such as Lactobacillus iners (PubMed 34881196). A gynaecological diagnosis of bacterial vaginosis, by contrast, is based on examination, pH and microscopy according to Amsel or Nugent (PubMed 35118003).

A microbiome test can therefore provide additional information but cannot replace an examination when you have complaints.

Research describes typical patterns of complaints, although they overlap:

• Thin, greyish-white discharge with a fishy odour: typical of bacterial vaginosis; inflammation with redness is usually absent (PubMed 28502874).
• Yellow-greenish, thicker discharge, redness, burning and pain during sex: described in aerobic vaginitis, an inflammation with gut and skin bacteria instead of lactobacilli (PubMed 28502874).
• Itching and burning: often taken for a yeast infection. In one study, however, only about a third of women who had diagnosed themselves with thrush actually had it; the others had bacterial vaginosis, a mixed infection, something else or a normal finding (PubMed 11864668).
• No complaints: some women without complaints also had a flora with few lactobacilli and many anaerobic bacteria (PubMed 20534435), and Candida was found in many women without complaints (PubMed 35482711).

These are associations from studies, not causes in an individual. The test cannot explain complaints and does not provide a diagnosis. Persistent or new complaints should first be checked in a gynaecology practice.

With fever, lower abdominal pain, bleeding outside your period, after sex or after menopause, blisters or sores in the genital area, pain when urinating or strongly foul-smelling discharge, the first step is a gynaecology practice, not a self-test. The same applies if you are or might be pregnant: complaints during pregnancy should always be checked by a gynaecologist. If you may have been exposed to a sexually transmitted infection, have a medical examination.

Do not treat complaints on your own; self-diagnoses in the intimate area are often wrong.

This page does not give treatment recommendations, and the report is not a treatment instruction. Whether a result means anything at all and which steps make sense depends on complaints, examination, previous findings and medication. Bacterial vaginosis or a yeast infection is treated by a doctor.

What your report means for you is something to discuss with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation is included in the price.

Do not use the test during your period, during pregnancy or within three months after a pregnancy. Do not use other vaginal products for at least two days beforehand; vaginal contraceptives, condoms and water-based lubricants are allowed. If you are currently using vaginal medication or antibiotics, agree on the timing with us beforehand and do not stop anything on your own.

Wash your hands thoroughly before collection, do not touch the white bristles, take the sample standing up and turn the pink plunger five times. Measure the pH with the test strip and enter it on the request form. Hand in the shipping bag at a post office as soon as possible, do not put it in a letterbox, and only send it Monday to Thursday.

Analysis usually takes 7–21 days from the arrival of the sample at the laboratory. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

The vaginal microbiome test costs €193.21 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover microbiome analyses you order yourself. With private insurance, reimbursement may be possible; how it works is described under "Reimbursement by private insurance". If you have complaints, the examination belongs in a gynaecology practice.

The vaginal microbiome test (€193.21) shows the entire bacterial flora at species level by sequencing, plus Candida species. Vaginal flora with aromatogram (€193.21) uses culture and molecular detection of selected pathogens and also tests in the laboratory how cultured germs react to essential oils. The women's hormone profile (€160.05) measures cycle hormones in saliva.

Which scope makes sense for you can be clarified in the free initial consultation.