Vaginal flora with aromatogram – vaginal flora test at home

For the culture, the swab is placed on culture media; the germs that grow there are identified, for example enterococci, E. coli, streptococci, staphylococci or yeasts. Such gut and skin bacteria are found instead of lactobacilli in aerobic vaginitis (PubMed 28502874). Detection without complaints is not automatically an infection, however.

A culture only shows what grows on the media used. Some important vaginal bacteria, such as Lactobacillus iners, are hard to grow on standard media and were therefore overlooked for a long time (PubMed 34881196). The sample report also notes that chlamydia, gonococci and anaerobic bacteria were not cultured.

Gardnerella vaginalis is the key bacterium of bacterial vaginosis. In it, lactobacilli decline and Gardnerella forms a coating (biofilm) on the mucosa with other bacteria (PubMed 37097068). Gardnerella also occurs in smaller amounts in women without complaints, however (PubMed 20534435).

The test detects Gardnerella molecularly and reports "positive" or "negative", not the amount. Bacterial vaginosis is diagnosed by a doctor based on examination, pH and microscopy (PubMed 35118003).

Candida is a yeast. Detection is not the same as a yeast infection: in one study, 64% of women without complaints carried Candida in the vagina (PubMed 35482711). A yeast infection is only present when complaints and examination fit.

Trichomonas vaginalis is a single-celled organism transmitted during sex. The test reports it as well. A positive result belongs in a gynaecology practice, where confirmation and treatment are decided.

Lactobacilli keep the vaginal environment acidic with lactic acid (PubMed 20534435). When they decline, the pH rises; raised values are described in bacterial vaginosis and even more markedly in aerobic vaginitis (PubMed 28502874). pH also differs between healthy women (PubMed 20534435) and on its own does not show a cause. You measure it with the enclosed test strip and enter it on the request form.

In the aromatogram, each cultured germ is tested on a culture medium against various essential oils, in the sample report for example tea tree, manuka, eucalyptus, neroli, lavender, lemongrass and thyme. The inhibition zone is measured in millimetres, i.e. the zone in which the germ does not grow. The laboratory classifies this as resistant, intermediate or sensitive according to its own thresholds.

This is a laboratory result, not proof of effectiveness in humans. A systematic review found that tea tree oil has an effect against vaginal infections in the test tube, but no sufficient studies in humans, and therefore advises against recommending it (PubMed 12719677). Essential oils can also irritate skin and mucous membranes; among essential oils, tea tree oil has caused the most reported contact allergies (PubMed 27173437). The aromatogram is therefore not a recommendation to use an oil.

An aromatogram works similarly to an antibiogram: a germ is grown on a culture medium, discs with various essential oils are placed on it, and after incubation the size of the zone without growth is measured. Unlike for antibiotics, there are no clinical studies for essential oils that derive an effect in the body from the inhibition zone (PubMed 12719677).

The aromatogram therefore describes how a germ reacts to oils in the laboratory. Whether and how treatment makes sense is decided by a doctor after an examination.

In bacterial vaginosis, lactobacilli decline and anaerobic bacteria such as Gardnerella increase; it affects about one in four women (PubMed 40537474). In aerobic vaginitis, gut and skin bacteria such as E. coli or streptococci take the place of lactobacilli, and the mucosa is inflamed (PubMed 28502874). A yeast infection is caused by Candida.

The three are hard to tell apart by complaints alone and can also occur together (PubMed 28502874). In one study, women who diagnosed themselves with thrush were wrong in about two out of three cases (PubMed 11864668).

Culture shows germs that grow on culture media and is a prerequisite for the aromatogram. Molecular detection looks specifically for individual pathogens, here Gardnerella, Candida and Trichomonas. Sequencing, as in the vaginal microbiome test, captures the entire bacterial community with its proportions, including hard-to-grow species such as Lactobacillus iners (PubMed 34881196).

The medical diagnosis of bacterial vaginosis is still based on examination, pH and microscopy (PubMed 35118003).

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 aromatogram is not a treatment instruction. Sufficient human studies on essential oils against vaginal infections are lacking (PubMed 12719677). Bacterial vaginosis, aerobic vaginitis, a yeast infection or a Trichomonas 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.

Follow the enclosed instructions exactly: two blue swabs for the culture and one red swab for molecular detection, plus measure the pH with the test strip and enter it on the request form. If you are on your period, pregnant or using vaginal medication or antibiotics, agree on the timing with us beforehand and do not stop anything on your own.

Hand in the shipping bag at a post office as soon as possible, do not put it in a letterbox and do not send it on a Friday, so the samples reach the laboratory quickly.

Analysis usually takes 7–21 days from the arrival of the samples at the laboratory, because the germs first have to grow for the culture and aromatogram. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

Vaginal flora with aromatogram costs €193.21 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover tests you order yourself, nor an aromatogram. 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.

Vaginal flora with aromatogram (€193.21) uses culture and molecular detection of Gardnerella, Candida and Trichomonas and also tests cultured germs against essential oils in the laboratory. The vaginal microbiome test (€193.21) shows the entire bacterial flora at species level by sequencing, with vaginal type and BV score, plus Candida species. 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.