694: Understanding the Vaginal Microbiome and Vaginal Health With Priyanka Jain

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Katie: Hello and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com, and this episode is all about a topic that I have not directly ever covered on this podcast before, which is the topic of vaginal health and vaginal microbiome. So a little bit of a higher level topic. May or may not want to listen with small children unless you’re going to explain that conversation to them. But I think a very important topic for women, especially because we really get into how this is connected to fertility, to pregnancy, to better birth outcomes, and to women’s health in general. And it’s the deepest I’ve gone on this topic.

And I’m here with Priyanka Jain, who is the co-founder and CEO of a company called Evvy, where they’re on a mission to close the gender health data gap. And they’re starting with the first ever precision vaginal health care platform and the world’s largest data set on the vaginal microbiome, which has not been studied largely in the past. Her background is in data and she’s bringing this approach to women’s health and especially to vaginal microbiome understanding. And so just like we have a gut microbiome and an oral microbiome, she is directly involved in doing the research in the vaginal microbiome and how it’s impacting women’s health.

We talk about her own journey and what led to this, how women were not included in clinical research until 1993, and why women are still diagnosed years after men for the same conditions, how to actually make the best use of data that we now have access to, how vaginal discomfort is the leading reason women seek medical health in the US and at any given moment, 30% of women have some form of vaginal dysbiosis but it can be for many different causes and it’s often in conventional medicine treated as a single cause, the reason the vagina is meant to be acidic, what her data set on vaginal microbiome is showing and what we can learn from it, what the most common forms of vaginal dysbiosis are, how 84% of people with vaginal dysbiosis have no symptoms and get no treatment, and 66% of people who think they have a yeast infection actually have something else entirely.

We talk about things like boric acid and what the research shows, we talk about vaginal probiotics and what to know, and how vaginal health affects fertility, pregnancy, and birth, and how to optimize this to your advantage. And she has some really awesome life advice at the end, as well as a book recommendation that’s new. So I hope that you will enjoy this really fascinating episode with Priyanka Jain, and let’s join her now. Priyanka, welcome. Thanks so much for being here.

Priyanka: Thank you so much for having me.

Katie: This is going to be, I think, a really informative and fun conversation. And we’re going to get to go into some topics that actually I’ve not talked about on this podcast yet in almost 700 episodes. But first as a springboard, I feel like there is a relevant part of your story that relates directly into the work that you’re doing. And from researching you, it seems like you dealt with some certain health problems yourself and that that sort of led you into this world of health and wellness. So I would love to hear that story and what that journey was like for you.

Priyanka: Yes, definitely. I always joke that everyone has, or most women have their own version of my story, right? Of going to so many doctor’s offices, feeling like you have symptoms that are unexplained or things keep happening to you, but everything, you know, quote unquote, looks normal. And maybe you should drink more water or maybe you should sleep more or maybe you should have a less stressful job. And I come from a background in the data world, have always been really interested in ways that we could bring machine learning products to the world to help try to make the world a more fair place, and was just shocked at, you know, the lack of data that I had access to on my own body, right? To try to understand what was going wrong, why was I feeling this way? And the amount of just frustration from both the patient and provider side with the inability to get answers.

And as I started doing some of my own research, as I think so many women do when they have experiences like mine, I found out some of the absolutely wild facts that now underpin Evvy’s mission, right? The fact that in the US, women weren’t in clinical research until 1993. And that to this day, we’re diagnosed on average four years later than men across over 700 diseases. And what that screamed to me as data person is, oh wow, we actually have this massive data gap when it comes to our understanding of the female body.

We’ve essentially forever in history studied middle-aged mid-sized white men and then assumed that women were small men and we would just make everything smaller and that healthcare would work. And obviously that’s not the case, right? That’s not our lived experiences. And so I became so curious about, if we’ve never studied the female body, there must be so many unique signals, right? Messages that the female body is trying to give off saying, I’m doing well or I need help, but we just don’t measure those things because they didn’t exist in men. And so I was very curious about, okay, could we start to measure some of those signals and actually could that improve our ability to detect disease in women and treat it in a much more efficacious fashion? And that was the beginning of Evvy.

Katie: Yeah, and I’m glad you brought up that gap. It still blows my mind that really women were not even included in research until ’93 and are still not included equally in research now. And I know it’s like partially like we used to just assume women were small men and also women have hormones that seem to change and are confusing. So it’s easier to just ignore that part entirely and just focus on men because they’re sort of like easier to control variables, which I get. But I feel like to your point, it does a disservice to women.

And like you, I had that experience of having issues, not being able to get answers from doctors being told like that’s normal or that’s just postpartum or that’s just your hormones. And my thought was like even if it’s common, that doesn’t mean it’s normal. And it doesn’t mean that’s how we have to feel. And so I love that you’re taking the data driven approach and looking at like, we have access now in this time to all this data we didn’t used to have, whether it’s wearables, lab testing, whatever. But what do we do with it? I feel like we’re in the like interpretation era of data.

Priyanka: I love the way you frame that. And I think it’s, you know, there’s so many things in what you said, right? Around the fact that we doctors don’t have answers, we don’t have answers. We’re told that, you know, things, symptoms are normal in women, right? It’s normal to have all of these side effects to birth control, it’s normal. And I think to your point, normal is maybe the wrong word, right? Maybe it’s common, but I think that one of the things that I would love to change through Evvy, is whatever the opposite of normalizing is, unnormalizing. I would love to unnormalize female pain, right? I think we’ve just accepted that we have, we live longer, but we suffer more. And I think that we just have to change that. We have to decide that we’re not okay with women suffering in the healthcare system. And I think once we decide that, a lot will change.

Katie: Agreed. And to your point, that seems to be another area where there’s a huge discrepancy is that women are not even believed about their pain when they go into ERs with the same exact symptoms as a man. They won’t be believed that they’re in pain. And it seems like studies have also shown that women can handle a pretty intense amount of pain and still operate and function. And so I think often that just gets discounted. And then these women just aren’t given resources and answers when they’re having a legitimate thing going on.

Priyanka: Exactly, it’s honestly wild. There’s so much research showing that we’re more likely to be dismissed. I’m going to butcher the exact stat, but it’s something like we’re twice as likely to be misdiagnosed when we’re having a heart attack because people don’t take our symptoms as seriously and because symptoms can often manifest differently in women and a lot of doctors aren’t trained to understand the symptoms in women. So I think the gender health gap goes so, so far and wide. And I think we’re so interested in the component of it that’s driven by the lack of data and how we can help fix that problem.

Katie: And that’s a great springboard into what I hope is going to be the bulk of our conversation today related to what you’re looking at with data points in women and specifically related to the vaginal microbiome, which is the part that has not really been talked about here except for sort of peripherally in relation to babies getting seeded during the birthing process, which I hope we’ll also go into. But that’s like, I feel like one piece and a whole spectrum of important things to know about this. So why did you start there?

Priyanka: Yeah, absolutely. Such a good question. I feel like whenever I’m talking to, especially the many male investors, I get asked, what’s the vaginal microbiome? Or why is that where you started? But I mean, there’s there’s two sides to this.

One is that vaginal discomfort is actually the leading reason that women seek healthcare advice in the US. It’s an incredibly, incredibly frustrating symptom and to your point, very common symptoms. And there’s a lot of different ways to look at that, right? Like I said, leading reason that we go to the doctor at any given moment, 30% of vaginas are in dysbiosis, meaning that we are not dominated by protective bacteria. And what’s crazy to me is that even though this condition, these set of conditions and symptoms are so prevalent, when we go to the doctor, we’re more likely to be misdiagnosed than correctly diagnosed, and we’re more likely not to get better than we are to get better.

And to just kind of explain how the vaginal microbiome works and then kind of how it’s not related, not just to these symptoms and infections, but also what we’re talking about today around motherhood and pregnancy, essentially just a little 101 on the vaginal microbiome. I’m sure you’re familiar with the gut microbiome or other microbiomes that exist in or on the body: skin, mouth, gut, etc. Turns out we also have one in our vaginas. And I always say, you know, it’s actually playing this very interesting kind of like barrier immune system role for us down there.

And what I mean by that is that when it’s dominated by protective bacteria, the most common of which is lactobacilli, which you might’ve seen on certain probiotics or supplements. And that lactobacilli, what it’s doing in the vagina is essentially producing lactic acid and hydrogen peroxide and taking up space on the vaginal wall. And basically they’re keeping the vagina very acidic. So too low pH, I’m sure you’ve heard of vaginal pH. And what that does is it makes it so that if any pathogen gets into the vagina, and you know, the vagina is essentially an open gateway between the outside World and then some of your most important reproductive organs.

But when your vagina is in a healthy protected state, if anything, any type of pathogen gets into the vagina, it just can’t replicate, it can’t survive, if there’s no space for it, because those protective microbes are keeping them out. But you know, you say you have sex with someone new or you sit in your swimsuit for too long or you have a long menstrual cycle. All of those things can disrupt the vaginal microbiome. And those pathogens as the pH rises can start to replicate.

And what happens is we start to experience things like yeast infections and recurrent UTIs and bacterial vaginosis. But what’s happening also is that we’ve lost that protective barrier between the outside world and our reproductive organs. So what you start to see is much higher rates of miscarriage, infertility, IVF failure, preterm birth, all the way to cervical cancer progression, STI acquisition, because we no longer have that barrier that a healthy vaginal microbiome is providing you. And I think as people with vaginas, we just are not educated about that and the important role that our vaginas are playing in our system. And we really hope to change that.

Katie: Yeah, I think this is such a fascinating concept. And I think also the distinction is important to understand. Like you mentioned, there’s many microbiomes that exist within the body’s ecosystem. And most people are most familiar with the gut microbiome probably. And there’s thankfully a lot of information happening, a lot of research happening here. There’s also my area of research, which was the oral microbiome, which I think is also fascinating, obviously very connected to the gut as well. We have a skin microbiome, of course, vaginal microbiome like you just explained.

But what I think is so cool is understanding that our digestive system, for instance, while it is inside the physical part of our body, is also considered an external system because it’s a tube where things pass through, but there’s barriers of entering our bloodstream. And in the same way, our reproductive system is actually sort of an external system with that barrier, like you explained, bacterially. And so this is like a very, like you said, very vital and important line of defense between our body and the outside World. And I feel like this part isn’t very well talked about at all.

Priyanka: Totally, and I think there’s so many reasons for that, right? There’s the classic stigmas and taboos of women’s health, and then you bring it to the vagina, and you just 10x the issues there. But I also think that we just haven’t applied a lot of the best technology to this problem, right? When you think about what you were saying earlier, we’re living in an age where we do have good technology. We can sequence things. We can actually look at what’s going on, and yet we’re not seeing that technology being applied to this incredibly important problem, both from a quality of life standpoint for all of the women who are suffering from symptoms, but also from a preventative standpoint so that we can start to prevent things like infertility and preterm births that maybe there are actually ways for us to start paying attention to the female body so that we can prevent those types of things from happening.

Katie: And I know you’re now able to have access to a lot of really detailed data around this. So I’m really curious, what are other emerging patterns and trends or the things you’re seeing in a lot of women? Like what’s coming up most often in the data that you’re seeing?

Priyanka: Yeah, such a good question. So we now have the world’s largest and most comprehensive data set on the vaginal microbiome ever, which is very exciting in terms of being able to finally unlock better research, right? And I think the way we’ve built that data set is actually by providing answers to people one-to-one, right?

We have our platform, which I realize I didn’t explain, but essentially anyone can order an Evvy test online. When they order the test, it’s like a little Q-tip swab that you take at home of your vagina. You mail it back to our lab, and we do metagenomic whole genome sequencing on the sample. And what that means is we’re able to see at the highest fidelity all bacteria and fungi that are in a sample. And then we bring that back and we educate you about, okay, here’s everything we found, here’s how it’s related to your health goals, here’s what we know about it, here’s how the symptoms might manifest, and most importantly, here’s what you can actually do about it. This is the step-by-step plan. You can either take it to your own doctor, or now we can actually help you get customized prescriptions specifically for you.

And through offering that to tens of thousands of women now, we’ve been able to not only help them better understand their own bodies, but also when they consent to research, we then can also start to do this research. And I’m a data nerd, the data is fascinating, like truly, truly fascinating. And I think there’s a couple of early takeaways.

One is that the clinical way that we understand the most common vaginal infections, bacterial vaginosis, is the most common one, and that’s the one that has the most kind of reproductions, or implications from a reproduction standpoint. It’s just so misguided. And what I mean by that is that our clinical understanding is so broad, the definition of bacterial vaginosis is literally an overgrowth of bacteria. But obviously when we actually look at it, you see tons of different types of bacteria in different levels, different types of pathogens that tend to cause symptoms or don’t cause symptoms or are actually associated with a negative outcome or aren’t, right? And I think the summary learning I would say is that there’s so much more specificity and nuance to what’s going on, that we are just not capturing or paying attention to today. But if we actually did pay attention to this much higher fidelity data, we could actually help intervene and change someone’s microbiome, both improving their symptoms and really improving their longer-term outcomes.

Katie: That makes sense. And it reminds me of, I mentioned oral health was my area of microbiome research, how you’ll see similar things. And understanding at a base level, first of all, bacteria is not a bad thing, especially when you’re talking about a microbiome. It’s absolutely important. It’s only when a pathogenic one gets out of balance in a negative way that we have an issue. So in the mouth, that would look like you could have the strep mutans bacteria that tends to cause cavities, or you could have a whole family of bacteria that tend to cause gingivitis. And you don’t typically see them both at the same time because they’re both pathogenic and opportunistic. So typically only one or the other will take off. But both can be helped by getting the oral microbiome in balance.

And I would guess that we have a similar thing, probably even more complex maybe, happening with vaginal microbiome where, like you said, there’s a whole host of different things that could be out of balance, but they all just get lumped under one umbrella. And do they get treated the same then in medicine? It’s like, oh, this is this, treat it with the same thing every time?

Priyanka: Literally, I mean, I could go on about this forever, so I will spare us, but the TLDR is that if you have bacterial vaginosis or vaginitis, we throw an antibiotic at it, essentially bomb the vaginal microbiome, and then hope that something different grows back, which is obviously not what happens, and that’s why you see extremely, extremely high recurrence rates, because to your point, we’re not focusing on actually rebalancing it. We’re not focusing on saying, how do we actually regrow the good bacteria? Because if you do that, you actually prevent the bad bacteria from being able to survive in the first place, right? And that good bacteria is actually what’s creating that barrier for you that protects the rest of your system.

And the other thing I’ll say that really is so interesting to me is that 84% of people who are in dysbiosis, right, don’t have a protective vaginal microbiome, actually have no symptoms. And those people today, we don’t do anything for. And so I think there’s a large way to go, both in helping people who do have symptoms, but then also educating people about why they should care about this barrier, even if they don’t have symptoms, and how do we help them rebuild it either way?

Katie: That’s a great point because if a person goes into their gynecologist just for a normal checkup, they may be checked for bacterial vaginosis potentially, but they’re not getting like a microbiome test of their vagina to find out if something’s out of balance, right? And typically, like from my understanding, they might only be tested if they’re having symptoms outside of just a pap smear, for instance.

Priyanka: No, exactly. I mean, actually, doctors are encouraged not to check the vaginal checks of patients’ vaginal health outside of if they have symptoms, which I understand, right? We don’t have until, I mean, we didn’t have a lot of good answers or a lot of good tools, but today, yeah, we ignore everyone who is not symptomatic. And then even when you are symptomatic, we’ll look for the kind of binary presence of is a certain microbe there or not, but we aren’t actually looking at that whole community, right? It’s like what you said about the oral microbiome. It’s all about the balance of the community, and it’s not about the binary yes/no on a certain microbe. And so I think there’s a lot of work to be done in kind of shifting our understanding of the vaginal microbiome so that we can actually take care of the community and not just treat it like a sinus infection, right? Where it’s like, oh, you have an infection, we’re just going to clear it. And it’s like, you actually don’t want to clear the vaginal microbiome. You just want a different one.

Katie: Yeah, exactly. Same thing with, to tie in again, like the oral microbiome. It’s the reason I encourage people don’t use harsh mouthwash because you’re wiping out all that oral microbiome, which also, like for instance, depletes your nitric oxide levels and has this whole host of ripple effects. Probably the same in vaginal health, which makes me wonder like, what are some of the kind of maybe common things or like at least things people might encounter that are actually really bad for our vaginal microbiome that we don’t even know not to do? Like I can think of, for instance, douching might be on that list, but what are some of the common things that can sort of spur that imbalance to begin with?

Priyanka: Completely. Well, douching is at the top of that list, like you said, no matter what company tries to convince you that their douche is good. No douching is good. You do not want to clean the inside of your vagina. Your vagina should be self-cleaning. And if it’s not, it means you have a problem that you need to deal with and a douche is not going to fix it. So that’s the biggest no-no.

And then there’s other things, scented products down there. You don’t want to put any type of soap into your vagina. Even things like wipes and washes, all of that you just have to be careful with because again, you just don’t want to disrupt what’s going on inside. And I think, you know, there’s so many other things that go wrong for people down there. I would say one thing to realize is just that there’s more than yeast infections. I think what we’ve seen from our community is everyone thinks every itch is a yeast infection. And there’s actually so much more that could be going on. I think it’s something like 66% of people who think they have a yeast infection actually have something else. So I think just not assuming that everything is one condition and really starting to pay attention to your body can really help.

And then the last thing I’ll say is that sex plays a huge role in the vaginal microbiome. And there’s a couple of different ways, right? One is your partner’s microbiome is now mixing with yours. And so you’re introducing a lot of bacteria. Two is that in the case of semen, semen actually has more bacteria in it than sperm. So there’s a whole host of bacteria that can be introduced to your vaginal microbiome through sex.

And then three is just that your microbiomes down there can really start to move around with all the friction and that’s something to be really careful of. And so if you’re somebody who’s prone to having these infections, if you’re not trying to conceive in that moment, then condoms actually are not just helpful for sexually transmitted infections, they can actually also be extremely helpful for the vaginal microbiome.

Katie: So much follow up to unpack there. I think what you said about yeast infections is fascinating because if that’s true that the majority of people who have some symptom think it’s a yeast infection and it’s actually not. It seems like logically that would also mean that treating it as a yeast infection might actually cause more problems than it helps.

Priyanka: Exactly. And this is, I think there’s so many reasons for this, but one of them is just that these conditions are taboo and the only things that people have heard of are yeast infections. They just assume any type of discomfort down there is yeast when it actually could be hundreds of different bacteria that could be causing the problem and an antifungal is not going to fix a bacterial infection.

But there also are skin issues, right? There’s dermatitis. Like in sclerosis, there’s so many other conditions that could be going on down there. And I think so much of what we can do and what your amazing platform is doing is educating women about these things, right? So that we don’t just make the assumption, we do actually do our own research and get the data so that we do get a treatment that actually helps us and doesn’t hurt us.

Katie: Are there also lifestyle and/or I wonder if even diet is correlated here factors that women can learn from and benefit from? Like I know we probably a lot of us got the advice don’t wear a wet swimsuit for too long, things like that. But are there like lifestyle related factors that make a difference and or foods that when we eat them actually are supportive or not supportive?

Priyanka: Such good questions. As with most things in vaginal health, unfortunately my answer has to be that there’s not a lot of research yet. We are doing some really exciting research on diet, actually with Viome and thinking about the relationship between the gut microbiome and the vaginal microbiome, which is desperately under-researched.

I think that a lot of our patients tell us that their lived experience says that eating sugars or eating glutens promotes certain types of infections for them. But again, there’s not a lot of research to back that up. Definitely we see people say a wet swimsuit. An interesting one is that menstrual blood actually has a higher pH than the healthy low pH of your vagina. So what some people will see is that during or after their period, they’ll experience some discomfort because their vaginal pH is being raised and that might promote some of those pathogenic microbes. And so if you have a really long period for one month, that is something that, you know, it’s normal to then maybe experience some set of symptoms and also that throughout the menstrual cycle, as your estrogen levels fluctuate, estrogen actually plays a huge role in the vaginal microbiome.

So for patients who are pregnant, for example, you might’ve heard that you’re more likely to get yeast infections, because estrogen plays a role with candida, which is very interesting. But the good news is that estrogen produces glycogen, which then feeds the healthy lactobacilli. And so what you see is often during pregnancy, women are less likely to have bacterial vaginosis, but some women postpartum, when their estrogen levels drop, start to experience infections again. So just remembering that your diet, your hormones, your body’s one organism, right? Well, it’s a host of many organisms, but they’re all working together. Instead of not treating them like they’re separate, if you take an antibiotic for an eye infection, it’s going to affect your vaginal microbiome. So think about that, right? And I think the more we can remember that all of these things are connected, the more likely we are to make decisions that won’t disrupt it.

Katie: And then I guess the flip side is, what are the things we can do, if any, that you know of from the data right now or that you hope to uncover in the future related to positive things we can do to support? Because like in the mouth, I know we’ve identified some oral probiotics that actually help, prebiotics, all kinds of things that we’re testing and understanding more now. Is that the same in the vaginal microbiome as well? And if so, what are some of the ways that we can support that good balance?

Priyanka: 100%, such a good question. Well, I would say the first thing is to know. Know what’s going on for you. And of course, I’m biased, I’m obsessed with data, but I think that the most important thing you can do is understand your own body. Understand when you feel great, what does your vaginal microbiome look like? Or maybe you actually are experiencing dysbiosis, but you’ve normalized a lot of those symptoms for yourself, right? So how can you actually start to get the data? Because that’s the starting point is, okay, what is my balance?

And with Evvy, one of the things we do is we share a score for the protective bacteria and a score for the disruptive bacteria. And our goal is to increase the protective and decrease the disruptive, and we’ll actually help you put together a step-by-step plan of how to do that, thinking about the roles that biofilms could play. I know those also play a role in the oral microbiome, right?

Katie: Yeah, absolutely. Like definitely we see biofilms, like we said, the pathogenic bacteria can get out of balance. And often for a lot of people, it all starts from just over sterilizing the mouth because it’s meant to be bacteria rich. And so I would assume for a lot of women, maybe this is what’s going on vaginally too, is like we’ve done things that like, whether it’s douching, whether it’s antibiotics, whatever, and we’ve like inoculated the whole microbiome and then now what’s coming back could be pathogenic because we’ve just disrupted everything.

Priyanka: Completely, completely. And I think that, you know, especially with vaginal health, and I think similarly with oral, right? There’s this shame of bad breath or a shame of vaginal odor. And so when something feels off down there, people do things that actually make it worse, right? Like extreme mouth washes or like douching.

And so all that to say that, you know, there’s the role of biofilms in the vaginal microbiome that you might want to be aware, like do you have bacteria in your vagina that do produce biofilms? Because if so, that could actually be an important thing to consider in treatment. But something I’m really excited about that we only just launched in January actually is the ability to actually get these custom compounds from Evvy.

So what we can do now is connect patients to a doctor who will look at your results and prescribe customized vaginal suppositories that are actually prescription. They’re actually prescription-grade medications, but they include the probiotics, prebiotics, and supplements to feed those probiotics to regrow the good bacteria. And you can do it vaginally, which is so important because so many, you know, quote unquote, vaginal probiotics are taken orally, which is so crazy to me. I’m like, how do we expect that to get to your vagina? And so a lot of the work we did was making sure that those ingredients could be available vaginally, but medical grade, pure ingredients. So we’re very excited about that.

Katie: Yeah, so I’d love to learn a little bit more about that because I know I’ve seen, again, not-talked-about topics very much, but I’ve seen some anecdotal data of people taking like boric acid suppositories, for instance, or using vaginal probiotics. Are those areas that you guys are looking at specifically? And if so, do you think those have a potential to be promising in improving vaginal microbiome?

Priyanka: That’s a good question. So boric acid is such an interesting one. I mean, as you’ve probably seen, it is like probably the internet’s best-selling product, I think, like it is truly everywhere. And I think what’s so crazy is the fact that it is so widely used and so under-researched. Like the understanding of what boric acid actually does to the vaginal microbiome is extremely far behind. I think the studies that we’re the most excited about are the ones that use boric acid specifically as a way to break down biofilms in patients who have biofilms.

I think unfortunately it’s often used more for kind of symptom management, but in those cases it’s actually just like a band-aid, right? You’re essentially adding acid because your vaginal microbiome isn’t producing it, but the real solution is to get to a place where you have bacteria that’s producing the acid. And I think that, you know, at the end of the day, it is a strong acid that we probably don’t want people to be using forever. And so we like to think about it more as a treatment versus kind of like a day-to-day maintenance, if you will.

And then on the vaginal probiotic side, there’s so much exciting research going on in that space. There’s live biotherapeutics being worked on, which we can’t wait for, so we can make those available to our patients. There’s some really exciting research going on around vaginal microbiome transplants, and all of the studies so far actually show that they’re extremely successful. Not that I think that’s going to be the treatment for people forever, but I think it does show that if you can really understand the community of the ideal microbiome, you can actually implant that and replace a disrupted microbiome, which is so exciting for the role of probiotics. And so we’re strong believers in vaginal probiotics. I think they absolutely, when you think about the role of the protective bacteria, it makes so much sense that re-adding it back to the microbiome can help improve outcomes. And so that’s a huge part of Evvy’s care protocols as well.

Katie: That’s fascinating. So I wasn’t aware they were actually researching microbiome transplants vaginally as well. I know that they have done a lot of research on this with fecal matter transplants and it’s still like an emerging and somewhat like we’re not quite sure exactly how it works. And we’ve got to be careful with an area of research with fecal microbiome transfers. But that makes sense that it would be potentially something worth looking at here as well.

But it seems like there’s also going to be that extremely personalized aspect to this as well, which is where companies like you come in that can actually look at things on a personalized level, not just like a one size fits all, like let’s throw these products in and see what happens.

Priyanka: Completely, exactly. And I think that with microbiomes, what’s difficult is that it’s just hard to imagine that there is a silver bullet, that there’s one community of bacteria that’s going to work for every single person regardless of their background, their current community, etc. And so I think our hope is that through data, we can help every person get access to the treatments that are most likely to improve their microbiome, right? Most likely to optimize their chances of successful fertility, successful IVF cycle, healthy pregnancy, getting rid of symptoms, you know, like all of the things that we all deserve, I think we’ll start with much more personalized data.

Katie: It makes sense.

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And I would love to go deeper on related to especially pregnancy and birth because I’m a doula and I’ve actually facilitated several times what they call seeding when a baby is born via C-section necessarily. And we know that during the birthing process, the baby gets their initial gut seeding through interaction with vaginal bacteria. Of course, in a C-section, that process isn’t happening. And so I’ve been the one in the OR to help seed the baby immediately, which there’s some fascinating studies on. But I think it really highlights just how important a mother’s vaginal microbiome is to her child’s lifelong gut health. And so I’m curious what you guys are, do you have any specific testing around pregnant women or any specific advice for pregnant women or women who want to get pregnant on really optimizing that ahead of time to give their baby the best shot?

Priyanka: 100%. I think, you know, this is something that I think we will look back on. You and I will talk about this again in three years and it will be unheard of to try to get pregnant without taking into account your vaginal microbiome.

When you look at the studies about the role of the vaginal microbiome before, during, and well, before and during pregnancy, during birth and then after birth, I mean, it is just, it is unbelievable. And what I mean by that is, to kind of go down that journey from thinking about conceiving, there’s so much research showing that both from a natural pregnancy standpoint, people with a healthy vaginal microbiome tend to get pregnant much faster. They tend to be less likely to have a miscarriage. When they go through IVF, they’re four times more likely to have a successful IVF cycle. If they have a healthy vaginal microbiome during pregnancy, they’re much less likely to have a preterm birth. And then to your point, during the actual birth, if they have a healthy vaginal microbiome, they’re passing on those healthy microbes to their kid, right?

And so it’s just such a big part of the reproductive journey. And I just can’t believe how overlooked it’s been, given how much research there is saying that it plays this interesting role. And we really hope to kind of translate that research to clinicians. How do we actually give them access to the right information for the right patient, give them actionable ideas about what to do next so that they can start to do this at scale? And to be fair, I think that, you know, we’ve only started to understand this over the past 10, 20 years, right? And we’re only just at the time where we can sequence at scale at a cost that’s affordable, that we finally understand, you know, which types of strains are most successful. And I think we are just at the precipice of a big turning point in our understanding of vaginal health and pregnancy. But if I, when I always tell all of my friends who are pregnant, when I am pregnant, like I will absolutely be putting my vaginal microbiome first. And I think, you know, in a few years that will become the norm.

Katie: Yeah, I feel like the only area that’s actually talked about or researched is in relation to group B strep or GBS, which women are tested for at the end of pregnancy. And I feel like even here, there’s not a lot of great consumer information available. Like doctors are aware of this, they test for it, but women often don’t fully understand the implications of it and can get really scared if they test positive. That’s often like an instance where antibiotics are used automatically without question. And it just makes me wonder, like, is there a better approach? Like if we address this earlier in pregnancy, could we potentially reduce the chance of showing up later in pregnancy at all?

Priyanka: Totally. I mean, to exactly what you said about the way the oral microbiome works, it’s very similar, right? If you have a healthy, protected vaginal microbiome, the chances that a microbe like GBS will be able to grow and cause problems is just lower, right? So how do we, you know, optimizing the vaginal microbiome from, you know, the same way that we start to take prenatals or eat healthier, you know, change our habits as we start to think about getting pregnant, I think that, you know, proactively taking care of your vaginal microbiome will become an obvious thing to do at that step in the journey.

Katie: Exactly. Because just like in the mouth, strep mutants exist in everybody’s mouth in low levels. It’s not a problem in and of itself. It’s a problem when it gets out of balance. Same thing with group B strep exists in every vagina in some level. It’s not bad that it’s there. It’s bad when it gets overgrown. And I feel like I’m so excited by this research of if women can have better options of understanding that and being proactive earlier on versus we now know talking about the birth process and that transfer of microbiome, of course, taking antibiotics at that moment might have a big impact on the baby’s gut health as well.

Priyanka: Yeah, totally. And I think that there’s so much more to be learned. And I think that there’s, again, just to be back on my research rant, I think the fact that these problems and symptoms are so prevalent in women that they play such an important role in our health outcomes. And yet here we are saying, oh, there’s only a little bit of initial research. It is crazy, but it’s also time. I think companies like Evvy are banging down the doors and saying we demand better research, we demand better information and where we can’t get it, we’re going to do it ourselves.

And it’s been so cool to see the amazing community of hundreds of thousands of women that are like all on board, right, who are like, I want to learn about my vaginal health. And we always joke that, you know, Evvy growing up in the age of TikTok is actually kind of perfect because people are like looking for that type of content. They’re not looking for something pretty and perfect. They’re learning. They’re looking for something that’s maybe a little surprising and different. And I think because of that, we’ve really been able to scale that education. And I think it’s only a matter of time before, no one will be scared of saying vaginal microbiome, vaginal odor, vaginal discomfort, or just the word vagina at all.

Katie: I love that. And I say often on here, probably even the listeners are tired of hearing it, but I love saying it, that at the end of the day, we are each our own primary healthcare provider. And I think we live in a fascinating time where we actually have more access than we’ve ever had by an exponential amount to data about our own bodies and the ability to make decisions based on that data. I think we’re still in that interpretation era and learning how to actually integrate all this data that we have available now. But I think areas like this make it awesome because even if doctors aren’t testing for this, now women can have that information themselves and take charge of their own health. I also am curious from the data you’re seeing. I think you’re right, this is a taboo subject. Women have shame if they feel like there’s anything wrong.

But with the research you’re seeing and with the data you’re seeing, it seems like, and correct me if I’m wrong, but most things that you identify actually can be fixed. There is a solution to these things. And when you have the information, that allows you to then find a solution.

Priyanka: Completely. I think there’s, I wouldn’t say that there were good solutions in the current standard of care. I think so many of our patients are people who have felt weird down there. They do go to the doctor. They either get misdiagnosed, but even if they get correctly diagnosed, they have an over 50% chance of the infection coming back within three to six months. So a lot of people are stuck in this cycle. And I think we now have better information about the importance of rebuilding the good bacteria.

And companies like Evvy are making that available at scale to anyone, which is I think a huge step in the right direction of helping people realize it’s okay to get tested because we can help you feel better, right? We can help you get better. But I think a lot of people before Evvy didn’t feel like there was a path to getting better. And so there was a lot of kind of mistrust and lack of hope and distrust in the system. But I love what you said about, I’m sure your listeners still love hearing you say that because it’s a hundred percent true about being your own doctor or being your own primary care provider, caring about your body first.

And I think one of the things we feel really strongly about is thinking about how do we equip every single one of our patients to engage in shared decision-making with their doctors. And I think a lot of the reasons that we don’t feel like we can do that is because we don’t have the data. We can’t bring the right study to the doctor about our bodies. And I think our hope is that we can give you super specific data on your own body. We can give you the research that you can take to your doctor to have the most productive conversation. And we not only give that to you digitally through our product, but every single patient of Evvy also gets assigned a board-certified health coach who helps them actually understand their results, talk through them, prepare for, okay, I have a doctor’s appointment coming up. What are the three questions I should ask? What should I print out? Or I want to talk to my partner about wearing condoms more often. Like, can you help me prepare for that conversation?

And I think those coaches, and I’m sure what you see being a doula, like having somebody who actually helps you sit down and work through something, I think has really changed people’s perception of themselves to feel like they can participate and they can be a decision maker about their health care. And I think it’s so unfortunate that we’ve made women feel like they can’t be, and we definitely want to change that.

Katie: Yeah, I love what you just said. And to build on that, I think the follow-up to what I usually say is that the best outcomes happen when you have an informed patient and a practitioner doctor who listens to that patient and who they’re partners in that. Because while the doctor might have more medical training and more knowledge in certain areas, no one has more data about your body and how you feel than you. So you are a very much key point of that decision-making process. And I think the best outcomes, like you said, happen when there’s a really strong synergy between the practitioner and the patient working toward a solution. And I feel like this is another of the great steps of helping that process happen more organically and more easily and with better outcomes.

And I also remind people, you know, if a practitioner isn’t working for you, you’re hiring them. Even though they are very much the authority figure in that relationship, you’re choosing to hire them and you can find one that’s a better fit if you have a practitioner who’s not an awesome fit for you. And I’ve even done that at 37 weeks pregnant when my doctor told me, for instance, like, you’re not allowed to do this during your birth. I was like, well, then you’re fired. And then I was like, oh, I got to find a new doctor pretty quick. But just remember that your practitioner is a partner with you. And if they’re not being a good partner, find one who is because that’s when the really good outcomes happen.

Priyanka: I love that so much. And I really feel for so many women who don’t feel like they have a partner and a support system in their provider. But I also feel for providers that just don’t have access to the right tools to help women. And I think like we both need to equip our providers with better education in medical school about the things that uniquely happen to female bodies. There’s just not enough focus on that. And then we also need to remind ourselves that we deserve a doctor who listens to us. And there is one, there always is one. And it’s just a matter of putting the time and effort into finding one. And especially in moments like pregnancy, it’s so worth it. There’s so many decisions to be made. It’s so personal. And you don’t want to feel like you’re just taking someone else’s word over listening to what you also want.

Katie: Such a good point. And also, as I’m sure you’ve seen, statistically, even when research gets caught up in a certain area, it can take a long time for that to trickle down through medical school and get to the actual practicing doctors. And so I love that you guys are taking a consumer-focused approach and getting that directly in the hands of the people who it matters to, whose bodies are being affected, and then also giving them the tools to have that really productive conversation with their providers to get really good results. I think that’s the best way to build the system and how we are going to see change the fastest.

Priyanka: I love that so much. And I think what’s been so interesting is I think we’ve had over a hundred providers reach out to us saying, okay, a patient brought me these results. I feel like I need to understand this better. Can you help me? Can you help me learn about the vaginal microbiome? What can I do to become trained on this? I have so many patients suffering. I don’t have the information. And I think that gives me so much hope, right? So many providers who want to do better, who want to learn what’s new out there. So it is out there. I think and patients being the ones to bring it to the doctors, you know, once the doctor emailed me and was like, okay, I’ve now seen this three times in the past month. Like I have to know what’s going on.

And I think to your point, you can vote with your dollars. And I think they they’re starting to realize that too, where it’s like, if they’re not going to pay attention, you will find someone else. So they’re starting to pay attention. And I think at the end of the day, frankly, the system is not set up for anyone to be incentivized for it to change except for you. You are the person who wants the best outcomes for yourself. You are the person who’s incentivized to do whatever it takes to get the right answer. And so a lot of times, unfortunately, it falls on us to really change the system. And I think starting with women gives us the best chance of changing the system long-term.

Katie: Agreed. There’s so much freedom in that. At the end of the day, our health is ultimately our responsibility, which is awesome news because that means we have the ability to figure out what needs to happen and to affect change and to work with great practitioners to make that happen. And so, like I said, I love that you guys are really pioneering in this space for women especially. Can you briefly walk us through what the process looks like of getting tested, getting results back, what kind of information they get, and what to do with it?

Priyanka: Yeah, absolutely. So it starts with just evvy.com. You can order a test. Actually, most of our patients choose to take it over time, as you can imagine your vaginal microbiome shifts, with medications, with new partners, with pregnancy, etc. And what we find is that if you keep proactive tabs on it, today, we wait until literally the vaginal microbiome smells until we take action clinically. And our hope is that we can catch slight imbalances before they become these full-blown infections. So that’s why we offer that kind of ongoing option. When you order the test, it comes to your house. You don’t have to leave your house. Like I said, it’s a little Q-tip swab of the vagina. I can’t wait for you to take yours so we can talk through the results together. I always joke, it’s easier than putting in a tampon. You swirl it around, you send it back to our lab. Our lab is CLIA-CAP validated. It’s the actually the only, first and only CLIA-CAP validated metagenomics test for vaginal health, which is just a fancy way of saying, like I said earlier, we can see with extremely high fidelity, all bacteria and fungi that are in your vagina.

And then we package up all of that information. We take into account, are you pregnant? Are you in menopause? What are your symptoms? Do you have PCOS? What period products do you use? What birth control are you on? And we put that all together into an amazing educational experience. Things that we probably all should have learned in sex ed, but we did not about what, how do you think about your vaginal health? What does yours specifically look like right now? What are the relevant studies on that as it relates to your health goals? And a lot of kind of personalized education. And then we also give every single patient a step-by-step list of next steps of what to either talk to their existing—if they have an amazing practitioner, we’re very happy for them. We give them the list of steps and studies that they can review.

And if they don’t, then they can work with Evvy directly. And now, like I said, we can connect them to practitioners who can interpret their results and create these amazing customized treatment programs where they’ll actually get custom compounded vaginal prescriptions sent to their door. They’ll get matched with a health coach who will explain everything along the way. And our hope is that people feel supported both by Evvy, the coaches, the peer community, and then they finally feel educated to really make better decisions about their vaginal health.

Katie: And for all of you listening, I will put a link in the show notes at wellnessmama.fm as well to the test itself and to, I know you have a tremendous amount of educational information available online, so you guys can find all of that. And I am fascinated to follow up on mine as well, and I’ll keep you guys posted on how that goes. And a couple of questions I love to ask at the interviews that are only semi-related, the first being if there is a book or number of books that have profoundly influenced you personally, and if so, what they are and why.

Priyanka: Yes, such a good question. One of my favorite books in line with starting Evvy is an amazing book called Invisible Women by Caroline Criado-Perez. And she writes about how kind of in a world that was designed based on data on men, how does that actually affect you as a woman? And she specifically has an amazing chapter on health care where she talks a lot more in depth about some of the things that you and I talked about at the beginning of this call. So if you’re interested, I think it’s just an amazing, amazing book. And then there’s so many other more kind of just fiction, incredible stories, but I do love reading.

Katie: I love it. That’s a new recommendation for book on this podcast as well. I’ll put that link in the show notes for you guys listening too. And lastly, any parting advice for the listeners that could be related to all the topics we’ve talked about or entirely unrelated advice that you find helpful.

Priyanka: Oh, such a big question. I think something that at least helps me and hopefully can help every woman who’s thinking about whether it’s your own professional journey or your own health care journey, it’s just like, it’s okay to not be the expert, you still have a role to play. And I think when I was starting, Evvy, I got so many questions, you know, you’re not the PhD, you’re not the doctor, like what, what role could you possibly have in fixing the system? And I was like, well, I’m the patient, I’m the person who’s suffered, and I want something better. And I’m going to find the best PhD experts, and I’m going to find the best doctors, and I’m going to make us focus on this problem that really matters. And I think that was hard, it was really hard to be someone who didn’t have the right degree or didn’t have the right background for people to trust me. And I think that can translate or manifest in so many different ways in our lives.

And I think I feel so grateful every day that I didn’t let those people stop me because I think there’s, there’s so much power that comes from people who aren’t the current expert deciding to care about a problem, right? And whether that’s, like you said, being the expert on your own health, like you are the authority on your body, you do know it the best. Or it comes, it’s about, you know, something professional where you don’t feel like you’re the right or most perfect person to do it. I think that’s where a lot of magic happens. And just trusting yourself to do so and not listening to people who think you can’t.

Katie: I absolutely love that advice. And I don’t know, it’s often quoted, who knows if it’s actually accurate or not. But I think back to the story that’s attributed to Henry Ford when he was trying to figure out shatterproof glass. And they kept telling him, all the experts kept telling him, it can’t be done, it’s not possible. And he finally fired all those people and said, bring me the young people who don’t yet know it’s not possible. And then those people figured it out. Because precisely because they weren’t the experts that thought they already knew all the answers. And I think often that this is a common theme for me is like that curiosity, that childlike mentality, that willingness to learn new things and have an open mind is often just a huge asset in life and business and anything. And so I love that you brought that up as your advice. I think that’s absolutely perfect advice.

Priyanka: I love that. Yes. I feel like there’s all day I feel like I’m saying to my team, I’m really sorry if like this is a really obvious question, but I’m just going to ask it anyway. And I’d say 90% of the time, they’re like, yeah, that’s a very obvious question. And here’s the answer. But 10% of the time, they’re like, oh, that’s actually an interesting way of thinking about it, or that parallel to that industry we hadn’t thought of before. And so I think just being aware that you have something to bring to the table, even if it’s just your passion and your experience, like that is valuable too.

Katie: I love it. Well, perfect place to put a pin in it for today. Like I said, I will follow up with my own results and what I learned and we can keep building the conversation from there. But thank you so much for being here. This was a fascinating topic when I feel like it’s not talked about well enough. And I love that you are bringing this conversation into the mainstream. So thank you.

Priyanka: Thank you so much and for everything that you do for all of us. We are all so grateful to have you.

Katie: And on that note, thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did, and I hope that you will join me again on the next episode of the Wellness Mama podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.