Say "microbiome" and it conjures thoughts of bacteria and other microorganisms in the gut. But the thriving microbiomes in other body areas are opening new avenues for research and entrepreneurship. The startup Evvy is advancing the science of the vaginal microbiome to yield more precise diagnostics that could improve women’s health and shaping a market that has significant potential.
Alterations in vaginal flora may affect women’s risks of preterm birth, cervical cancer, bacterial vaginosis, yeast infections and urinary tract infections (UTIs), among other conditions. Leveraging genomic sequencing of the vaginal microbiome gleans important data and insights into a woman's urinary and reproductive health, which may lead to better treatment outcomes, explained Pita Navarro, co-founder and Chief Science Officer of Evvy, shared at a Cure Tuesday Talk in April 2024.
New York City-based Evvy now is one of the fastest-growing healthcare companies in the United States. Evvy markets an at-home vaginal microbiome test that use metagenomics to screen for more than 700 bacteria and fungi. Paired with Evvy’s personalized one-to-one coaching, consumers can share their test results with doctors to choose more effective treatments for genitourinary disorders. Cure spoke with Navarro about the potential of this approach.
This conversation has been edited for length and clarity.
Cure: Why is the vaginal microbiome important?
Navarro: Vaginal discomfort is a leading reason women seek healthcare advice, and 90 percent of those cases can be attributed to the vaginal microbiome. Research has also started to point to a crucial role that the vaginal microbiome plays in female health beyond the vagina.
If you think about the vagina as a structural connection between the outside and your most important reproductive organs, the vaginal microbiome plays a really interesting role. Infectious microorganisms going through the vagina can increase inflammation, alter the immune system and affect the entire reproductive system. We're starting to see links between the vaginal microbiome and things like cervical cancer progression, preterm birth and even IVF outcomes. It's such a critical component of female healthcare that we've been overlooking.
Unlike the gut microbiome, we have a much better idea of what healthy looks like and what unhealthy looks like in the vaginal microbiome. That's why it's a lot more clinically translational.
Cure: How does Evvy's test work?
Navarro: Our comprehensive test uses whole genome sequencing. It's very simple. A woman can go to our website and purchase the test, and we ship it directly to her home. She swabs her vagina and returns the swab in a tube back to our lab for metagenomic sequencing. She also fills out a health profile and receives curated education about the microbiome. If we can treat her through our prescriptions, we then offer her the opportunity to send her test results to one of our doctors, who can ship a prescription straight to her door.
We ran a small pilot study with a medical center here in New York and showed that by starting with a much more comprehensive test like ours and looking at the whole picture, we were able to put people on treatments that changed the vaginal microbiome — not just by using antibiotics, but different types of supplements and in some cases estrogen for women in menopause. We were able to see symptom resolution and a reduction in recurrence. It was exciting to prove that with more data, we can help more patients get effective treatment.
Cure: What is the link between vaginal health and mental health?
Navarro: Vaginal health is truly mental health. It affects all aspects of our lives. Our health coaches can help a woman decipher her triggers. Is it her menstrual cycle? How is that related to the vaginal microbiome? Are there behavioral aspects she can change based on her triggers? We create a lot of awareness and provide mental support for women who have been suffering from these conditions for so long.
Cure: How is it to be a female founder of a healthcare company?
Navarro: My biggest frustration as a female founder is knowing that deep in my heart, I'm solving a very pervasive problem that affects so many women. Yet the healthcare system is so deeply flawed and seemingly unchangeable that no one has taken the time or put in the effort to solve this problem. There hasn't been enough awareness. As a female founder, you have to create awareness. You have to market the problem at the same time you're solving it and do a lot of education of investors.
Cure: What advice do you have for other female founders?
Navarro: Number one, focus on the translation side of things in addition to science. That's where the magic happens — when you really study the market that you're going into and the game that is being played. Second, you don't need to do anything alone. Build your bench early on with the right mentors and lean on those mentors. And third, stay persistent and stay patient. It may take twice as long and twice as much money as you think to build a biotech company.
Hopefully, if we are able to accomplish what we set out to accomplish, women of all ages and races with any type of risk or condition can know exactly how to prevent diseases and how to treat them. They can then go on to live healthy lives and be successful at work and be great mothers.