You Were Told It's Normal. So Why Don't You Feel Normal?

By Gabrielle Gleeson-Solomon, CEO of Tota
Scientific Review by Dr Nick Parkinson, PhD
On recurring UTIs, BV and other vaginal or urinary symptoms that keep coming back — even when every test says you're fine.

“Normal.” It's one of the smallest words in medicine and one of the heaviest to hear when you don't feel it. You've had the appointment, the swab, the dipstick - maybe all three, more than once. And each time the answer comes back the same: everything looks normal. Nothing significant. No concerns.

And yet here you are still uncomfortable, still cautious about what you eat or wear or do, still googling the same symptoms late at night, still asking ChatGPT or Claude for answers, still wondering if you're somehow imagining all of it.

You are not imagining it.

I want to say this plainly, before anything else, because it's the thing I want you to remember from this. A “normal” result is real information. But it is not the same thing as an explanation. And for a lot of women living with recurring vaginal or urinary symptoms, that gap — between being told nothing was found and still feeling something is wrong — is where the real frustration lives. And that frustration runs deep.

I run a company that exists because of that gap. So I want to use this piece to do something I think we don't do enough of in women's health: explain, honestly and without hype, why “normal” doesn't always settle the question. And to be honest about what a fuller picture can, and can't, add.

What “normal” actually means on a standard test

When a doctor tests a urine sample - usually with a dipstick or sends it to a lab for a standard culture, they are doing something genuinely useful. They're checking for a specific, known list of organisms most commonly responsible for the symptoms you're describing. If one of those organisms is found in a way that indicates infection, the test flags it. If it isn't, the result comes back clear. Normal.

That's not a flaw in the test. It's how it was designed to work. Standard tests are built to answer a specific question, quickly and reliably: is this a common infection at the level considered an infection, yes or no? For a huge number of people that's exactly the right question and the answer is genuinely reassuring.

The difficulty is that “was the organism on our list present” and “is anything present that could explain how you feel” are two different questions. A standard test can only answer the first one. When people hear “normal,” they reasonably assume it's answered the second. It hasn't. It was never designed to.

The list problem

Most microbiology testing — the kind used in GP surgeries and hospital labs every day — works by looking for what's expected. A urine culture is grown and checked against a shortlist of organisms known to cause UTIs.^[2] A vaginal swab is typically tested for a handful of specific, well-understood causes of infection.^[3] This is sensible, fast and appropriate for most situations. And it works for lots of people, especially if it's the first time you've had these issues.

But it means that anything outside that shortlist, a different organism or an imbalance of multiple organisms rather than a single organism causing an infection won't show up as a finding. Not because it isn't there. Because it wasn't on the list.

A negative result usually means ‘nothing on our list was found,’ not ‘nothing is there.’

It's a subtle difference in wording that makes an enormous difference to how someone feels about their own body afterwards.

The vaginal and urinary microbiomes, in plain English

Here's a piece of biology I wish was talked about more openly: your vagina and urinary tract aren't sterile. They're home to communities of bacteria and other microorganisms living together. This is called a microbiome, in the same way your gut has one.

In a typical, healthy state, specific bacteria tend to dominate and keep things in balance. Symptoms like discomfort, odour, discharge or recurring infection are often connected to a shift in that balance, rather than a single, isolated organism arriving from nowhere.

Think of it like a neighbourhood. When lots of friendly neighbours live there, everything stays calm and under control. But if some of them move out, the troublemakers who were already around have more space to take over. It's not always that something new has arrived, the balance of the neighbourhood has simply changed. That's when symptoms can start. When that balance shifts in your microbiome, that's often when discomfort, odour, discharge or recurring infection show up. It's rarely about one 'bad' organism arriving from nowhere. More often, it's changes in the balance of what's already there.

Because the vagina and urinary tract sit so close to one another, changes in one may be connected to changes in the other. This can be why some women notice vaginal and urinary symptoms appearing around the same time or one seeming to follow the other. This is an area where the science is still developing and it's important we don't overstate what's currently understood. In short, the vaginal and urinary microbiomes are closely related.^[1]

Standard tests weren't built with this whole-ecosystem view in mind. They were built to catch known infections quickly. That's a different job to understanding the balance of what's actually living there, which is where broader microbiome testing comes in.

What broader microbiome testing may add

At Tota, we use non-targeted DNA sequencing. Instead of checking a sample against a predefined shortlist, this approach reads the genetic material of organisms present and identifies the organisms actually there — the full range of bacteria and fungi, not just the ones we thought to look for in advance. We then translate that into a simple report, because knowing an organism's Latin name isn't much use to anyone if they can't understand what it might mean for them.

This kind of testing may help provide a more complete picture of what's present in your vaginal or urinary microbiome, which can be useful information alongside standard testing, particularly if you've had repeated “normal” results but symptoms have continued. For some people, it can highlight organisms or patterns that a standard, targeted test simply wasn't designed to catch.

What it can't tell you

I think it matters just as much to be honest about the limits. A broader microbiome test is not a diagnosis. It doesn't tell you what's “wrong” with you and it can't replace a healthcare professional's clinical judgement. It won't identify the definitive cause of your symptoms and it isn't a substitute for urgent medical care if you need it. What it can do is give you more complete information about what's present. It gives you information you can take to a conversation with your GP or specialist, alongside everything else you already know about your own body.

Microbiome science is genuinely exciting, but it's still a young field. We try hard not to promise more certainty than the science currently supports. Ambitious about what's possible; honest about what isn't proven yet. That's the balance we're aiming for.

Why symptoms still deserve attention, even after a “normal” result

None of this is a criticism of clinicians or of standard testing. Clinicians are working with the tools available to them, often under real pressure, doing a genuinely difficult job well. The problem isn't that anyone failed to look. It's that the tools most widely available were built to answer a narrower question than the one many women are actually asking.

That's not a reason to stop investigating. If anything, it's exactly why women's health needs continued research, better tools and more options. So that “normal” can eventually mean “we looked at everything,” not just “we looked at what we expected to find.”

Women's vaginal and urinary health has, for a long time, been under-resourced relative to how many people it affects. Investment in research, in diagnostic technology and in simply explaining the science properly has lagged behind other areas of medicine. That's slowly changing and I think it's one of the most exciting things happening in health right now. It's not about one single breakthrough, but a gradual shift towards asking more complete questions and building the tools to answer them. Standard testing will keep playing an important, everyday role in that picture. It just shouldn't have to do all the work on its own.

A wider view: better tools and research

I think this is a moment worth naming honestly. We don't have every answer yet and I'd be wary of anyone in this space who claims otherwise. What we do have is better technology than we used to, a growing willingness to look at the whole picture rather than a fixed list and a slowly shifting understanding of just how much the vaginal and urinary microbiomes influence day-to-day comfort, confidence and health. Getting from here to a place where “normal” reliably means “fully understood” will take continued research, more rigorous tools, and companies like ours being honest about both what we've built and what's still unknown.

Why Tota exists

Nick and I started Tota because we believe women deserve better answers than “everything looks normal” and a shrug. We built a test that looks at the fuller picture of the vaginal and urinary microbiome and we spend just as much effort explaining what that picture means as we do generating it, because information nobody can understand isn't much use to anyone.

We're not trying to replace your healthcare provider and we're not claiming to have the answer to every symptom. What we're trying to do is give people access to more complete information about their own bodies — information that, combined with good clinical care, can support a better, more informed conversation about your health and what happens next.

Is this for you?

You might consider a broader microbiome test if you've had recurring vaginal or urinary symptoms alongside repeated “normal” or inconclusive standard results, if you're preparing for a fertility journey and want a fuller understanding of your vaginal microbiome for reproductive health, or if you're someone who'd rather understand your body proactively than wait for something to go wrong.

And please do see a healthcare professional if your symptoms are new, severe, persistent, or getting worse.

The full picture, finally in your hands

Being told your results are normal should never be the moment you stop trusting what your body is telling you.

It should be an invitation to ask a better question. And, where possible, to look a little more completely for the answer. That's what we're here for.

Explore About Our Tests →

Sources

1. Komesu YM, Dinwiddie DL, Richter HE, et al. Defining the relationship between vaginal and urinary microbiomes. Am J Obstet Gynecol. 2020;222(2):154.e1-154.e10. PubMed: 31421123
2. Haley E, Luke N, Mathur M, et al. Comparison shows that multiplex polymerase chain reaction identifies infection-associated urinary biomarker-positive urinary tract infections that are missed by standard urine culture. Eur Urol Open Sci. 2023;58:73-81. PubMed: 38152485
3. Broache M, Cammarata CL, Stonebraker E, et al. Performance of a vaginal panel assay compared with the clinical diagnosis of vaginitis. Obstet Gynecol. 2021;138(6):853-859. PubMed: 34736269

This article is for general information and does not replace medical advice. If you're experiencing new, severe, persistent or worsening symptoms, please speak to a GP or another qualified healthcare professional.