Understanding Bacterial Vaginosis: What You Need to Know
Bacterial Vaginosis (BV) is a common yet often misunderstood condition that affects many women and gender-diverse people worldwide. It’s an overgrowth of bacteria in the vagina, which disrupts the natural balance of good and bad bacteria. Unlike yeast infections, BV isn’t typically itchy or painful, but it can lead to a significant change in vaginal discharge and odor. Some people find themselves caught in a vicious cycle and treatment for months, even years. Let’s discuss ways to prevent infection and the need for recurrent treatment.
What Causes BV?
BV results from an imbalance in healthy vaginal bacteria. When vaginal flora is healthy, “good” bacteria (called lactobacilli) flourish, creating an acidic vaginal environment. The acidic PH helps to kill pathogenic bacteria and keeps everything balanced. When harmful bacteria and yeast overgrow, they outnumber the good bacteria, leading to BV and yeast infections. Factors contributing to this imbalance include douching, having multiple sexual partners, having sex without condoms, taking oral antibiotics, wearing underwear made of synthetic materials (trapping moisture), and using scented hygiene products.
Symptoms of BV
- Unusual vaginal discharge (thin, grayish-white)
- Fishy odor, especially after sex or menstruation
- Mild irritation, itching, or discomfort
It’s important to note that some people with BV may not exhibit any symptoms at all.
Diagnosis and Treatment
Diagnosing BV involves a visit to your midwife or OB provider, who will take a sample of the vaginal discharge for testing. This swab should test for yeast, BV, and other sexually transmitted infections. BV is treated with prescription antibiotics such as Metronidazole or Clindamycin, which is taken orally or inserted vaginally in a gel form.
Prevention Tips
- NO DOUCHING: It disrupts the natural balance of vaginal bacteria.
- No soap in the vagina! The vagina is a “self-cleaning oven” and does not need soap. Only use a clean washcloth with warm water in the shower.
- Practice safe sex: Use condoms to lower the risk of all infections.
- Maintain good vaginal hygiene without using scented products (scented pads, baby wipes, and baby powder can throw off healthy vaginal flora)
- Take a high-quality oral probiotic such as this one to maintain healthy gut flora.
- Decrease sugar and refined carbohydrate intake (diets high in sugar feed harmful bacteria in the body, including bacteria in the vagina).
- Cotton underwear only – and sleep commando if you can!
When to Seek Medical Advice:
If you notice any unusual symptoms or suspect you have BV, please get in touch with your midwife or OB provider. Untreated BV can increase the risk of sexually transmitted infections (STIs) and complications during pregnancy (preterm labor)
Other things you can do at home to prevent BV:
- Boric acid suppositories are proven to treat and prevent BV by supporting an acidic vaginal environment (Müller et al.). PLEASE DO NOT EAT BORIC ACID PILLS (they are toxic when taken orally). The pills are used as vaginal suppositories. If you have a history of chronic, recurrent BV, I suggest placing one pill deep in the vagina every night before bed for 3 weeks. You may notice increased discharge in the morning, but this is just the pill casing dissolving and coming out. I recommend this brand
- Increase cultured foods in your diet, such as sugar-free Greek yogurt, kombucha, kimchi, and sauerkraut. I also recommend a daily high-quality probiotic to help balance and replenish good gut flora.
- Take baths with apple cider vinegar and baking soda to support an acidic vaginal environment: 2 cups of ACV and ½ cup of baking soda in a clean bathtub. Soak for 10-30 minutes several nights a week.
- Sleep without underwear to “let things breathe.” Also, only wear cotton underwear (no thongs – thongs are the vagina’s archenemy).
- Have partners shower and wash their genitals before sex. If you have sex with men, using condoms or withdrawal during intercourse can help maintain the acidic environment of the vagina. Semen decreases vaginal acidity (so sperm can survive and fertilize an egg) but also creates a hospitable environment for harmful bacterial overgrowth in the vagina.
- Get tested for sexually transmitted infections (STIs) at least every 6 months. STIs disrupt healthy vaginal flora and can cause a host of other problems. If you are sexually active (even if you are in a monogamous relationship), get tested regularly!
Other thoughts:
Some people with chronic BV and recurrent UTIs carry other infections, such as Ureaplasma and/or Mycoplasma Genitalium (Mgen). Ureaplasma and Mgen are infections that are passed between partners through unprotected sex, though they are not technically considered sexually transmitted infections (STIs). Providers rarely test for it, but these co-infections can contribute to recurrent BV, infertility, recurrent UTIs, pelvic pain, increased risk of contracting HIV, bleeding with sex, and pain during sex. The treatment for these two infections differs from treatment for BV, but treating these infections can help break the cycle of recurrent BV. Ask your provider about testing (Nye et al.).
At Pennyroyal Health, we will review your history, rule out infections contributing to your symptoms, and prescribe the proper treatment/preventative care for your recurrent vaginitis. We have same-day appointments (online and in-person) and look forward to working with you to optimize your health!
Citations
Lærkeholm Müller, M., Damsted Petersen, C., & Saunte, D. M. L. (2024). Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti‐Infective Agent: A Systematic Review. Dermatologic Therapy, 2024(1), 2807070.
Nye, M. B., Harris, A. B., Pherson, A. J., & Cartwright, C. P. (2020). Prevalence of Mycoplasma genitalium infection in women with bacterial vaginosis. BMC Women’s Health, 20, 1-5.
