Bacterial vaginosis (BV) is a common vaginal infection that mainly affects women in their reproductive years, most commonly ages 15-44. In fact, it's the most common vaginal condition women in this age group experience, though anyone can get it.
It's caused by the overgrowth of normal bacteria found in the vagina. While many women don’t have symptoms, others can experience unpleasant symptoms as well, such as unusual discharge, itching and a fishy odor.
In this article, I’ll break down exactly what BV is, what causes it, some of its most common symptoms, effects on fertility and pregnancy, and the best natural treatments for the condition.
What Are the Symptoms of Bacterial Vaginosis?
Most of the time — in 84% of cases — bacterial vaginosis is asymptomatic, meaning that a woman may have the infection and not even realize it.
However, many women do experience some common unpleasant symptoms.
Bacterial Vaginosis Symptoms
- Unusual vaginal discharge (thin, and white, gray, or green in color)
- Fishy odor (typically more noticeable during intercourse or during a woman’s period)
- Vaginal itching
- Painful urination
If you’re experiencing any of these symptoms, it’s important to visit your doctor so you can receive a diagnosis and start treatment.
It’s not always BV and there’s also a chance you have multiple infections, so meeting with your doctor can help you differentiate the cause of your symptoms and help you get the best treatment for you.
What Is Bacterial Vaginosis?
Bacterial vaginosis (BV) is an infection of the vagina usually affecting women of reproductive age. BV is caused by an imbalance in vaginal bacteria. In women with bacterial vaginosis, lactobacillus becomes scarce, and other kinds of bacteria (for example. Gardnerella vaginalis, Ureaplasma urealyticum, Anaerobes, and Mycoplasma hominis) become too plentiful. This is referred to as overgrowth of normal flora.
Women with bacterial vaginosis experience a rise in the pH of the vagina. In women who are not in menopause, a healthy vagina is acidic, with a pH of between 3.8 and 4.5. This is due to Lactobacillus species producing lactic acid, which maintains a low, acidic pH that keeps the critters in check!
Is Bacterial Vaginosis an STI or STD?
No, bacterial vaginosis isn't an STI (sexually transmitted infection) or STD (sexually transmitted disease). Although sexual activity does increase the risk of BV, nearly 20% of women who have never had vaginal, oral, or anal sex are still affected by it, too.
There is currently some scientific discussion as to whether or not bacterial vaginosis might sometimes be sexually transmitted, but remember: for the most part, this condition results from your own vaginal microbiome getting out of balance.
So why might sexual activity be a risk factor?
One reason for that is because sexually activity that introduces semen into the vagina can shift the pH. Semen is slightly alkaline. Vaginas should be moderately acidic. So when semen enters the vagina, it causes a rise in the vagina’s natural pH (meaning less acidic and more basic), which can lead to the overgrowth of normal bacteria that call the vagina their home. Hello bacterial vaginosis!
In addition, certain lubes can alter vaginal pH leading to BV. Interestingly, though, there have been multiple studies showing that spermicide does not lead to an increase in bacterial vaginosis overgrowth.
Another insight from research is that having BV makes a woman more vulnerable to STIs, because BV changes the flora of the vagina and affects your immune response. Which is another reason to see your doctor immediately if you think you might have it.
What Causes Bacterial Vaginosis?
Bacterial vaginosis symptoms are caused by an imbalance in the flora of the vagina.
More specifically, BV is often associated with a decrease in Lactobacillus, a vital “good” bacteria for a healthy vagina, which is what ultimately leads to bacterial vaginosis symptoms. This is why some women find Lactobacillus suppositories helpful.
So what factors lead to this bacterial imbalance? There are a few key culprits.
Risk Factors for Developing Bacterial Vaginosis:
- Intercourse (sex)
- Period blood
- A new sexual partner or multiple partners
- Oral and anal sex
- Imbalances in gut flora
While none of these factors guarantees BV in and of itself, the more that are present, the higher your risk.
Douching Disrupts Healthy Flora
Have you ever been made to feel like your vagina needs assistance in keeping clean? For a long time, women were told that vaginas are inherently dirty, and need to be cleaned. This harmful, sexist message has spread down through the generations. At one point, women were even told to use Lysol to clean their vaginas, to eliminate any odor and keep their husbands happy.
While we now know that Lysol is definitely not safe for use inside our bodies, the narrative of “keeping the vagina clean” persists. Let me be clear. Genitals have an odor (yes, a penis can, too). Some odors can indicate problems, such as the fishy smell brought on by bacterial vaginosis.
But healthy vaginas do have a smell and despite what clever marketers tell you, this is normal.
Unfortunately, women are often made to feel ashamed of their natural scent, and turn to douches and scented washes to “clean” themselves. Good hygiene is, of course, important. But the vagina is magical. It is self-cleaning, so there is absolutely no need for douching.
In fact, douching causes an imbalance in the vaginal flora, as well as a disruption to its natural pH. Yes, douching makes it easier for harmful critters to grow! All of which are recipes for bacterial vaginosis.
And BTW, those scented lady labia wipes are also not doing you any favors, either. These can disrupt healthy flora and introduce endocrine disrupting chemicals to this sensitive mucosal tissue.
If you're struggling with bacterial vaginosis symptoms then it is a good idea to step away from these practices.
How Am I Supposed to Clean My Vagina?
There’s never really a reason to clean your vagina (the internal structure). Your vulva, the outer portion of your genitals doesn’t really need more than water.
Intercourse (Especially Unprotected)
In a perfect world, vaginas and semen would have the same pH, but trust me when I say that nature doesn’t get it wrong. Unfortunately, semen isn’t the same pH and can make us susceptible to bacterial vaginosis and yeast infections. Semen is actually mildly alkaline, so during unprotected sex, semen slightly raises the pH of the vagina.
While this is usually a temporary change for the vagina, it is sometimes enough to encourage the growth of both beneficial and unhealthy bacteria. An acidic environment supports the growth of favorable bacteria, so maintaining a moderately acidic vagina is important.
I'm not saying you need to stop having sex to prevent bacterial vaginosis, but if you have recurring BV, make note of your sex life around the times infections occur. You may find it coincides with new partners or times when you're having more sex.
Antibiotics kill the harmful bacteria that cause infections. However, they also kill the good bacteria that we need to stay healthy.
This lack of good bacteria can destroy the acidic environment of the vagina, which can lead to bacterial vaginosis. Remember, those Lactobacillus species make acid that keeps the whole ecosystem in check.
And yet antibiotics (topical or oral) are a common prescription given for bacterial vaginosis, which is a catch-22. What should you do?
Research suggests that taking an oral probiotic if you're prescribed antibiotics for BV can help support your vaginal health.
Consider adding in a probiotic if you require antibiotic treatment.
This is another weird, ironic quirk of our bodies. In an ideal world, period blood would be acidic and match the pH of our vaginas, since the blood passes through the vagina as it leaves the body.
But your blood must maintain a specific pH in order for enzymes and other metabolic processes to function optimally — this is vital for your health. The pH of blood is just above 7 meaning that,Like semen, period blood is slightly alkaline. Therefore, it can alter the pH of the vagina, potentially leading to BV.
Although it's not actionable, this is another factor to make note of, especially if you have recurring bacterial vaginosis.
How Is BV Diagnosed?
Bacterial vaginosis must be diagnosed by a medical professional. During a pelvic exam, a doctor will usually check for four things in order to diagnose BV.
- Thin discharge that is white, gray, or green in color
- Fishy odor with potassium hydroxide (KOH) test
- Elevated vaginal pH
- Presence of “clue” cells (cells from the vaginal lining coated with bacteria)
Your doctor may also want to perform a physical exam, which may include a speculum exam to visualize your cervix. I know it’s never fun, but it is an important exam to rule out other possible causes of your symptoms.
My Discharge Smells Bad, but Not Like Fish
This doesn’t necessarily mean it is not bacterial vaginosis. It does mean that you need to make an appointment with a doctor to rule out BV and other serious infections.
How Is Bacterial Vaginosis Treated?
I’m going to review several treatment options available, including pharmaceutical and natural treatments. Remember, the best way to know what you’re dealing with and the best treatment is to speak with your doctor — but it's also helpful to be prepared for an appointment so you can discuss the different options and their pros and cons.
What Antibiotics Treat Bacterial Vaginosis?
Bacterial vaginosis symptoms are treated in non-pregnancy women with antibiotics, specifically metronidazole or clindamycin. They both work equally well, and the medication prescribed usually depends on which is more accessible and cost-effective.
These antibiotics can be taken orally (in a tablet or capsule), or in gel or cream form inserted directly into the vagina. Deciding how to take the antibiotic is usually dependent on the patient, but oral use of antibiotics does come with more side effects, such as nausea and diarrhea.
Because antibiotics can lead to further unfavorable shifts in both your vaginal ecology and gut microbiome, it's wise to use caution with these medications. They are sometimes necessary to get you relief, but if you find that you need a monthly dose of antibiotics to keep your vagina happy then it is time to bring in more support. Check out the sections below for more info on natural treatments, too.
Metronidazole for the Treatment of BV
Metronidazole is a medication your doctor may recommend in either an oral or vaginal form. Whether it is vaginal or oral treatment, alcohol should not be consumed during treatment or for one day after following treatment.
Other side effects to be aware of are nausea, metallic taste, and tingling in the hands and feet. It is not uncommon to have digestive upset when using the medication orally, which is why your doctor may recommend vaginal dosing instead.
Clindamycin for the Treatment of BV
As mentioned, clindamycin is another antibiotic that is used in the treatment of BV. It is important to note that using clindamycin vaginally has been associated with increased bacteria resistance to this antibiotic following treatment. We don’t see similar resistance with metronidazole.
If you experience diarrhea, abdominal pain, or fever while using this medication it is important to contact your doctor. Using both oral and topical clindamycin can make you susceptible to overgrowth of bacteria in the colon leading to inflammation and digestive symptoms.
Any time you are using a topical medication in the vagina there is a risk that it will make condoms ineffective. Be sure to ask your doctor if this medication can be used with latex condoms. It’s really best to avoid sex while treating the infection, but just in case, you should know the risks.
Natural Treatments for Bacterial Vaginosis Symptoms
1. Don’t Douche, Skip the Scent, Be Gentle with Your Vagina
Your vagina will tend to itself and while the odor may make you feel like you need to lend some assistance, you don’t. Douching is a risk factor for developing bacterial vaginosis. And as I mentioned above, scents and harsh personal care products used internally can do more harm than good.
Hydrogen Peroxide for Bacterial Vaginosis
Hydrogen peroxide has been used for years (ages even) for the treatment of BV and it proves to be pretty effective in some studies. What we don’t know is if it can shift the flora too much and leave you susceptible to other infections.
In a small 2003 study it was found that the use of hydrogen peroxide decreased odor and eliminated signs and symptoms of BV. However, in a randomized control trial, a single treatment with hydrogen peroxide was found to be less effective than a single dose of metronidazole.
The bottom line is that hydrogen peroxide might be worth keeping in mind, but I want you to talk to your doctor about it, not do it on your own.
Apple Cider Vinegar for Bacterial Vaginosis
Apple cider vinegar (ACV) is up there with coconut oil in how it is recommended for just about everything. Can apple cider vinegar treat BV? The answer is, there really isn’t any evidence it can, but let’s talk about how it might seem like a viable treatment because it is definitely something you’ll find on the internet.
Firstly, ACV is antimicrobial, but it appears to be only against certain strains like E. coli, Candida albicans, and Staph aureus. These organisms may or may not be the cause of your symptoms and being specific matters when it comes to clearing infection.
Apple cider vinegar is also acidic due to the presence of acetic acid. This may help shift your vaginal pH, but I wouldn’t recommend it over getting those Lactobacilli to do their job, which is essential to naturally maintain your pH.
Some women report symptom relief from taking a sitz bath (a warm water bath covering the hips and buttocks) with ACV. If it makes you feel better, there isn’t much harm in doing this.
But as to whether you should douche with apple cider vinegar? I wouldn’t advise it.
What About Vaginal Steaming for BV?
I know so many ladies who love this self care routine. And done safely (read: no steam burns) this practice can be a way for women to take some time to pamper their lady parts. But with regards to clearing bacterial vaginosis or any other microorganism growing in the vagina, the evidence just isn’t there.
I know some women claim that certain herbs steamed can be beneficial to their vaginal health, and I’m not saying they are wrong. What I am saying is that we don’t have sufficient studies to support this and even more importantly, we don’t understand if some herbs used that have antimicrobial properties could actually disrupt the flora further.
Eucalyptus, oregano, and even lavender have antimicrobial properties, which may prove to be beneficial in a steam in future research. However, as it stands, herbal steam baths aren't a treatment I can recommend for BV.
2. Use Eco-friendly Period Products
You may have heard that it doesn’t matter if your period products are organic, but as more information is coming to light we are understanding that non-organic products can contain glyphosate and other environmental toxins.
Not only can your vagina absorb these toxins, the toxins themselves can disrupt vaginal flora.
Good for the environment and good for your vagina! If you’re struggling with recurrent bacterial vaginosis, consider making the switch.
3. Support Healthy Vaginal Ecology
Have you heard of the gut-vagina axis? New research suggests your gut health plays a role in your vaginal health, and that your gut microbiome may influence your vaginal microbiome, too.
The gut and vagina share organisms and as I’ve found many times in my practice, we can’t totally clear recurrent vaginal infections until we’ve addressed the gut.
Make sure your diet supports female hormonal balance and gut health. Consider taking a probiotic daily, especially if you’re currently on antibiotics or have recurrent infections. And be sure to address any gut issues you may have, especially leaky gut.
My free Hormone Starter Kit is designed to help women kickstart their hormonal health with a free 7 day diet and recipe plan!
4. Get Your Blood Sugar in Check
Blood sugar imbalances cause hormone imbalances and all of the above can make you more susceptible to bacterial vaginosis.
This is not to say if you eat sugar then boom, you’ll have an infection. But it is part of the bigger picture of overall health.
If you’re struggling with chronic BV or yeast infections, this is a good area to have your doc check out. You can get fasting glucose, hbA1C, and possibly postprandial glucose checked — your physician will know the best options.
5. Vitamin C Suppository
During my clinical rotations at a homeless youth clinic vitamin C suppositories were one of our go to treatments for bacterial vaginosis because of access and it being a low cost treatment. I’ve also used vitamin C suppositories within my clinical practice for women who can’t or don’t want to use pharmaceutical interventions. I’ve found great success with this treatment, especially in recurrent BV cases.
In a randomized, double-blind, placebo-controlled clinical trial it was found that recurrence of BV in women treated with vaginal vitamin C was substantially lower than those in the placebo group at 3 months and 6 months of treatment. This study used 250 mg of ascorbic acid (vitamin C) for 6 days every month over the course of 6 months and concluded that this treatment drops the risk of repeat BV by half!
Another double blind clinical trial also found that vitamin C was effective in the management of BV.
There are over the counter vitamin C based suppositories available. You can talk with your doctor to see if they're appropriate treatment for you.
Can Bacterial Vaginosis Clear Up on Its Own?
Bacterial vaginosis is considered a mild infection of the vagina, and in some women, it certainly can and does go away on its own.
However, if left untreated, BV can also cause more serious health problems, so this isn't a recommended strategy.
Untreated BV leaves you vulnerable to:
- Increased risk of miscarriage or preterm labor
- Pelvic infection
- Increased risk of contracting STIs (such as gonorrhea and HIV)
It’s best not to assume symptoms are bacterial vaginosis and to meet with your doc because again, it could be something else, or something else could be accompanying the BV.
What About Homeopathic Treatments for BV?
While there are plenty of “homeopathic” options sold that claim to treat bacterial vaginosis, I don't recommend them for women with this condition.
Keep in mind that homeopathy often gets lumped together with other complementary and alternative treatments, but this term specifically refers to highly diluted ingredients that are usually mostly water. It's a separate category from most herbal products or supplements, for example.
Although research suggests that they're unlikely to cause adverse effects, there's not enough evidence for homeopathic products for bacterial vaginosis, so the better option is to try the other treatment options I've discussed in this article.
Can I Treat Bacterial Vaginosis at Home?
Using the above natural therapies (not homeopathy), it is possible to treat bacterial vaginosis at home. However, I can’t stress enough how important it is to be sure that you are actually dealing with BV and to meet with your doctor to discuss the best treatments.
The good news is that once you treat bacterial vaginosis successfully, there's a lot you can do at home to prevent it from recurring!
How to Stop Recurring BV Infections Permanently
There are a few steps you can take to reduce your risk of getting bacterial vaginosis or prevent recurring BV.
1. Do Not Douche
Douching has no benefits for your vagina. It may cause the vagina to smell “clean”, but it wreaks havoc on its beneficial bacteria and its healthy acidity. Avoid it to prevent BV and to maintain a healthy vagina.
2. Keep Vaginal Bacteria Balanced
By maintaining an optimal balance between good and bad bacteria, you will create an inhospitable environment for bacterial vaginosis. You can do this by not using harsh, heavily fragranced soaps to clean the outside of the vagina, and by wearing breathable cotton underwear.
3. Abstain From Sex (Temporarily)
This is a recommendation made to women with BV and it lives all over the internet. But let’s be real, abstaining from sex isn’t an option for most women (for whatever reason) who are experiencing BV. It is best, however, to abstain from sex while treating a vaginal infection.
If you are going to continue having sex, you can also consider using a condom to avoid exposure to ejaculate while you help restore the normal ecology in your vagina.
If you have multiple partners, definitely use a condom. I know, I sound like a mom. I am a mom. But this sincerely comes from the place where all the knowledge I’ve acquired about medicine lives. As a doctor, please, consider a condom.
Try Changing Up Your Lube
It could be you’re using something that has antimicrobials in it to prevent bacterial contamination (a good thing) and yet, for you and your vagina’s needs, you may need to switch.
If you're looking for a new lube, check out Coconu, which is free of harsh ingredients and comes in either a coconut oil or coconut water based formula. You can use the code: drbrighten to get 15% off your first order.
As a friendly reminder in the infection arena:
- Always pee after sex.
- Don’t change orifices without being mindful about what bacteria (and other organisms) you’re transferring from one area to another.
- Please be mindful to properly clean sex toys (and use body-safe sex toys that are made from healthy materials).
Can I Get Bacterial Vaginosis from My Boyfriend?
While your boyfriend’s semen can make you more susceptible, your boyfriend probably isn’t actually giving you BV. It is well recognized that new partners or having multiple partners can put you at increased risk.
Can I Get Bacterial Vaginosis from Oral Sex?
Saliva can shift the pH of the vagina, so it is possible this could lead to bacterial imbalance and cause BV.
Bacterial Vaginosis and Fertility
Some research has linked bacterial vaginosis and other gynecological diseases (pelvic inflammatory disease, chronic endometritis) to infertility. BV has actually been found to be three times more common in women with fertility problems, but that doesn't necessarily mean it directly causes infertility.
In vitro fertilization (IVF) studies have allowed researchers to look closely at what may be causing decreased conception rates and higher rates of early pregnancy loss in women with infertility. They’ve found that these women had lower levels of Lactobacillus affecting the production of antimicrobials such as hydrogen peroxide which increased the likelihood that bacterial vaginosis would occur. (42,43)
Studies have found that infections of BV may affect fertility by:
- Bacterial toxins causing damage to vaginal cells and sperm – bacterial vaginosis affects vaginal cells but let’s not forget the men! We know that bacteria from the vaginal microbiome as well as the semen microbiome are exchanged during sexual intercourse. Yes! There is a semen microbiome in men’s urogenital tracts and Lactobacillus is a good guy there as well, so it stands to reason that BV could harm sperm.
- Increasing inflammation and immune system activity in the reproductive organs of women with BV.
- Inhibiting the sperm and egg from meeting in the fallopian tubes due to scar tissue caused by recurrent infections.
- Bacterial vaginosis bacteria ascending from the vagina, impairing the immunity barrier and the health and function of the upper genital system.
- Inhibiting the production of healthy cervical mucus during ovulation. These cells usually produce compounds that fight off invading bacteria.
- Increasing the risk of sexually transmitted infections as I mentioned previously, which are known to lead to fertility issues.
So we can see why the vaginal microbiome has been implicated in infertility challenges.
Bacterial Vaginosis and Pregnancy
Untreated bacterial vaginosis can also cause problems during pregnancy, so it’s important to see a doctor if you are pregnant and suspect that you have BV.
For that matter, any time you have any concerns about what may be growing in your vagina in pregnancy please go straight to your doctor and get it checked out!
Can Bacterial Vaginosis Cause Miscarriage?
According to a study of women undergoing in vitro fertilization (IVF), BV significantly increases the risk of miscarriage in the first trimester, compared to women with normal vaginal flora.
Don't stress because that doesn't mean you're going to miscarry if you have bacterial vaginosis. Just get it taken care of and stay calm.
Does Bacterial Vaginosis Harm the Baby?
BV can cause a woman to go into preterm (early) labor, and may also cause low birth weight in the baby. Neither of these conditions are ideal for a healthy baby. However, underweight babies and premature babies often can and do still grow up to be very healthy.
How Can I Treat BV Naturally During Pregnancy?
It's vital to see a medical professional in order to get rid of the infection as quickly as possible, and therefore avoid some of the potential risks to the pregnancy. In terms of natural treatments, they're the same whether you're pregnant or not.
Bacterial Vaginosis Is Easy to Treat, but Should Never Be Ignored
Bacterial vaginosis is common in sexually active women of reproductive age. Many women do not experience symptoms, and the infection resolves itself in a few days.
However, women also experience several uncomfortable symptoms, and should seek the advice of their chosen medical professional as soon as possible. BV is successfully treated with oral or intravaginal antibiotics.
If left untreated, bacterial vaginosis can cause pelvic infections, lead to a greater risk of contracting STIs, and cause miscarriage or preterm labor in pregnant women. So, while it is not necessarily a serious health condition, it is definitely not one that should ever be ignored.
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