Bacterial Vaginosis

What is Bacterial Vaginosis (BV)?

BV is an infection that develops when levels of “good” bacteria and “bad” bacteria in the vagina are unbalanced. It is very common. Although many women have never head of this infection, more than 21 million women in the US are affected every year. Many women who get BV tend to get it repeatedly, which can be very bothersome.

How does someone get BV?

The truth is we don’t really know why women get bacterial vaginosis. The human vagina contains many different species of bacteria but these are usually kept in a careful balance by acid producing “good” bacteria. Anything that disrupts the natural pH balance in your vagina can increase your risk of getting BV. Antibiotics, sexual activity, douching, and even stress may cause the “good” bacteria levels in the vagina to drop allowing the “bad” bacteria to overgrow. It’s also possible that some people just have lower levels of “good” bacteria to begin with, making them more susceptible to BV.

What are the symptoms of BV?

A fishy odor with and an increase in thin, white or yellow discharge are the most common symptoms of BV. Some women also experience itching, pain or a burning sensation in or around the vagina, and less often, pelvic (lower abdominal) cramping. Sometimes BV has no symptoms at all but is just found during a routine visit. Since the symptoms can vary, you should talk to your health care provider if you think you may have BV.

How is BV diagnosed?

BV can only be confirmed by visiting your health care provider. Most likely, you will have a pelvic exam to look for signs of BV. Your provider may check the vaginal pH, take a sample of discharge and examine it under a microscope, and/or send a vaginal culture to a lab to make the diagnosis of BV. The classic diagnosis for BV is based on four clinical findings:

  • A thin white or yellow and often malodorous discharge
  • An odor when potassium hydroxide is added to vaginal secretions
  • Vaginal secretions with a high pH level
  • The presence of “clue cells” (a particular type of vaginal bacteria that can be seen under a microscope)

How is BV treated?

BV is treated with antibiotics that you take by mouth (pill or granules) or insert vaginally with an applicator (gel, cream or suppository). As with any antibiotics, you may experience side effects such as upset stomach or nausea. You may need to avoid drinking alcohol with some of the medications that treat BV. Your health care provider may also advise you to abstain from sexual contact until treatment is complete.

Can BV be prevented?

Because experts don’t know exactly what causes BV, we also don’t exactly know how to prevent these very common infections. We do know that practicing good vulvar (the external genitalia) and vaginal (the internal genitalia) care can prevent irritation and may reduce the risk of getting infections such as BV and yeast. The vagina is self-cleaning so avoiding douching can reduce the risk of getting BV.  Wash outside the vaginal only with warm water, avoiding using soaps, “feminine” washes, or deodorant sprays which can cause vulvar and vaginal irritation.  Wearing cotton underwear can help allow the area to breathe which may also reduce the risk of vaginal infections. Using condoms if you are sexually active with a male partner can also reduce the risk of getting bacterial vaginosis.  Finally, it is possible that oral probiotics containing Lactobacillus rhamnosus GR may also reduce the risk of getting recurrent BV if you are prone to these infections.