What Is Bacterial Vaginosis?
The vagina contains a number of bacteria, known as the vaginal biome. There are good bacteria, mostly lactobacilli, that keep everything balanced and healthy. There are also unhealthy bacteria like gardnerellla .
The lactobacilli helps maintain a slightly acidic environment, which protects against infections.
In BV, that balance between lactobacilli and unhealthy gets thrown off. The helpful lactobacilli decrease, and other types of bacteria, like Gardnerella vaginalis, start to overgrow. This shift is what leads to the symptoms of BV. It’s not technically a sexually transmitted infection (STI), but sexual activity can play a role in triggering it.
What Causes BV?
Let’s be clear: BV is not caused by poor hygiene. In fact, sometimes too much cleaning, especially inside the vagina (like douching), can contribute to it. Here are the most common causes and risk factors:
- Disruption of the Vaginal Microbiome
The vagina is self-cleaning and usually maintains its own balance. But certain actions or exposures can disrupt this balance:
- Douching or using vaginal deodorants
- Strong soaps or scented feminine products
- Bubble baths or heavily perfumed bath products
- Wearing tight, non-breathable underwear
- Sexual Activity
BV isn’t classified as an STI, but:
- New or multiple sex partners can increase the risk.
- Unprotected sex may change the vaginal flora.
- BV is more common in women who have sex with other women, though it can happen to anyone.
- Hormonal Changes
Hormonal shifts, especially around your period, pregnancy, or menopause, can also affect the vaginal environment.
What Are the Symptoms?
Many women with BV actually don’t notice anything at all. That’s right—you can have BV and not even know it.
But when symptoms do show up, here are the most common ones:
- Unusual Discharge
- Thin, watery, gray or white discharge
- It may be more noticeable after sex
- “Fishy” Odor
- A strong, unpleasant vaginal smell
- It often becomes more noticeable after sex (due to the alkalinity of semen interacting with the vaginal pH)
- Itching or Irritation
- Mild itching around the vagina
- Some women feel burning during urination, though this is less common
It’s important to know that BV doesn’t typically cause redness, swelling, or severe pain—those signs may suggest another infection, like a yeast infection or STI.
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BV vs. Yeast Infection: What’s the Difference?
This is a common point of confusion. Here’s a quick comparison to help:
Feature | Bacterial Vaginosis | Yeast Infection |
Discharge | Thin, gray/white, fishy-smelling | Thick, white, cottage cheese-like |
Odor | Fishy smell | No odor, or mild bread-like smell |
Itching | Mild or none | Often intense |
Cause | Bacterial imbalance | Overgrowth of Candida yeast |
pH level | Elevated (above 4.5) | Normal to slightly elevated |
If you’re ever unsure, don’t guess—let your doctor take a look or run a test.
How Is BV Diagnosed?
Diagnosing BV is usually straightforward. If you come in with symptoms, your doctor may:
- Ask about your symptoms and sexual history.
- Do a quick pelvic exam.
- Take a sample of your vaginal discharge using a swab.
We can sometimes diagnose BV right in the clinic using a “whiff test” (yes, it’s what it sounds like—adding a solution to the discharge to see if the classic odor appears) or check your vaginal pH. In some cases, we’ll send the sample to the lab for confirmation.
How Is BV Diagnosed?
Diagnosing BV is usually straightforward. If you come in with symptoms, your doctor may:
- Ask about your symptoms and sexual history.
- Do a quick pelvic exam.
- Take a sample of your vaginal discharge using a swab.
We can sometimes diagnose BV right in the clinic using a “whiff test” (yes, it’s what it sounds like—adding a solution to the discharge to see if the classic odor appears) or check your vaginal pH. In some cases, we’ll send the sample to the lab for confirmation.
What If It Comes Back?
Unfortunately, BV has a bit of a reputation for coming back—sometimes within a few weeks or months. If this happens:
- We might prescribe a longer course of treatment.
- Some women benefit from maintenance therapy, such as using metronidazole gel a few times a week for several months.
- Research is still ongoing, but probiotics (especially vaginal ones with lactobacillus) may help maintain the healthy bacteria. You can ask your doctor if that’s a good option for you.
Can BV Cause Complications?
Most cases of BV are mild and don’t lead to long-term issues, especially if treated early. However, in some cases, untreated BV can cause complications, such as:
- Increased risk of STIs (like chlamydia, gonorrhea, or HIV)
- Pelvic Inflammatory Disease (PID), which can affect fertility
- Pregnancy complications, such as preterm labor or low birth weight
That’s why it’s important to come in if you notice unusual symptoms.
How Can I Prevent BV?
Now that we know what causes BV, here are some practical ways to keep your vaginal flora happy and balanced:
- Avoid Douching
Really, your vagina is smart and self-sufficient. Douching strips away good bacteria and does more harm than good.
- Limit Scented Products
Skip the perfumed soaps, sprays, and bubble baths. Use gentle, unscented cleansers around the vulva—not inside the vagina.
- Use Protection
Condoms can help reduce the risk of BV, especially with new partners.
- Practice Good Hygiene
Change out of wet clothes or sweaty gym wear quickly, and opt for breathable cotton underwear when you can.
- Be Cautious with Probiotics
Probiotics are trendy, but not all are created equal. Look for those with lactobacillus strains, and talk to your doctor before starting any.
Final Thoughts: Don’t Be Embarrassed!
BV is very common—millions of women get it each year. You haven’t done anything wrong, and you’re not unclean. Bodies are complex, and sometimes they just need a little help to get back in balance.
If you’re experiencing symptoms or just feel like something’s “off,” don’t hesitate to reach out to your healthcare provider. We’re here to help, not to judge.
And remember: your vaginal health is a part of your overall health. Let’s keep it simple, balanced, and comfortable—just the way it should be.
