Bacteria is everywhere. Too much of it can cause problems. When there’s excess bacteria in your vagina, you may experience bacterial vaginosis (BV).
“The vagina is home to both ‘good’ and ‘bad’ bacteria,” says Dr. Eve Ashby, FACOOG, board-certified gynecologist at Beaufort Memorial Lowcountry Medical Group Specialty Care. “Bacterial vaginosis occurs when the ‘bad’ bacteria outnumbers the ‘good,’ which throws off the balance of bacteria in your vagina.”
Find out what causes the condition, what the common symptoms are, and what you can do to treat or prevent the problem from affecting you.
What Causes Bacterial Vaginosis?
According to the Centers for Disease Control and Prevention, bacterial vaginosis is the most common vaginal condition affecting women ages 15 to 44. It isn’t confined to childbearing years. It also affects younger girls and older women. Despite its frequency, it’s unclear what causes the bacterial shift that leads to BV, though there are a few factors that may increase your risk.
Most risk factors for bacterial vaginosis involve lifestyle choices, but not all. Your risk may increase with the following:
- Intrauterine device (IUD) — You’re at higher risk for BV if you have an IUD.
- Pregnancy — The Office on Women’s Health reports that 25% of pregnant women get BV.
- Race — Black women are more likely to experience BV than white women.
- Sexual activity — Being sexually active without condoms or dental dams may increase your risk. BV is also more common if you have multiple sex partners or a new sex partner.
- Vaginal insertion — Placing herbs in the vagina or using douches or scented soaps may increase your risk of BV.
Bacterial vaginosis is not a sexually transmitted infection (STI), but rather an imbalance of normal vaginal bacteria. While sexual activity can increase the risk, BV isn't solely contracted through intercourse. Other factors like hormonal changes and certain hygiene products can also contribute.
If you don’t have risk factors, you may still contract BV. Seek medical attention if you notice symptoms.
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Common Symptoms of BV
Bacterial vaginosis doesn’t always cause symptoms. In fact, you may never know about your infection.
“It’s fairly common to get BV and not know it,” Dr. Ashby says. “You may even recover fully without any treatment or knowing you were infected.”
When symptoms of bacterial vaginosis arise, they include the following:
- Burning sensation, pain or itching inside the vagina
- Odor described as a fishy smell that comes from the vagina, often noticeable after sexual intercourse
- Itching outside of the vaginal canal
- Painful burning sensation when urinating
- Thin vaginal discharge that may be gray or white
Read More: Sexually Transmitted Diseases: The Unspoken Truth
Could You Have Bacterial Vaginosis?
Detecting bacterial vaginosis starts with a genital evaluation and discussion of your medical and sexual history. There are two approved ways to detect bacterial vaginosis. Depending on your healthcare provider’s preference, your diagnosis may come via the Amsel criteria or laboratory testing.
With the Amsel criteria, your provider uses results from a few clinical tests to identify whether you have BV. For a definitive diagnosis, you need at least three of the following:
- Bacteria (seen with a microscope) sticking to the cells lining the vagina
- Discharge coating the inner walls of the vagina
- A fishy odor in vaginal discharge, which may occur with the "whiff test," where potassium hydroxide (KOH) is added to a sample
- Vaginal pH greater than 4.5 (determined by placing a pH strip against the vagina)
When appropriate, your women’s health provider may take a sample of your vaginal discharge. Your health provider then sends this sample to a laboratory. There, laboratory technicians determine if harmful bacteria are present that may indicate BV.
Treatment Options for BV
To treat bacterial vaginosis, your healthcare provider may prescribe an oral or topical medication. A common treatment is an antibiotic, such as metronidazole. You may take the oral version for seven days or daily apply a metronidazole gel inside your vagina for five days.
While BV isn’t considered an STI, treatment of a BV patient’s partners with antibiotics may help alleviate recurrent symptoms. Additionally, starting on probiotics for at least one month may help align your “good” bacteria to avoid symptoms.
Read More: The Truth About Antibiotics
“We can cure bacterial vaginosis fairly easily,” Dr. Ashby says. “It just takes the right treatment, and you can return to life and put BV behind you.”
Left untreated, BV can occasionally cause serious complications. These include:
- Pelvic inflammatory disease (PID) — There are many types of PID, including endometritis. All of them cause inflammation in the upper female genital tract.
- Pregnancy problems — BV can cause preterm delivery, spontaneous abortion and other pregnancy-related complications.
- Sexually transmitted infections (STIs) — Having BV can make you more likely to get HIV and other STIs.
Read More: Adenomyosis vs. Endometriosis: What’s the Difference?
Preventing Bacterial Vaginosis
Because it’s unclear what causes BV, it’s difficult to prevent bacterial vaginosis. The best technique is to limit your risk factors. You can do that with the following tips:
- Avoid sex. Not having sexual intercourse may help you maintain a proper balance of bacteria in your vagina.
- Keep foreign objects out of the vagina. Stop douching or inserting herbs into the vagina.
- Practice safe, smart sex. If you choose to be sexually active, avoid unprotected sex. Semen can change your vaginal pH, so always use a condom and limit the number of people you engage with sexually.
Even with these prevention techniques, you may experience BV. When you do, seek treatment and follow your women’s health provider’s advice.
“More than half of the women who get BV get it a second time within a year after treatment,” Dr. Ashby says. “For lasting relief, you have to combine treatment with lifestyle changes. Otherwise, you may wind up with another infection in the future.”
Are you experiencing symptoms of bacterial vaginosis or other women’s health issues? Request an appointment with a women's health provider at Beaufort Memorial.
