Bacterial vaginosis (BV) is common and uncomfortable. The Centers for Disease Control and Prevention (CDC) estimates that almost 30% of women will get BV at some point. BV is “the most the most common vaginal condition in women ages 15-44”. But what is BV? And what causes it?

This article guides you through all you need to know about bacterial vaginosis.

Causes of BV

A change in the balance of bacteria in the vagina causes BV. The vagina contains bacteria that help protect the genital area and keep it healthy. These healthy vagina bacteria are known as “good bacteria” or “vaginal flora”. BV occurs when an overgrowth of harmful vaginal bacteria starts to overtake the “good bacteria,” and the vaginal pH (acidity) changes.

BV Risk Factors

There is no one cause of BV. Common risk factors for BV include:

1. Sexual activity: BV is not an STI. However, sexual activity increases your risk of developing BV. Women with many sexual partners are at higher risk of getting BV. The same is true for women who have unprotected sex and women who have sex with women.

2. Douching: Douching kills off healthy bacteria (lactobacilli) in the vagina. This increases the risk of bad bacteria growing out of proportion and causing an infection.

Other factors that can put you at risk of BV include:

• Pregnancy
  
• Using an intrauterine device (IUD)
  
• Using dental dams
  
• Not properly cleaning sex toys
  
• Antibiotic use
  
  

You cannot get bacterial vaginosis from swimming pools, toilet seats, or bedding. You also cannot get BV from tampons or menstrual cups if you use them correctly.

Symptoms of BV

The symptoms of BV vary. Some women have severe pain. Others have no symptoms.

Common symptoms of bacterial vaginosis include:

• Abnormal vaginal discharge (usually a thin, white, or grey liquid)
  
• A foul-smelling, fishy vaginal odor
  
• Vaginal itching
  
• Pain during urination
  
• Vaginal pain, soreness, or burning
  
  

Again, many people experience mild symptoms if they experience them at all. If you begin to notice any of the signs above, contact a healthcare provider.

Complications of BV

BV can cause serious health problems if left untreated.

Complications caused by BV include:

1. Sexually transmitted infections: BV can lead to an increased risk for STIs, also known as sexually transmitted diseases (STDs). These include chlamydia, gonorrhea, genital herpes, and HIV.

2. Pregnancy complications: BV has been linked to preterm birth in pregnant women. It can also cause complications like low birth weight.

3. Pelvic inflammatory disease (PID): PID can result from recurrent bacterial vaginosis. PID is an infection of the reproductive tract that can cause infertility.

Because of the risk of these issues, get medical help when you notice the signs of BV.

When to See A Doctor

BV can go away on its own. However, if it is left untreated, BV can lead to serious complications. Because of this, it is important to seek medical attention if you notice the signs of BV.

Talk to a healthcare provider if:

• You have abnormal vaginal fluid.
  
• You notice a fishy smell from the vagina.
  
• You have abnormal vaginal discharge coupled with a fever.
  
• You have BV symptoms and have a new sex partner.
  
• You tried to treat a yeast infection with over-the-counter medication. But your symptoms persist.
  
  

The earlier vaginal infections are caught, the better. Early treatment can prevent serious—even life-threatening—complications caused by a bacterial infection.

What to Expect from a BV Appointment

Your healthcare provider will take a couple of steps to diagnose BV. These include:

1. Questions about your health: Your provider will ask you about your medical history. They want to know your risk factors for BV. This will likely include questions about past vaginal infections. It will also cover your sexual history, including any prior STIs.

2. Pelvic examination: During a pelvic exam, your provider will examine the vagina for signs of infection. These signs include white or grey discharge. They might also insert two fingers into the vagina while pressing on the abdomen. They do this if they are concerned that an infection is affecting your pelvic organs.

3. Sample vaginal fluid: Your healthcare provider may take a sample of vaginal fluids with a swab. Vaginal fluid with higher pH levels is a sign of a bacterial infection. They will also look for bacteria cells.

If your provider needs to test a sample of vaginal fluid, you will likely hear about your results within minutes. If your doctor has to send swabs out for lab testing, it may take a day or two to get your results back.

BV Treatment

Bacterial vaginosis is commonly treated with antibiotics. These medications may be given as a medicated cream or gel, a pill to take by mouth, or a fine powder to be sprinkled over food.

The FDA has approved these drugs for the treatment of BV:

• Metronidazole (generic for Flagyl, Metrogel)
  
• Clindamycin (generic for Cleocin, Clindagel)
  
• Tinidazole (generic for Tindamax)
  
• Secnidazole (sold as Solosec)
  
  

You should start feeling better within a day or two after starting treatment. Continue to take your medication, even if you are feeling better. Bacterial infections need to be completely treated to prevent them from coming back.

Tell your provider if you begin to notice any side effects from antibiotic medication.

Preventing BV

You can help protect yourself against bacterial vaginosis with a few self-care tips.

BV prevention strategies include:

1. Practice safe sex: Unprotected sex has been linked to BV. Use latex condoms during sex to lower your risk of getting an infection. You should also regularly clean sex toys.

2. Limit sexual partners: BV has been linked to sex with new partners or sex with multiple partners. Limiting sex partners (and using contraception with new sex partners) may help minimize your risk of contracting BV or STIs.

3. Don’t douche: Douching removes good vaginal bacteria. This can lead to too much bad bacteria. Don't douche, and don't use cleansing products, like harsh soaps or deodorants, on the vagina.

4. Avoid irritation: Wear breathable underwear, ideally cotton. It wicks moisture from the genital area and prevents irritation. Avoid scented cleaning products and tampons.

5. Use boric acid suppositories: Boric acid vaginal suppositories may help patients with relapsing or recurrent BV. Suppositories are small capsules that are, in this case, inserted into the vagina. Boric acid should not be used to treat BV alone. Boric acid is very toxic if eaten. In addition, boric acid suppositories are unsafe to use during pregnancy. Ask a licensed healthcare professional for advice before you use boric acid suppositories.

There is not enough evidence to support using probiotic supplements as a way of preventing BV.

If you have multiple sexual partners, you should get regular STI tests and sexual health check-ups. These tests can help prevent dangerous infections.

How Sesame Can Help

Don’t wait to treat BV. Get same-day care with an online women’s health appointment on Sesame for BV. These convenient video visits offer the opportunity to speak to a healthcare provider about your symptoms and concerns. Providers on Sesame can diagnose and treat BV. If appropriate, they can order prescription medication to be picked up at your local pharmacy.

Sources:

• (2020). Bacterial Vaginosis (BV) Statistics. CDC.
  
• (2021). About Bacterial Vaginosis (BV). NIH.
  
• Abbe, C., & Mitchell, C. M. (2023). Bacterial vaginosis: a review of approaches to treatment and prevention. Frontiers in reproductive health.
  
• Abou Chacra, L., Fenollar, F., & Diop, K. (2022). Bacterial Vaginosis: What Do We Currently Know?. Frontiers in cellular and infection microbiology.
  
• Kairys N, Garg M. (2024). Bacterial Vaginosis. NIH.
  
• Powell, A., Ghanem, K. G., Rogers, L., Zinalabedini, A., Brotman, R. M., Zenilman, J., & Tuddenham, S. (2019). Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis. Sexually transmitted diseases.
  
• Thomason, J. L., Gelbart, S. M., & Scaglione, N. J. (1991). Bacterial vaginosis: current review with indications for asymptomatic therapy. American journal of obstetrics and gynecology.