Bacterial vaginosis

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Bacterial Vaginosis (BV)

Bacterial vaginosis is a very common vaginal infection that many women are not aware of. Read on for more information!


What is bacterial vaginosis (BV)?

Bacterial vaginosis is an overgrowth of several bacteria that normally exist in the vagina. It can develop when an external factor disrupts the balance between beneficial and harmful bacteria. It is generally not thought to be a sexually transmitted infection, because it occurs in women who are not sexually active. According to the Centers for Disease Control and Prevention, bacterial vaginosis is the "most common vaginal infection" in people of childbearing age.

In the past, bacterial vaginosis was called nonspecific vaginitis, Gardnerella vaginitis, Haemophilus vaginitis, Corynebacterium vaginitis, and anaerobic vaginosis.

Source: Brown University

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What causes bacterial vaginosis?

The exact cause of bacterial vaginosis is unknown, and it is usually attributed to a variety of causes. We do know that the healthy vagina normally contains a variety of bacteria, and that women who have bacterial vaginosis lose the protection of healthy bacteria. Women who have bacterial vaginosis have both a large increase in the number of potentially harmful bacteria and a large decrease in the numbers of normal, protective bacteria in their vagina. This change in numbers and kinds of bacteria is believed to be the cause of bacterial vaginosis.

Source: Brown University

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Who is at risk for bacterial vaginosis?

Women who:
  • Have just had gynecological surgery
  • Are diabetic
  • Are going through menopause
  • Are pregnant – The American Pregnancy Association tells us that 10-30% of pregnant people will develop BV during their pregnancy.
  • Are sexually active – intercourse or other sex play (including fingers and sex toys) can introduce harmful bacteria into the vagina
  • Douche – douching disrupts the natural bacteria present in the vagina
  • Have IUDs
  • Are Women! All women are at risk for bacterial vaginosis, just some more than others.

While bacterial vaginosis is more common in women who are sexually active, it occurs in women who are not. Brown University tells us that “it (BV) is widely believed to be even more common than yeast infections and is the most frequently occurring vaginal infection – affecting from 10% to 64% of the female population at any given time.” So while certain factors may increase the likelihood of contracting bacterial vaginosis, none of them guarantee it.

Sources: Centers for Disease Control and Prevention and Brown University

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How do you know if you have bacterial vaginosis? What are the symptoms?

  • White or gray discharge with a milk-like consistency that can stain undergarments (women have also sometimes experienced yellow or green discharge as well)
  • An odor usually described as “fishy” that can be more present or obvious after intercourse
  • Vulvovaginal itching, burning, or pain
  • Pain during intercourse
  • Painful urination

Not all women experience a change in odor or discharge, and some may only experience itching. It’s important to remember that bacterial vaginosis can be present with little or no symptoms.

Source: Mayo Clinic

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How do I treat it?

It is recommended that you see a doctor the first time you are experiencing symptoms of bacterial vaginosis, to get proper diagnosis and treatment. Since many infections carry similar symptoms, it’s wise to be sure that bacterial vaginosis is what you have. Brown University says that “a medical provider can detect bacterial vaginosis by examining vaginal secretions under a microscope and checking pH. Occasionally, bacterial vaginosis will be incidentally picked up on a routine Pap smear.”

There are two ways to treat bacterial vaginosis:

  • Prescription treatment from a doctor
  • Natural, at-home methods

Prescription treatments

Usually metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) will be prescribed either in pill or vaginal medication form. Oral and vaginal metronidazole have been known to cause nausea in some women, and it is recommended that you absolutely do not drink any alcohol while on this medication. Drinking alcohol while on metronidazole can cause extreme nausea and vomiting. It is important to take the medicine as directed and to abstain from sexual contact until the treatment is completed. Some women do get yeast infections from vaginal BV medication, but not all.

Sources: Brown University and Feminist Women’s Health Center

Will using antibiotics for bacterial vaginosis make my hormonal birth control less effective?

VP SSM jennifer0246 tells us in this VP on LJ comment that:

“Metronidazole is a general-spectrum antibiotic, and thus can reduce the effectiveness of hormonal birth control. I'd recommend backup protection for the course of the treatment and 7 active pills thereafter (so it could be longer than 7 days depending on where you are in your pill pack) to be safest. You're the only one capable of assessing what level of risk you're comfortable with, but that is my "to be safest" recommendation.”

If you are worried about your contraceptive efficacy during your treatment period, it is always a good idea to ask your doctor or pharmacist if your medication will interact with your HBC method.

At-home methods

Some women use boric acid to re-acidify their vagina while having a yeast infection or bacterial vaginosis. Also detailed in the Vulvapedia entry about yeast infections, boric acid has a good success rate, can be found fairly easily at most drug stores, and is usually found behind the pharmacy counter. Dilute it one teaspoon to one cup of warm water and mini-douche daily with the barrel of a syringe, or use a diaphragm jelly inserter, which can be bought at the pharmacy without having to buy the jelly. You can also buy empty 00-sized capsules and fill them with boric acid powder and insert two of them nightly. Don't use if the skin is raw or broken, and discontinue if an irritation develops. It can be wet and messy but boric acid is anti-bacterial and will cleanse some non-specific vaginitis as well. (Click here and here for links to more info about boric acid, including a fabulous how-to photo essay on making your own capsules!)

If you're shopping for boric acid, you're probably looking for a brand with some type of National Formulary monograph or other designation that it's suitable for pharmaceutical use. In the U.S., the specific designation is USP-NF, which indicates that it meets certain quality specifications that make it suitable for pharmaceutical use.

You can also use probiotics to aid other treatments. Some studies suggest combining them with prescription antibiotics improves the success rate.

Please keep in mind that while bacterial vaginosis can sometimes go away on its own or be treated effectively with at-home methods, it is recommended to seek medical attention if symptoms or irritation continues. Left untreated, there are risks to your reproductive health.

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What are the risks?

The Centers for Disease Control and Prevention tell us that "in most cases, BV causes no complications." The risks associated with BV, although serious, usually only occur when bacterial vaginosis has gone untreated.

  • Pelvic Inflammatory Disease (PID) - a general term that refers to infection and inflammation of the upper genital tract in women. It can affect the uterus, fallopian tubes, ovaries, and other organs related to reproduction. The scarring that results on these organs can lead to infertility, ectopic pregnancy, chronic pelvic pain, abscesses, and other serious problems that may require hospitalization. It is the leading cause of infertility in the United States. (To read more about PID, look here.)
  • Premature delivery and low birth weight for women who are pregnant and have bacterial vaginosis. Pregnant women with BV also run higher risks of pregnancy loss, especially in the first trimester.
  • Increased risk of transmission of HIV and other STIs

Sources: Brown University and Planned Parenthood

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Can I have sex while I’m being treated for bacterial vaginosis? Does my partner need to be treated?

Can you? Yes. Should you? Not really. It is not recommended that you engage in any sexual activity while being treated for bacterial vaginosis, because it can disrupt the healing process and introduce more harmful bacteria into the vagina. It also has the potential to make any symptoms or irritation worse. If you must engage in sexual intercourse, use a condom to lessen the transmission of harmful bacteria, but take note that this may not be effective. You can read more about sex while treating BV in this VP on LJ entry.

Since bacterial vaginosis is not thought to be caused by sexual intercourse, most medical providers will not treat your sexual partner. If your infection should return, your medical provider may recommend treating your partner.

Source: Brown University

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Can I treat bacterial vaginosis while I am on my period?

Yes. You can use both oral and vaginal medications for bacterial vaginosis when you are on your period. It is not recommended that you use tampons or other internal menstruation products, however, since they can further irritate the vagina and absorb vaginal medication. You can read more about BV and tampons in this VP on LJ entry.

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What can I do to prevent bacterial vaginosis?

Many women will experience recurrences of bacterial vaginosis, and it is unclear why or how these recurrences or relapses occur. We do know, via the Centers for Disease Control and Prevention, that “Women do not get BV from toilet seats, bedding, swimming pools, or from touching objects around them.”

Things to do:
  • Wipe from front to back
  • Clean the vulva thoroughly and keep it dry, but avoid feminine hygiene sprays and harsh soaps. You can read more about vulvovaginal hygiene here.
  • Wear cotton underwear
  • Using condoms may decrease BV recurrence in some women

Things to avoid:
  • Scented tampons and pads
  • Douching
  • Tight clothing (it traps in moisture)
  • Wearing damp bathing suits for a long period of time
  • Going from anal play to vaginal play without using a different condom or properly cleaning fingers, toys, or penises
  • Bubble baths
  • Harsh soaps and feminine hygiene sprays
  • Condoms that contain nonoxynol-9

Source: Feminist Women’s Health Center

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See Also

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NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.

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