Bacterial Vaginosis

Bacterial Vaginosis (BV)

Bacterial vaginosis is not a sexually transmitted infection (STI) but rather an imbalance of the natural bacteria in the vagina. It is the most common cause of unusual vaginal discharge and affects many women at some point in their lives.

What Is Bacterial Vaginosis?

Your vagina naturally contains many different bacteria that help keep it healthy. Bacterial vaginosis occurs when the balance of these bacteria changes, with harmful bacteria outnumbering the helpful ones. This creates an environment that can cause uncomfortable symptoms.

Main Symptoms

Vaginal Discharge Changes

• Smell: Often described as “fishy,” particularly after sex or during menstruation
• Color: Thin, watery discharge that may be white or grey
• Consistency: Different from your normal discharge

Important to Note:

• Some people experience no symptoms at all
• BV does not usually cause soreness or itching
• If you have itching, it may be a different condition like thrush

What Causes Bacterial Vaginosis?

Primary Cause:

The exact cause of the bacterial imbalance is not fully understood, but research shows it involves a disruption of the vaginal microbiome.

Risk Factors:

• Being sexually active (though it’s not an STI)
• Having a new sexual partner or multiple partners
• Using scented soaps, bubble baths, or vaginal deodorants
• Douching or over-washing the vaginal area
• Having an intrauterine device (IUD)
• Smoking

What Doesn’t Cause BV:

• Poor hygiene
• Toilet seats or swimming pools
• Bedding or towels

How Common Is It?

• Most common vaginal infection in women of reproductive age
• Affects approximately 1 in 3 women at some point
• Can occur at any age but is most common between ages 15-44
• Often recurs - about 30% of women have it return within 3 months

Diagnosis

Your healthcare provider may:

• Ask about your symptoms and medical history
• Perform a pelvic examination
• Test a sample of vaginal discharge
• Check the pH level of your vagina (BV typically makes it more alkaline)

Treatment

First-Line Treatment:

• Antibiotic tablets (such as metronidazole) taken by mouth
• Antibiotic gel or cream applied inside the vagina
• Treatment typically lasts 5-7 days

For Recurrent BV:

• Longer courses of antibiotics
• Maintenance therapy with antibiotic gel used intermittently
• May require treatment for several months to prevent recurrence

Partner Treatment:

• Male partners typically don’t need treatment
• Recent research suggests partner treatment may help prevent recurrence in some cases
• Female partners may benefit from treatment

Self-Care and Prevention

Helpful Practices:

• Use mild, unscented soap only on the outside of the vulva
• Avoid douching or vaginal deodorants
• Wear cotton underwear and loose-fitting clothes
• Change out of wet swimwear or gym clothes promptly

During Treatment:

• Complete the full course of antibiotics even if symptoms improve
• Avoid alcohol if taking metronidazole tablets
• Use additional contraception if using latex condoms (some treatments can weaken them)

When to Seek Help

Contact your healthcare provider if:

• You notice changes in vaginal discharge or smell
• Symptoms don’t improve after treatment
• BV keeps returning (more than 4 times per year)
• You’re pregnant and notice changes in discharge
• You have pain when urinating or during sex

Important Information

Pregnancy:

• BV can slightly increase the risk of pregnancy complications
• It’s important to get treatment if you’re pregnant
• Some treatments are safer during pregnancy than others

Impact on Sexual Health:

• BV can make you more susceptible to STIs
• It’s not harmful to your partner but can affect your own vaginal health
• Symptoms may worsen after unprotected sex

Living with Recurrent BV

If you experience frequent episodes:

• Work with your healthcare provider to develop a management plan
• Keep a diary to identify potential triggers
• Consider maintenance treatment options
• Don’t let embarrassment prevent you from seeking ongoing care

Remember: BV is extremely common, easily treatable, and nothing to be ashamed of. Many women experience it, and effective treatments are available.

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For detailed medical information, visit the NHS bacterial vaginosis page and speak with your healthcare provider about the best treatment approach for your situation.