Women's Health

The truth about bacterial vaginosis: It’s nothing you did wrong

Women's Health

The best way to prevent BV is to have regular checkups with your gynecologist.

Did you know your vagina has its own ecosystem? It contains a delicate balance of bacteria, with lactobacillus as the most common species. This is one of the probiotic or “good” bacteria that makes the vaginal pH acidic.

But sometimes, a shift in the ecosystem allows anaerobic or “bad” bacteria to take over. Changes in bacterial growth create a pH imbalance called bacterial vaginosis (BV) – an infection that approximately 30% of women ages 14-49 in the U.S. will develop.

BV can cause uncomfortable, sometimes distressing symptoms such as:

  • Vaginal discharge that is unusually thin, creamy, or off-white or gray
  • Irritation or inflammation of the vulva, the outer part of genitals
  • Pelvic pain during sex or urination
  • A “fishy” smell from the vagina

However, half of women with BV don’t have symptoms and often don’t receive treatment until the infection becomes severe. It’s important to get a well-woman exam at least once a year, since you may not detect it without one. Long term, BV increases the risk of:

  • Contracting sexually transmitted infections (STI)
  • Developing pelvic inflammatory disease, when bacteria spread from the vagina to the uterus, ovaries, or fallopian tubes
  • Preterm childbirth
  • Infertility and low fertility

Outdated notions persist that BV is an STI or that people who get it have bad hygiene. Neither are true, and although BV is unpleasant, it’s easy to treat with medication and a few simple changes to your daily routine.

What causes BV?

Bacterial vaginosis occurs when new bacteria are introduced to the vagina, changing its pH balance. This can be caused by experiences such as:

Clue cells are a diagnostic feature of bacterial vaginosis found during light microscopy of a cervical smear.
  • Sex with a new partner, multiple partners, or after a long stretch of abstinence. Unfamiliar bacteria from a new male or female sex partner can enter the vagina during intercourse.
  • Bathing or douching. Women often feel self-conscious about normal vaginal sweating or smells, so they use douches, scented soaps, and powdered products to mask it. But all of these are opportunities to introduce foreign bacteria.
  • Lifestyle choices. Eating an imbalanced diet and smoking have been associated with an increased risk of BV.

Women with a history of BV have a higher risk of getting it again. Black women are more likely to develop BV than white women; more research is needed to understand why.

How is BV diagnosed?

There are two ways to learn whether you have BV. If you don’t have symptoms, your health care provider might find it during a routine Pap smear. But if you have symptoms, your provider can diagnose BV with a simple, painless vaginal swab test.

UT Southwestern uses sophisticated lab technology that tells you whether you have BV within hours. If you have a particularly severe or recurring case, we will send your sample for analysis to identify which strain of BV you have within a day or two. This information will help us tailor your treatment.

If you’re a woman who has sex with women, it’s also recommended that your partner get tested for BV. However, if your partner is a man, he won’t need to be tested – BV cannot be passed from women to men.

What treatments are available?

A five-to-seven-day course of antibiotics is the gold-standard treatment for BV. Oral antibiotics are effective, and vaginal suppositories are available for women with severe symptoms, a history of allergies to oral antibiotics, or difficulty taking pills. Vaginal medications are self-administered at home with an inserter that works like a tampon or a yeast infection cream dispenser.

Take your medication as prescribed and abstain from sex while you’re being treated. Otherwise, the infection may not go away.

Women also should avoid drinking alcohol while taking certain types of BV medication to reduce the risk of nausea, vomiting, stomach pain, flushing of the face, or a faster heartbeat. Avoiding alcohol is especially important for women with preexisting liver disease. Talk with your health care provider about alcohol use before starting medication for BV.

How can you prevent BV?

While there’s no magic wand to eliminate all risk, there are easy ways to lower your chances of developing BV:

  • Avoid douching and using other vaginal cleaning products. Your vagina is self-cleaning – there is no need to use anything else unless prescribed by a provider. And you don’t need fancy soaps or powders to wash your vulva. All you need is warm water and a gentle washcloth to stay clean.
  • Use protection during sex. Condoms and barriers can help reduce the risk of BV while also lowering your risk of STIs.
  • Maintain a healthy diet. Some research suggests that eating a diet high in saturated fat can increase the risk of getting BV.
  • Quit smoking. Tobacco use can alter your vaginal chemistry and heighten your risk of BV.

Going to your gynecologist or women’s health provider regularly is the best way to detect and prevent BV, even if you’re asymptomatic. Routine checkups can also identify other concerning conditions, such as STIs and cervical cancer. It’s also important to pay attention to how much vaginal discharge is normal for you, so you can identify changes sooner.

Patients often worry about being judged for having BV. It’s nothing you did wrong, and it is easy to diagnose and treat. So, talk with your provider at the first sign of symptoms. We can help you start feeling better fast and avoid another infection.

To connect with a gynecologist, call 214-645-8300 or request an appointment online.