Having an itchy, painful, smelly vagina is a special kind of terrible. Even more terrible is when treatment to remedy these issues doesn’t work — which happens far too often for people who get bacterial vaginosis.
The condition is very common, as is recurrence. New treatments are being studied but, in the meantime, here’s what you need to know about how to manage it.
What causes bacterial vaginosis and why does it recur?
“Bacterial vaginosis results from a change in the normal vaginal microbiome,” says Dr. Anita Tiwari, an OB-GYN at UW Medical Center – Northwest. “The main thought is that the vaginal microbiome changes from being Lactobacillus predominant to overgrowth of other normal bacteria which increases the pH of the vagina.”
This makes bacterial vaginosis different from other vaginal problems like yeast infections, which are caused by fungi.
So, what exactly causes the bacteria colony to change? Not using condoms during sex, having multiple sex partners and vaginal douching are all thought to play a part — but not always, and other factors could be involved.
Research has shown that the condition is more common during your period. It may also be more common in people who have copper IUDs, but not in people who use injected or implanted hormonal methods.
Unfortunately, it’s not uncommon for bacterial vaginosis to come back after you think it’s been successfully treated. Recurrence rates may be anywhere from 15% to 30% of all cases, Tiwari says, and why it happens is unclear.
“Recurrent BV is defined by having greater than three symptomatic infections in one year. Recurrence tends to occur within the first few months after the initial treatment,” she says.
What are the symptoms of bacterial vaginosis?
Many people who have bacterial vaginosis won’t have symptoms, but if symptoms do occur they are usually annoying things like vaginal itching, discharge and odor (sometimes described as fishy-smelling) and pain when peeing.
“Symptomatic BV can be uncomfortable and recurrence of these symptoms can impact personal relationships and intimacy,” Tiwari says.
Since these symptoms are similar to symptoms of a sexually transmitted infection (STI), it’s worth talking with your doctor about even if you suspect bacterial vaginosis.
Bacterial vaginosis isn’t an STI but it can put someone at higher risk for developing an STI if they are exposed to one during sex. This includes STIs like gonorrhea, HPV and even HIV. The Centers for Disease Control and Prevention (CDC) actually recommend that people who are diagnosed with BV get tested for HIV and other STIs.
It may also increase the risk of infertility and cervical cancer plus preterm birth in pregnant people.
How can I prevent bacterial vaginosis from recurring?
If you’re one of the many who get recurrent bacterial vaginosis, you have our condolences — we know how frustrating it can be.
All cases of bacterial vaginosis, even recurring ones, are treated with antibiotics, either as pills you take or tablets you insert into your vagina. Other options are being studied, but so far don’t show much promise.
Whether you’re prone to bacterial vaginosis or have never had it but want to avoid it, there are some things you can do to prevent it.
Finish your full course of antibiotics
If your doctor prescribes antibiotics to treat bacterial vaginosis, make sure you take all of them as prescribed. Stopping antibiotics early can prevent them from fully eradicating the infection, making it more likely to return.
Try boric acid capsules (in the vagina)
Boric acid is often recommended by doctors to help treat bacterial vaginosis. It’s generally safe to use as long as you insert it into your vagina — never take it orally. It’s also only shown to be effective in addition to, not instead of, antibiotics.
You can purchase boric acid suppositories, or capsules, over the counter. However, make sure your symptoms are actually caused by BV before trying this remedy, as using boric acid in a healthy vagina could actually upset your vagina’s natural pH and bacterial makeup — aka create a problem where there wasn’t one.
Douching — cleaning the inside of your vagina — increases the risk of BV. Douching is also unnecessary because your vagina cleans itself naturally. Many douching products have scents or other ingredients that could cause vaginal irritation as well as upset the natural pH and bacteria in your vagina.
You also don’t need to scrub your vulva, the outside of your vagina. Rinsing the area with water in the shower or using a mild soap is good enough.
Use condoms during sex
No matter the gender(s) of your sex partners, there are condoms available to create a protective barrier if you’re having sex where something is inserted into your vagina. This is especially important if you have multiple sex partners, as exposing your vagina to multiple sources of bacteria can increase the likelihood that BV will develop.
Clean menstrual cups and sex toys
Bacteria can collect on things you put in your vagina, like menstrual cups and sex toys, so it’s always important to clean them after use (yes, every time).
Regularly change pads and tampons
Along with possibly helping prevent BV, this is also just a good habit to get into, as leaving a tampon in for too long in particular can increase your risk for developing toxic shock syndrome (TSS).
Avoid wearing tight underwear
Tight underwear or underwear made from non-breathable fabric (like silk or polyester) can prevent airflow and encourage bacteria to grow. And if you’ve been sweating a lot down there, change underwear or clothing as soon as possible to help prevent bacterial overgrowth.
Take a probiotic
This one is controversial, as there still isn’t much research on whether probiotics actually do much to help treat or prevent bacterial vaginosis. In general, taking probiotics isn’t harmful, so if you want to give it a try, talk with your doctor and see what they recommend — since probiotic supplements come in many forms and aren’t nationally regulated.
Vaginal fluid transplant: the future of bacterial vaginosis treatment?
If you’re thinking that it seems like there aren’t a lot of options for treating bacterial vaginosis, especially the recurring kind … well, you’re right. Even though nearly 30% of women and other people with vaginas have the condition at any given time, and despite the long-term health risks it can contribute to, there have not been many breakthroughs.
Researchers are hoping to change that. In the summer of 2022, a U.S. hospital performed the first vaginal fluid transplant in a patient with recurring bacterial vaginosis. The procedure was simple and surgery-free, using an eyedropper to transfer the fluid during a standard gynecologic exam.
The idea is that promoting growth of Lactobacillus by adding more of it will reestablish a healthy vaginal microbiome. Researchers don’t yet know if the fluid transplant is helpful, though, so it will be a while before (if) the treatment is available to the general public.
Donors need to be screened to make sure their vaginal fluid does not contain any STIs or yeast, and one treatment would require fluid from many donors — plus there’s the question of how to develop the treatment for large-scale use, Tiwari explains.
Alternatively, the vaginal microbiome could be replenished by using a probiotic delivered intravaginally, which would be easier to produce. Early research has shown this to be a promising strategy, particularly for preventing recurrence.
Until more robust treatments are widely available, it’s important to finish your full course of antibiotics if you have bacterial vaginosis, and never hesitate to talk with your doctor if the condition comes back post-treatment.