Breastfeeding & Battling BV: Expert Advice

Hello Aunt Vadge,

I have been struggling with recurrent BV since the birth of my daughter 1 year ago.

The symptoms I typically develop are yellow/green discharge (and lots of it, usually when I relax my pelvic floor to use the bathroom) and occasional itchiness. I am currently breastfeeding but my cycle returned 4 months postpartum, so I imagine there is a lot of hormone fluctuation going on.

I use boric acid to offset major symptoms and have been taking an oral probiotic for a month now.

I did a vaginal swab a month ago and the results came back positive for Gardnerella V aginalis and Group B Strep (I was GBS negative during pregnancy though).

With that information, I chose not to take the antibiotic assuming there is a biofilm present.

Instead, I diluted my oral probiotic in water and inserted some vaginally for a few days. This helped tremendously, but after having sex a few times I am back to the same discomfort.

Is this something I can continue doing? Is there a stronger vaginal probiotic suppository you would recommend? I am desperate for long term relief!

Sincerely,
Suffering
Age 24, Texas USA

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Dear Suffering,

I’m genuinely sorry to hear that you’re dealing with recurrent BV – it’s such an annoying issue to wrestle with, especially with a little one to care for and all the hormonal merry-go-round postpartum life brings.

First things first, it’s okay to be GBS positive now even though you were negative during pregnancy, but it’s important to work out if Group B Strep is contributing to your current symptoms.

The green/yellow discharge suggests it is, which may indicate it’s more of an aerobic vaginitis (AV) problem, rather than a bacterial vaginosis problem.

The difference here is in which microbes are causing all the fuss, which helps us in terms of which to prioritise to get your vagina back on track.

In your case, we don’t have a comprehensive vaginal microbiome panel (which you don’t need a doctor to order BTW). We’ll use the G. vaginalis and GBS as indicators of what’s going on, plus the breastfeeding, which is an important clue to the why of all this.

Down the bottom, you’ll find my treatment recommendation, but first I’ll explain a little.

So, you’re right; fluctuating hormones can certainly contribute to the ups and downs of vaginal health, particularly during breastfeeding, when oestrogen levels can be low due to high prolactin levels.

Oestrogen stimulates a sugar, glycogen, in your vaginal cells, which is the food source for your protective lactobacilli species. Without this energy source, lactobacilli numbers dwindle, and protection gets low, allowing any ole microbe in for a hang. Hello G. vaginalis and GBS!

In a post, vulvovaginal specialist naturopath Jessica Lloyd discusses the impact of breastfeeding on oestrogen levels, and the vaginal microbiome. The post also has a list of foods that contain phyto-oestrogens, which you can use to increase your systemic oestrogen levels while breastfeeding.

That way you can work on using food as medicine, rather than relying solely on vaginal treatments, by incorporating some of these foods into your diet on the regular. The problem of low oestrogen isn’t going to go away until you stop nursing.

Now, about that biofilm assumption – you’re onto something there. Gardnerella vaginalis can be a sneaky little bugger that forms biofilms, which can make treatment more challenging.

Using boric acid can indeed help alleviate symptoms since it has antiseptic properties. The thing with boric acid is to use it wisely and with a clear understanding of when and how often to use it, but realising it is not a cure – it is very useful but most of the time only seems to work as a management tool.

As for vaginal probiotics – kudos for taking the initiative to introduce some good bacteria into the environment. However, creating your own vaginal probiotics by mixing formulations with water may be an issue because plain tap water contains chlorine – designed to kill bacteria! Good idea, but make sure to use unchlorinated water if you opt for this in future.

Look for probiotics that contain vagina-specific Lactobacillus strains, which are typically the dominant protective bacteria in the vagina.

And about that sex connection – it’s quite common for sex to throw off the vaginal flora. Using condoms, urinating after sex, and ensuring both partners have good hygiene can help reduce the impact on your vaginal environment. This is especially true when you have low oestrogen, such as when nursing.

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Two week treatment recommendation:

This vaginal treatment may move you out of being symptomatic and into the light.

Alternating nights use Aunt Vadge’s Fennelope and Aunt Vadge’s Double Whammy, so never at the same time.

Across the first week, use a vaginal probiotic during the day.

I’d also recommend keeping track of your vaginal pH using strips, so you can see when your problems might be returning and can do spot treatments to keep them at bay.

Additionally, check out the searchable phyto-oestrogen foods list, and add a few of the higher listed items into your daily diet. Crushed flaxseeds are a great choice, as you can put them on just about everything.

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This combination of treatments will help strengthen and support your vaginal cells so they are producing glycogen again, while specifically targeting the G. vaginalis and GBS, and providing food for your healthy lactobacilli to thrive once again.

As for continuing the approach you’ve been taking, if what I’ve suggested doesn’t offer the results you’re after, it might be worth discussing your situation with a healthcare provider, who could recommend a treatment plan tailored to you.

Lastly, don’t give up hope for long-term relief! Keep advocating for your health, consider a chat with a healthcare professional about your concerns and treatment options, and keep taking care of yourself, both down there and overall.

Sending you lots of strength and hoping you find that relief very soon! Keep your chin up, you’re doing the best you can.💕

Lots of love,
Aunt Vadge