The ultimate guide to understanding and treating bacterial vaginosis (BV)

Bacterial vaginosis (BV) is the overgrowth of disruptive bacteria in the vagina, which can result in odour, unusual discharge and a shift in vaginal pH. BV may be asymptomatic, only found during health testing for other reasons.

A premenopausal healthy vaginal microbiome tends to be made up largely of protective bacteria such as lactobacilli, a lactic-acid-producing bacteria that fight pathogens and keep infections away.

If you’ve been diagnosed with BV, sadly, you’re not alone!

The Center for Disease Control (CDC) says BV is the most common vaginal issue in ages 15-44 – a whopping 30% get BV each year.

When lactobacilli dominance is disrupted, the vaginal pH can rise, allowing other types of bacteria to grow and cause an imbalance (known in medicine as vaginal dysbiosis).

This vaginal bacterial imbalance can contribute to symptoms like vaginal odour, irritation, itching, burning and unusual vaginal discharge. ‍But, up to 84% of those with a BV diagnosis won’t get any symptoms.

Symptoms of bacterial vaginosis (BV)

• Greyish, watery discharge
• Unusual discharge
• Fishy, foul, musty or ammonia vaginal odour
• Symptoms worsen during or after menstrual bleeding
• Certain BV-related bacteria may contribute to other symptoms such as itching or inflammation
• Vaginal pH above 4.5

Understanding why BV occurs

In some uncomfortable news, the CDC also says that we don’t know why BV develops. Why some of us and not others?

BV is not an infection, but an imbalance, caused by a change in bacterial species in your vagina. There is an umbrella term for this change in species: vaginal dysbiosis. Dysbiosis means a microbial imbalance, or simply put, the wrong bugs in the wrong place.

Vaginal dysbiosis appears in many forms, including yeast infections and aerobic vaginitis (AV).

Why does the balance shift to BV?

Your vagina is not an isolated area; your entire body supports it. There are lots of reasons why the balance of your vaginal flora may change for the worse, including:

• Hormonal changes (periods, birth control, pregnancy, low oestrogen states such as losing one or both ovaries, perimenopause, menopause, surgery, radiation, oestrogen-blocking breast cancer drugs, chemo, post-partum)
• Food intolerances^​1–3​ (certain food colourings, for example, are known to inhibit your immune system)
• Stress (stress hormones like cortisol block glycogen production in the vagina, starving your healthy bacteria)
• Digestive problems^​4,5​ (people with irritable bowel, Crohn’s and other digestive problems/diseases tend to have more vaginal infections and imbalances)
• Lifestyle choices (those who drink a lot of alcohol and smoke get more BV, while recreational drugs^​6​ and lack of good quality sleep reduce immunity^​7–10​)
• Poor diet^{​11–15​} (if you live on burgers, chips, frozen food and pasta, you’re setting yourself up for immune deficiencies)
• Poor immunity (your immune system is critical in fighting off pathogen invaders)
• Unprotected sex (you can catch BV from a sexual partner)
• Naturally low levels of lactobacilli (certain ethnic groups inherit naturally low levels of lactobacilli from their mothers, which can result in a greater susceptibility to BV)

What is a bacterial biofilm in BV and why does it matter?

Many bacteria build biofilms. Think of it like a perspex case that covers the vaginal cells, protecting the bacteria from treatments and other bacteria (antibiotics).

If your vagina has a lot of biofilm, symptoms may disappear temporarily as the treatments kill bacteria, but there are always more hiding under the safety of the biofilm, so BV returns, whether in a day or a week or a month.

Understanding the vaginal microbiome and symptoms

Your symptoms will depend largely on what bacteria you have present. Not all BV is the same.

For example, a G. vaginalis dominant vaginal microbiome is likely to have a fishy odour, and watery, grey discharge without inflammation. Add Prevotella or Ureaplasma, and you may start getting inflammation.

Meanwhile, in aerobic vaginitis (AV), an E. coli dominant vagina is likely to be inflamed, burn, and have yellow-green discharge.

Get a comprehensive vaginal microbiome test to find out what’s growing in your vagina. A culture isn’t enough, and a PCR test is only just passable.

How BV is diagnosed – getting the right test

Regular swabs and culture

Every country does BV diagnosis a little bit differently, but the main method is a culture. Cultures are barely useful and now outdated compared to a comprehensive vaginal microbiome test).

A lab culture is the process of taking a vaginal fluid sample, sending it to the lab, and seeing which bacteria or fungi grow over a set period of time, say 12 or 24 hours.

Vaginal culture cannot detect some BV-related bacteria, because some microbes are hard to grow in these conditions. The dominant strains of bacteria will appear, while others will be dismissed as unimportant – which isn’t always true.

Comprehensive DNA-based vaginal microbiome testing

A comprehensive vaginal microbiome test looks for microbial DNA/RNA, and can detect the genetic material from even a dead microbe.

Polymerase chain reaction (PCR) tests can only find what the test asks for. If you don’t ask, it won’t tell. This is why the more comprehensive NGS tests are preferable. Get a comprehensive vaginal microbiome test online, and delivered to your door.

Testing vaginal pH (acidity levels)

In BV, vaginal pH may be above 4.5, indicating an abundance of non-lactobacilli species. You can, and should, regularly test your vaginal pH at home using correctly measured vaginal pH strips.

Effectively treating BV

BV can be resolved with appropriate treatment, which may be antibiotics, non-drug treatments or a combination of multiple treatment strategies.

My Vagina’s effective, natural treatments for BV

We recommend first getting a good test, then using one of our effective non-drug BV treatments, such as the BV Vaginal Pessary.

Other effective My Vagina BV treatments include:

• Lactulose Vaginal Prebiotic to feed protective lactobacilli
• Add a vaginal V-Spot and oral vagina-specific probiotic
• Double Whammy Vaginal Pessary if you’re not sure exactly what you have
• Fluomizin (non-drug, easy vaginal tablets)
• For severe or chronic BV, use the Four-Pronged Approach Fixer Box with the antimicrobial of your choice

Antibiotic treatment of BV

The most common medical treatment for BV is antibiotics, usually metronidazole or clindamycin.

Home remedies for BV

There are loads of at-home treatments online, which My Vagina explains the value of (or lack thereof), such as apple cider vinegar, tea tree oil, live yoghurt, boric acid and others.

Treating chronic BV

Recurrence rates after standard medical treatment with antibiotics (usually metronidazole or clindamycin) are unacceptably high, leaving many with chronic symptoms.

If your BV won’t go away, schedule an appointment with one of My Vagina’s qualified, experienced naturopathic practitioners. Working out why BV keeps coming back over and over is important to resolve it over the long term.

Antibiotics can work well, but there are some key problems with repeated antibiotic use, including antibiotic resistance, damage to the overall microbiome, a poor cure rate, and feeling unwell while taking them.

My Vagina’s unique, effective Killing BV system

Here at My Vagina, we specialise in treating BV and take treatment failures seriously. We know how horrible BV is – we’ve had it too.

We also take antibiotic resistance seriously – considered a global health emergency by the World Health Organisation. Our treatments are antibiotic and hormone free, using nature-based ingredients and a holistic approach to microbial imbalances.

Understanding how and why BV develops is the key to unlocking its driving factors in your body. All BV is not created equal.

Join Killing BV and join the tens of thousands of others who have benefited greatly from the immense wealth of information and effective treatments.

Enjoy exclusive membership to the support section for plenty more information and tips and tricks. Start your drug-free journey to a healthy, happy, BV-free vagina guided by one of the world’s very best and only vulvovaginal specialist naturopaths, Jessica Lloyd.

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References^{​16–19​}

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BV Vaginal Pessary

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