Bacterial vaginosis (BV) – Practitioners’ Guide

Effectively treating BV means first identifying the real problem, then targeting your treatment options.

What is bacterial vaginosis?

Bacterial vaginosis is a form of vaginal dysbiosis that can cause a range of unpleasant symptoms like a fishy or foul vaginal odour. BV can be asymptomatic, discovered during routine tests.

BV fast facts:

  • Polymicrobial
  • Recurrent BV typically includes bacterial biofilms
  • BV is not an infection per se, but an imbalance in flora
  • Varies widely in specific bacteria present
  • Not tested for adequately
  • Often improperly treated with antibiotics, which do not break down biofilms
  • Medicine does not have adequate treatments
Diagnosing BV

Initially, sexually transmitted infections and other underlying pathology should be eliminated with an examination and STI screen.

The main issue in treating BV is identifying the correct microbes so that effective treatment can be administered, however many areas do not offer comprehensive vaginal microbiome testing, so treatment can be a little hit and miss. If you can get a BV/AV/lactobacilli PCR test, do so, since these tests offer us the best information about what is in the vagina.

Do a pH test.


A culture is usually performed at regular medical clinics, however due to the polymicrobial nature of BV, some of the microbes involved are unculturable, so this culture misses these microbes.

Some microbes are slow to grow, fastidious in nature, or simply won’t grow in a culture for whatever reason. It is also some of these microbes that are naturally antibiotic resistant and/or are quick to develop resistance. Repeated antibiotic treatments are often given to these women, building the drug resistance of the microbes that nobody knows are there, creating a much harder problem to solve.

PCR testing

PCR testing, which looks for microbial DNA in a sample (even of dead bacteria), is a much more effective way of testing, but PCR testing still has its cons. You have to deliberately seek a DNA sequence to find it, which means you have to know what to look for to find it.

Bacterial vaginosis assays are getting better, but at the moment this testing can be difficult to request and results incomplete.

Choosing the best way forward with your patient

Our recommendation depends on your patient’s budget and the severity of symptoms – if your patient can afford to try a couple of treatments before one works, then extensive testing is not required (one treatment will work), but if their symptoms are severe, getting an extensive test will fast-track the correct treatment, including the recommended antibiotic therapy.

Treating BV effectively

The usual medical treatment for bacterial vaginosis is antibiotics, either metronidazole or clindamycin. If this treatment has worked, you will not hear about it from your client/patient, because it worked – it’s when this doesn’t work that women are trapped in a cycle of recurrent symptoms.

Further symptoms just result in more antibiotics through sheer lack of options, which is usually when women turn to the internet for help. This helps is often not forthcoming – the internet tells more lies about BV than about the moon-landing.

Our approach to treating recurrent BV

The treatment we use for BV starts out with the cheapest option that is most widely available – in most places, gentian (crystal) violet, or in Europe, Fluomizin. Both these options are excellent for broad-spectrum non-antibiotic treatments with a high cure rate without extensive testing, and are very affordable.

Basic vaginal BV treatment recommendations:

  • Gentian violet – 5-10 days with 0.5% (dilute with water) soaked tampon for a few minutes to a few hours each day. Any irritation, stop immediately, as ulceration has been reported.
  • Fluomizin – packs come with six vaginal tablets, we suggest doing 12 days, one vaginal tablet at night.

We recommend Jarro-Dophilus Women 10bn CFU (refrigerated type) orally one per day with food, and vaginally 1-2 per day, but transfer to vegetable capsules (as gelatin/enteric coated do not dissolve in the vagina). Dip in water before insertion to compensate for vaginal dryness during treatments.

Affordability and accessibility are important here, however what your patient will tolerate and comply with will be at your discretion. When women are desperate enough, they’ll try just about anything, which is great, because they may need to try a few different options to see what works and what doesn’t.

Treating a patient for recurrent BV

If you are treating your patient’s BV yourself, we suggest you read Killing BV – read whichever bits are of interest to you and skip right to the treatments in the support section if you don’t need a lesson on the vagina.

We have preferences for treatment starting with the least offensive/expensive, but this is going to depend heavily on your patient’s body, emotional resilience, and their capacity to afford testing and ingredients. Compliance is typically not an issue if a patient has a clear treatment program laid out that has the support of their practitioner.

Many of these treatments include biofilm/enzyme treatments which for some patients will require careful monitoring. Please check contraindications carefully.

Full treatment protocols for BV are in Killing BV and Killing BV: Guide for Men support sections for now. We’ll be broadening the Practitioners’ Section out more fully over time.

If you are providing advice to a client or patient to treat their BV at home

You can buy your client Killing BV and/or Killing BV: Guide for Men by bulk purchasing a set of five book codes or just buy a one-off code to give to them. The book codes apply to any book, or to taking $7.99 off the cart total at checkout.

With that code, your patient can download the books themselves, automatically creating a login so they can access the support section and emails to us here at My Vagina. Our specialist naturopaths offer general email support regarding treatments, which helps your patients through their treatments while also building our knowledge base of the weird and wacky things that can happen!

Practitioner email support for practitioners

At the moment we are not offering detailed practitioner support.

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
Read more about Jessica and My Vagina's origin story.