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You may have suffered for years with symptoms of bacterial vaginosis (BV), so getting properly diagnosed matters.
You might not have BV at all, and knowing exactly what you are treating means you can choose the best approach for your body and microbiome.
BV is diagnosed by pairing your symptoms with a few quick checks: the look of your discharge, your vaginal pH, a whiff test, and clue cells seen under the microscope.
A lab test – ideally comprehensive sequencing – then shows which bacteria are actually there.
Here is what to expect at your appointment, and how to make sure the result is one you can act on.
Once you have a clear diagnosis, talk to your healthcare provider about what was found and which tests were run.
Always get a copy of your lab results after every visit, for your own records. Not all tests are equal, and if your BV does not clear, you want to be able to investigate further – with another practitioner or on your own.
Why does BV happen?
In BV, protective vaginal bacteria are lost and disruptive bacteria take up residence in their place.1 The protective residents are mostly Lactobacillus species, which keep the vagina acidic.
When they thin out, a mixed crowd of anaerobes such as Gardnerella vaginalis moves in. Those bacteria can also build a sticky biofilm on the vaginal wall.
That biofilm is part of why BV can be so stubborn, and why it so often comes back after treatment.
One thing to get out of the way early: BV is not a sign of poor hygiene. If anything, over-washing and douching make it more likely, not less. It is a shift in an ecosystem, and it can happen to anyone with a vagina.
Plenty of things can tip the balance – hormones, sex, douching and washes, antibiotics, and a rise in vaginal pH among them.
That is why treating the bacteria alone often is not enough; the conditions that let them take over matter just as much.
How is BV diagnosed – what to expect
Most clinicians use a set of four signs known as the Amsel criteria, and three of the four are enough to diagnose BV.2
- An evenly coloured grey-white discharge coating the vaginal walls (you may not be able to see this yourself).
- Clue cells on a wet-mount slide, viewed under the microscope.
- A vaginal pH over 4.5 – disruptive bacteria make the vagina less acidic, while protective lactobacilli keep it acidic.
- A fishy odour, which your doctor may detect directly or bring out by adding potassium hydroxide to the sample – the whiff test.
In practice, this usually means a short speculum exam and a swab, though a self-collected swab works well for many of these checks too. A pH strip takes seconds.
A lab test – culture, PCR or NGS – is often run to identify the microbes present and guide treatment.
Not every microbe will grow in a culture, so a comprehensive NGS test, or at least a broad PCR, gives a fuller picture than culture alone.
This is where the type of test really matters. A culture only grows the bacteria that will grow in a dish, and many BV-associated anaerobes will not. A standard PCR checks a preset list of usual suspects.
Comprehensive sequencing reads whatever is actually there, which is why it so often explains a stubborn case that earlier tests called normal.
If your symptoms do not clearly fit BV, it is worth checking what else could be going on – our yeast, BV or something else symptom checker is a good place to start.
Do not wash away the clues before your test
If you have been douching to get rid of the smell, you may have rinsed away many of the very clues your clinician needs to diagnose you – which can give a false negative.
For an accurate result, do not douche or use any treatments before your appointment. The same goes for STI testing.
Antibiotics for BV often are not enough
A doctor will most likely prescribe antibiotics, usually metronidazole, since protective lactobacilli are relatively resistant to it and more of them survive.2
You may be given oral tablets, a vaginal gel, clindamycin cream, or tinidazole, sometimes in combination.
For many people antibiotics do work, at least at first. The trouble is recurrence: more than half of women have BV again within 12 months of oral metronidazole.3
If a first course does not hold, another is often prescribed. Your doctor may also test for STIs, consider allergies (to condoms, for instance), and check for pelvic inflammatory disease (PID) if that fits your symptoms.
If you keep ending up back where you started, it is worth understanding why antibiotics do not always work on BV – the biofilm and the underlying conditions are usually the reason.
Natural and functional-medicine treatment
Natural medicine and conventional care are allies here, not opponents. Antibiotics can knock back an acute flare; rebuilding a protective, lactobacilli-rich environment is what helps it hold.
Restoring those protective bacteria, rather than only clearing the disruptive ones, is central to how we treat BV, and a growing evidence base backs it.4
We have been treating BV for over a decade, and the biggest predictor of getting on top of it is an accurate diagnosis to start from – guessing from symptoms alone sends people in circles.
Our approach pairs a comprehensive vaginal microbiome test with your symptoms, so treatment is matched to what is actually there. You can also check your pH at home to track how things are going between tests.
If you want to treat at home with a structured plan, our Killing BV treatment guide walks you through why BV happens and how to work on it step by step.
Does my male partner need treatment?
For a long time the standard advice was that male partners did not need treating. That has now changed.
A landmark randomised trial published in 2025 showed that treating male partners alongside women roughly halves the rate of BV recurrence.5 This matters most if you have regular condomless sex with a male partner.
Men usually have no symptoms, but BV-associated bacteria have been found on penile skin and in urine and semen, and can be passed back to the vagina.
Treating both partners together gives you a much better chance of it staying gone.
My Vagina has been treating men and people with penises for BV for over a decade, and our Killing BV guide for men is a natural treatment protocol built for exactly this.
What this means for your vagina
An accurate diagnosis is the whole game with BV. It tells you whether it is BV at all, what is driving it, and which treatment is worth your time – so you are not treating the wrong thing for months.
See a doctor promptly, rather than self-treating, if any of these apply:
- You are pregnant, or think you might be – BV in pregnancy needs proper care.
- Pelvic or lower-tummy pain, fever, or pain during sex.
- Bleeding that is not your period, or bleeding after sex.
- Any chance of a sexually transmitted infection.
- Symptoms that keep returning or never fully settle.
This is general information, not a substitute for personalised medical advice.
Frequently asked questions
How is BV diagnosed at the doctor?
By combining your symptoms with quick in-clinic checks – discharge, vaginal pH, a whiff test and clue cells under the microscope – and often a lab test to confirm which bacteria are present.
Three of the four Amsel signs are enough to diagnose BV.
Can I test for BV at home?
You can check your vaginal pH at home, which is a useful clue but not a diagnosis on its own. For a full picture, a comprehensive microbiome test tells you exactly which bacteria are there.
Can they tell it is BV from symptoms alone?
Not reliably. BV, yeast and other causes overlap, so testing is the way to be sure before you treat. Guessing is how people end up treating the wrong thing.
Why does my BV keep coming back?
Recurrence is common because antibiotics clear the bacteria but do not rebuild the protective community, tackle the biofilm, or address what tipped the balance.
More than half of women have a recurrence within a year of oral metronidazole.
Do I need to stop treatments before my test?
Yes. Douching or using treatments beforehand can wash away the clues and give a false negative. Leave things alone before your appointment, and before STI testing too.
Is BV a sexually transmitted infection?
BV is not classed as an STI, but it is closely linked to sexual activity, and we now know that treating a regular male partner helps prevent recurrence. It is still worth ruling out STIs separately if there is any chance of one.
Does my partner need treating?
If you have a regular male partner, treating them alongside you roughly halves recurrence, so it is well worth doing. This is a recent shift in the evidence, so your doctor may not raise it first.
What to do next
If you think you have BV, the most useful first step is an accurate test rather than a guess. A comprehensive microbiome test, paired with your symptoms, tells you what you are actually dealing with.
From there you can treat with confidence – and if it keeps returning, that is the signal to look at the underlying picture.
You can ask Aunt Vadge’s Assistant, the chat widget in the bottom-left of your screen, or book an appointment with one of our practitioners.
- Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011;108(Suppl 1):4680–4687.
- Paladine HL, Desai UA. Vaginitis: Diagnosis and Treatment. Am Fam Physician. 2018;97(5):321–329.
- Bradshaw CS, Morton AN, Hocking J, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193(11):1478–1486.
- van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review. BJOG. 2020;127(2):287–299.
- Vodstrcil LA, Plummer EL, Fairley CK, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med. 2025;392(10):947–957.
