Vaginal pH and BV – how it works and why it does and doesn’t matter

TL;DR

Vaginal pH plays a significant role in the development and exacerbation of bacterial vaginosis (BV), with fluctuations throughout the menstrual cycle affecting the condition. While an acidic environment favours beneficial lactobacilli, alkaline conditions promote harmful bacteria like Gardnerella vaginalis. However, simply altering the pH with remedies like vitamin C or lactic acid tablets doesn’t tackle the root problem – the G.vaginalis biofilm.

A lot gets waxed lyrical about vaginal pH and how important it is in bacterial vaginosis (BV). This is only half true. Here’s why.

Your vagina should have an acidic pH of around 4 (between 3.5 and 4.5). The pH of your vagina changes naturally throughout your cycle, which is why some parts of your cycle seem to exacerbate BV symptoms as the vagina becomes more alkaline. Menstrual blood, semen and fertile cervical fluid are all alkaline, and therefore adjust the pH when present. Gardnerella vaginalis loves an alkaline environment; lactobacilli in turn like it acidic, which is why they produce lactic acid.

pH matters when alkalising bacteria overtake the vagina and lowers the pH, making the environment less conducive to lactobacilli, who enjoy acidity, being lactic-acid producing bacteria themselves. This is why lactobacilli (such as Lactobacillus acidophilus) can tolerate stomach acid, we can swallow them in the form of probiotics, and they make it into our intestine while most other bacteria die on the way in (as a protective mechanism).

Just filling your vagina with vitamin C, lactic acid tablets or apple cider vinegar is not going to cure your BV. In BV, the pH change does not attack and disrupt the G.vaginalisbiofilm, which is where your true problem lies, but merely makes a more acidic environment temporarily.    



Jessica Lloyd - Vulvovaginal Specialist 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)
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