Black women and BV

Black women and BV

Black women get more BV. Unfair, huh. This is another thing you can blame your mother for!

The incidence of bacterial vaginosis in black women is twice that of most other ethnic groups due to naturally low numbers of protective lactobacilli in the vagina and a greater diversity of bacteria. These species are passed down from mother to daughter, and you get what you’re given at birth.

Lactobacilli are typically the healthy bacteria that live in the vagina. These bacteria are well-suited to the vagina, and keep it healthy via a few mechanisms. They produce lactic acid, hydrogen peroxide, and special weapons of mass destruction that kill or deter invading microbes.

Bacterial vaginosis can cause unpleasant vaginal odours (fishy, rotten, etc.) and unusual discharge. There are other symptoms based on which bacteria are present, such as itching, soreness, and pain.

The very general breakdown of vaginal microbiome

  • Asian – mostly lactobacilli
  • European – mostly lactobacilli
  • African – 60 per cent lactobacilli
  • Hispanic – 60 per cent lactobacilli

Read more about vaginal microbes around the world

What do low lactobacilli counts mean in real life?

Low lactobacilli counts doesn’t mean an unhealthy vagina – it just means being more prone to vaginal infections and microbial imbalances. Pathogens are opportunistic, and you having low microbial defences means bad bacteria can more easily bust in and take over. Lactobacilli are very strong and enthusiastic vaginal warriors, so being low in lactobacilli can mean invasions are easier for pathogens.

Think of your country’s army being made up of zoo animals instead of people. If your army is a mixture of three blind mice, a cat, a dog and a camel, you’re in for a rough trot if a tiger tries to invade – none of your army personnel can beat a tiger.

If, by contrast, you have an army made up of a lion, two rhinoceros, and a deadly snake, you’re going to fare much better if that tiger tries to invade.

It’s the same with your vaginal bacteria. Good fighters – lactobacilli – make invasion much more difficult.

Low lactobacilli can result in more BV if you are regularly douching, have taken lots of antibiotics, or are exposed to infected sexual partners, for example, because your fighters get overwhelmed far more easily.

Why are the bacteria different between ethnicities?

Way back whenever (take your pick at a date), we all lived generally separate lives in tribes, or cavemen and women, and so the bacteria that we were exposed to were differed between regions. Humans had far less contact with ‘strange’, and thus far less children from ‘another mother’ outside of the base community.

How we get our vaginal bacteria in the first place

A woman gets pregnant, and as that baby comes out of the vagina, it’s nose and mouth – and if it’s a girl, it’s vagina – gets covered in the mother’s vaginal bacteria. This is what starts us off with our first ever bacterial colonies, and are the types of bacteria that will be with us for life (unless we change it somehow).

Women who have only African or Hispanic female maternal lines will naturally have far fewer lactobacilli than women who have mixed-ethnicity maternal backgrounds, or a complete other ethnic background. This means if you have non-African-descent mother, your vaginal microflora is likely to be more like where your mother is from, and where her mother is from, ethnically speaking.

Fathers do not matter here for obvious reasons – they do not contribute to our initial microbiome, at least not much and not vaginally.

Do low numbers of lactobacilli matter?

Yes and no. You can have a perfectly healthy vagina with low numbers of lactobacilli – it’s what’s normal for you. If your vagina is healthy, smells like nothing much, your periods don’t make you gag, and your discharge is not unusual, then there is no need to worry. If you get a test and it indicates an unhealthy vagina, then you can go from there with your healthcare provider in terms of treatments, but no treatment may be a suitable way forward.

Our vaginal microbiomes are complex and we don’t fully understand the way colonies work, or even what microbes make up a healthy or unhealthy vagina. Bacteria work together to promote the environment they want, and that can be good, neutral, or bad for us as their host. This means it’s possible to have a collection of vaginal bacteria, even low in lactobacilli, that don’t cause issues.

Low good bacterial counts matter if you are exposed to pathogens and your immunity is down. This might mean:

  • Low immunity (sick a lot, underlying health problems)
  • Stress
  • Low quality diet
  • Unprotected sex with partners who may be carrying unhealthy bacteria (without knowing)
  • Regular douching

Your army of lactobacilli – or whatever helpful, healthy microbes protect your particular vagina – need to be present in large amounts to protect you, and they must be good fighters.

What you can do about low lactobacilli numbers and being BV-prone

If you want to try some treatments at home cheaply and easily, you can boost your lactobacili numbers by introducing new species. This can be as easy as using live yoghurt vaginally, and eating it, but it has to be alive! Read more about live yoghurt for vaginas.

Some lactobacilli are better than others at colonising the vagina, and fighting for its health, so you want to opt for products that contain these species:

  • L. crispatus
  • L. gasseri
  • L. jenensii
  • L. reuteri
  • L. rhamnosus

One species, L. iners, is a sign of a vagina that may be turning bad, so if you get a test and L. iners comes up, don’t think you have good lactobacilli counts! L. iners is a shapeshifter.

The lactobacilli that you want are found in a few good-quality refrigerated women’s probiotics. Jarro-Dophilus Women has all the very good vaginal colonising strains. You can build up your good bacteria with new colonies of lactobacilli, even if you were born without them – we get new bacterial colonies all the time, so feel free to try to import microbes for a healthier vagina!

Lactulose can also work very well for selectively feeding good bacteria, so can be used with a source of good bacteria – probiotics, milk kefir, or yoghurt.

If you are struggling with BV, see your healthcare provider or read Killing BV for some treatment ideas out of the ordinary.

References

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.