Learn how to get rid of this itchy, fishy-smelling infection for good.
The first time you get bacterial vaginosis (BV) — a vaginal infection that can cause itching and fishy-smelling discharge — is never fun. The second, third, fourth and fifth times are even less fun.
If you've got a stubborn case of BV, the good news is recurrent BV is normal and preventable. This article will tell you everything you need to know about this pesky condition, including potential causes, treatment options and how to keep your BV from making a comeback.
What is bacterial vaginosis (BV)
Bacterial vaginosis ("BV" for short) is an infection that occurs due to a disruption of the normal balance of "good" and "bad" bacteria in the vagina. The most frequent cause of vaginal discharge, BV affects an estimated 21.2 million women between the ages of 14 to 49.
BV reoccurrence is common. An estimated 50 percent of people who get BV become infected again within the next three to 12 months.
Why do I keep getting bacterial vaginosis?
We don't know the exact cause of BV. However, research has linked the condition with an overgrowth of certain bacteria, including Gardnerella vaginalis, Prevotella and Mobilincus.
Certain behaviors, like not wearing a condom, may increase your risk of getting BV. Other risk factors for BV include smoking, douching and using a copper-containing intrauterine device (IUD).
In addition, you are at an increased risk for BV during your period due to the hormonal changes occurring in your body. Similarly, you have a higher risk of getting BV when you are pregnant. An estimated 10 to 30 percent of women experience BV, according to the American Pregnancy Association.
What are the symptoms of BV?
The most common symptom of BV is no symptoms at all. Around 84 percent of BV cases are asymptomatic, according to Centers for Disease Control and Prevention (CDC) estimates.
If you do experience BV symptoms, they may include:
- White or gray vaginal discharge
- A strong fishy smell, particularly after sex
- Pain, itching and/or burning in the vagina
If you suspect you have BV, seek medical attention. If left untreated, BV can increase your risk of contracting and spreading STIs like HIV, chlamydia and gonorrhea. Untreated BV can also increase your risk of getting pelvic inflammatory disease, a painful infection that can impact your ability to get pregnant.
How is BV treated?
To treat your BV, a doctor may prescribe either an oral or vaginal suppository antibiotic. Both pill and suppository medications can kill the harmful bacteria that cause BV.
MONA Health treats BV cases with Metronidazole (Flagyl), an antibiotic that works by stopping the growth of certain bacteria. When taken over multiple days, metronidazole is one of the most effective treatments for BV.
Why did my bacterial vaginosis come back?
If you've been treated for BV — only to find out it's come back within a few months — you're probably feeling frustrated. We wish we had a more satisfying explanation for you, but medical professionals don't really know why certain people are more prone to developing BV multiple times. Every vagina is unique, and some are more sensitive and reactive when exposed to factors like a penis microbiome.
Researchers are still exploring causes and possible treatments for recurring BV. If your symptoms return soon after treatment, tell your doctor.
How to keep BV from coming back
The most important step to preventing your BV from returning is to take antibiotics exactly as prescribed. Even if your symptoms go away, it's critical to take the full cycle of antibiotics to ensure the infection is eliminated and avoid building antibiotic resistance.
In addition, there are things you can do to help kick your BV to the curb once and for all. Here's how to keep BV from coming back:
Practice good vaginal hygiene
Good vaginal hygiene involves routinely washing the outside of your vagina with your fingers and warm water. Never wash the inside of your vagina. Soap is optional — if you choose to use it on your vagina, just make sure you use a brand that is gentle and fragrance-free.
Importantly, good vaginal hygiene does not mean using so-called "feminine hygiene products", including douches, wipes, perfumes, sprays, deodorants and perfumed soaps. Adding chemicals to the vagina alters its ecosystem and can induce the growth of bacteria.
Here's another important vaginal hygiene tip: always wipe from front to back after using the bathroom. This helps prevent fecal matter or bacteria from going into your urethra.
Wear breathable underwear and clothing
The type of underwear you wear matters. Lightweight, cotton underwear is the healthiest option. Avoid fabrics that trap moisture, like polyester, nylon and acrylic fabric, which can create breeding grounds for bacteria.
Consider going commando — or wearing no underwear — in bed and whenever possible. Skip leggings and yoga pants, and go for loose-fitting clothing that allows airflow around your vagina.
Practice safe sex
Semen exposure has been linked to an increased risk of BV. You can help reduce your chance of developing BV by having sex with a condom.
It's also a good idea to limit your number of sex partners, as multiple partners can expose you to a higher amount of bacterial strains. In addition, make sure to wash personal and shared sex toys after each use.
Consider boric acid suppositories
Boric acid suppositories may help maintain a low vaginal pH and potentially help prevent recurrent BV — though further research is needed.
If you want to try boric acid, speak to your healthcare provider first. Make sure you follow the instructions carefully and avoid exceeding the recommended dosage. Boric acid is highly toxic if ingested, so never take it by mouth. In addition, you should not take boric acid if you are pregnant.
Taking certain probiotics may help maintain a healthy BV, preliminary research suggests. Specifically, taking oral Lactobacillus after being treated for BV may help prevent reoccurrence, one clinical trial found.
Lactobacilli can be taken as a supplement. It can also be found in probiotic foods like kimchi, yogurt and kefir.
Stress isn't just in your head. It impacts your whole body — your vagina included. Studies have found that stress alters the composition of your vaginal microbiome. Specifically, stress can increase the pH of the vagina, making it more susceptible to infections like BV, researchers believe.
To cut down your stress, try stress-management tactics like getting enough sleep, exercising regularly and eating a healthy, well-balanced diet.
The bottom line
If you've got a case of BV that won't quit, you are in good company. Recurrent BV is common, but it's not inevitable. You can help reduce your risk of developing BV again with proper treatment and healthy lifestyle changes.
The good news is that BV — even stubborn, recurrent BV — is easy to treat. Use MONA to get an online evaluation from a medical expert and get your BV treatment medications delivered to right to your door.