Bacterial Vaginosis

In this blog we dive deep into what exactly is BV, what causes it, common signs and symptoms and the best ways to treat it both conventionally and naturally. Lets dive in..

What exactly is Bacterial Vaginosis & what causes it?

  • Bacterial vaginosis (BV) is a condition of vaginal flora imbalance and occurs when there is an overgrowth of normal vaginal bacteria.
  • Ideally the vagina microbiome should produce an abundant amount of lactobacilli bacteria, this is the type of bacteria that lives within the vagina microbiome. However, BV usually occurs when there are scarce amounts of lactobacilli and higher abundances of gram-negative anaerobic bacteria such as Gardnerella vaginalisMycoplasma hominis and Ureaplasma urealyticum that become overly abundant in the vaginal microbiome.
  •  The vagina is an acidic environment with a pH that ranges between 3.8 – 4.5. This is because lactobacillus produce lactic acid that helps maintains the pH of the vagina and helps to keep any nasties away! However, women with BV usually experience a rise in the pH of the vagina.
  • Take away: BV is caused by an imbalance in the flora of the vagina. This is because there is a decrease of lactobacillus (the vital and good bacteria for the vagina).

What are the signs and symptoms of BV?

50% of women with BV can be asymptomatic, which means women may have a BV infection, yet not even know it. However, many women do experience some hostile symptoms that can include:

  • A fishy vaginal odour – probably the most common symptom and is more noticeable during intercourse or during your period.
  • Unusual vaginal discharge (thin or white, grey, sometimes green in colour).
  • Vaginal itching.
  • Painful urination.

Risk Factors for Developing BV:

There are a few culprits for developing BV let’s explore these:

  1. Unprotected sex.
  2. Period blood.
  3. New sexual partner or multiple partners.
  4. Oral sex.
  5. Antibiotic use.
  6. Vaginal douching.
  7. Imbalances in the gut microbiome.
  8. Nutrient deficiencies. 

Douching:

  • Douching means washing or cleaning out the inside of the vagina with “cleaning mixes”. The vagina is actually a self-cleaning machine! It really does not need any additional help from vaginal cleaning products. Douching, scented washes and wipes can actually cause an imbalance in the vagina flora and disrupt the pH of the vagina. These products can also damage the mucosal tissue of the vagina and cause endocrine disruption.
  • If you’re struggling with BV then it is a good idea to stay away from these products and let your vagina do its natural cleaning thang!

Unprotected Sex:

  • Let’s talk semen. Semen does not have the same pH as the vagina and can make women more susceptible to BV. Semen is actually mildly alkaline, and slightly raises the pH of the vagina. This alkaline fluid can sometimes be enough to encourage the growth of both beneficial and unhealthy bacteria.
  • So you might be wondering, is my partner giving me BV? Or am I transferring BV back and forth to my partner? While your partner’s semen can make you more susceptible. Your partner doesn’t have and isn’t giving you BV. However, multiple partners do put you at an increased risk of BV.
  • Oral sex and saliva can also shift the pH of the vagina, so this too can make you more susceptible to BV.
  • If you are struggling with BV, consider using condoms while you work to treat the condition.

Antibiotics:

  • Antibiotics are excellent for killing bacteria that cause infections. However, they also wipe out the good guys that we need to stay healthy. This lack of good bacteria can destroy the acidic environment of the vagina, which can lead to BV. Remember, Lactobacillus species make acid that keeps the whole ecosystem in check. More on antibiotic use soon…keep reading!

Period Blood:

You would think that period blood that literally passes through the vagina would be acidic to match the same pH levels of the vagina. Surprisingly this is not the case! The pH of blood is just above 7. So just like semen, period blood is slightly alkaline. Therefore, it can alter the pH of the vagina, potentially leading to BV, especially if lactobacillus bacteria are already scarce in the vagina microbiome.

How is Bacterial Vaginosis Treated?

BV is diagnosed by a GP, during a physical swab examination. Never a comfortable time, but definitely necessary to rule out any other infections such as STI’s or HPV.  

BV symptoms are conventionally treated with oral antibiotics. International guidelines recommend the administration of Metronidazole, Clindamycin or Tinidazole.

While antibiotics work well to provide relief and ultimately eliminate the infection, they also wipe out the good bacteria, which can cause further shifts in both the gut and vaginal microbiome.

This is when it becomes a bit tricky and difficult to treat. While some women will respond well to antibiotic treatment, a lot won’t with 60% of women experiencing recurrence within 1 year after antibiotic use for BV.  

If you’re finding that you are getting recurring BV and are using regular doses of antibiotics to relieve symptoms to keep your vagina happy and fishy free! I highly recommended that you start to look at the root cause of what is causing recurring BV infections and look at some additional natural treatments.

Natural Treatments for Bacterial Vaginosis

Organic Period Products:

Non-organic products can contain glyphosate and other environmental toxins. Not only can your vagina absorb these toxins, the toxins themselves can disrupt vaginal flora. Consider making the switch to organic period products.

Gut Health & Vaginal Ecology:

  • The mouth, digestive track and vagina all have an ecology or microbiome. Supporting your gut health can significantly support your vaginal health too!
  • The gut and vagina share bacteria. Therefore, it’s vital to first address gut health and also identify any nutrient deficiencies in order to clear recurrent BV infections. I would recommend working with a Nutritionist or Naturopath for individualised care to address any gut issues you may have.

Stabilising blood sugar levels:

If you’re struggling with recurring BV looking at reducing sugar in your diet is a great start. Excess sugar consumption can cause hormone imbalance and can make you more susceptible to BV. Look to reduce sugar in your diet as much as possible and consider more alkalising foods.

Pessaries & specific probiotics strains to support the gut and vaginal microbiome.

  • Consider taking a probiotic daily, both orally and vaginally especially if you have recurring infections or have taken antibiotics to treat BV. However, not just any probiotic. The probiotic strains should be specific to help support vaginal flora and you should definitely get guidance with this under a health practitioner.
  • A combination of probiotic Lactobacillus rhamnosus GR-1 and L.reuteri RC-14 have been used in combination to support the maintenance of normal/healthy vaginal flora and function of the digestive track. Both these probiotic strains have shown to successfully treat BV without the use of antibiotics.
  • There are some excellent practitioner only probiotic supplements and pessaries to take including vitamin C suppositories. I suggest working with a Naturopath or talk to your health care provider to see if this is the best treatment for you.

Supplementation: Vitamin C

Clinical trials have used ascorbic acid (vitamin C) inserted vaginally to treat active flares of BV. Vitamin C suppositories have also be trialled along side Metronidazole (standard antibiotic treatment) for its efficacy in treating BV with higher success rate compared to Metronidazole. Pretty impressive really, plus vitamin C is well-tolerated and inexpensive to use.

Can BV clear up on its own?

BV can certainly clear up on its own. However, if symptoms persist and are left untreated, BV can cause more serious vaginal health problems and can make women more vulnerable to pelvic infections, STI’s, HPV and increased risk of miscarriage. 

If your currently experiencing any of the vaginal symptoms, it’s important to book an appointment with your GP for further testing to determine if you have BV or rule out any other vaginal infections.

Furthermore, it’s important to get to the underlying root cause in order to treat accordingly and know that there are natural ways of treating BV.


Disclaimer: This blog post is for educational purposes only. It is not designed to diagnose, treat or cure. For your individual health concerns, it is important to discuss these with a health professional. 

References:

  1. Krasnopolsky, V. N., Prilepskaya, V. N., Polatti, F., Zarochentseva, N. V., Bayramova, G. R., Caserini, M., & Palmieri, R. (2013). Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. Journal of clinical medicine research5(4), 309–315. 10.4021/jocmr1489w
  2. Martinez, R.C., Franceschini, S.A., Patta, M.C., Quintana, S.M., Gomes, B.C., De Martinis, E.C. and Reid, G., 2009. Improved cure of bacterial vaginosis with single dose of tinidazole (2g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomised, double-blind, placebo-controlled trial. Canadian journal of microbiology, 55(2), pp.133-138. DOI: 10.1139/w08-102
  3. Petersen EE, Genet M, Caserini M, Palmieri R. Efficacy of vitamin C vaginal tablets in the treatment of bacterial vaginosis: a randomised, double blind, placebo controlled clinical trial. Arzneimittelforschung. 2011;61(4):260-5. https://pubmed.ncbi.nlm.nih.gov/21650086/ DOI: 10.1055/s-0031-1296197
  4. Tuddenham, S., Ghanem, K.G., Caulfield, L.E. et al. Associations between dietary micronutrient intake and molecular-Bacterial Vaginosis. Reprod Health 16, 151 (2019). https://doi.org/10.1186/s12978-019-0814-6