Bacterial vaginosis, or BV, is an imbalance of healthy bacteria in your vagina. When certain types of bacteria (anaerobes) outnumber the good bacteria (lactobacilli), you can get BV. Bacterial vaginosis is a common infection, affecting 1 in 3 women at some point. Some women have recurring cases of BV. However, many women with BV do not show symptoms, and very mild cases can go away on their own.

Seeking medical attention is crucial if you notice an unusual odor in your vaginal discharge, experience discomfort, or if you've had previous vaginal infections but observe a difference in your discharge this time. It's also essential to consult a doctor if you have a new sex partner or different sex partners. In some cases, the symptoms of a sexually transmitted infection (STI) may overlap with those of bacterial vaginosis. Additionally, if you believe you have a yeast infection but still have symptoms after self-treatment, you should see a doctor.

Do I have BV?

If you have symptoms, you must see a doctor to get treated. Left untreated, BV can lead to pelvic inflammatory disease (PID), which can cause infertility issues.

Symptoms:

  • Unusual foul-smelling, "fishy" vaginal discharge, particularly after sex.
  • A change in color and consistency in vaginal discharge, often being thin and gray, white, or green in color.
  • Burning during urination.
  • Pain, itching, or burning around the outside of the vagina.
  • Redness or swelling of the vulva.

It can be hard to know if your symptoms are from bacterial vaginosis, a yeast infection, or trichomoniasis (an STI caused by a tiny parasite). These all can have similar-looking symptoms and are common in women. You must visit a doctor and get tested to know what you have and receive the proper treatment.

Even women who receive successful treatment from a doctor can keep getting BV. So, let's dive into why you keep getting bacterial vaginosis and ways to prevent BV from returning.

How Long Does BV Last?

The duration of bacterial vaginosis largely depends on how quickly you seek treatment and how your body responds. In most cases, a typical course of antibiotics prescribed by your doctor clears up the infection within about a week. However, it's not uncommon for BV to persist or come back—roughly 1 in 10 women may need an additional round of treatment to fully get rid of the symptoms.

If you're experiencing persistent or recurring BV, don't be discouraged. Return to your healthcare provider, follow your treatment plan closely, and discuss long-term prevention strategies to reduce your risk of future flare-ups. Prompt care is the key to feeling better and minimizing complications.

medication for womens health concerns like BV and yeast infections

How BV Can Happen

How BV is Transmitted

While bacterial vaginosis is technically not an STD, BV is more common in sexually active women, especially with multiple sex partners and female sex partners. Women with BV can give their female sexual partner BV through vaginal sex, sharing toys without protection, and improper use of dental dams.

Though women who have sex with men are at a higher risk of getting bacterial vaginosis, women cannot get BV directly from men. Studies suggest that the higher risk is due to the different pH levels of sperm. The more sexual partners you have, the more likely you are to get BV.

Is BV Contagious?

Bacterial vaginosis isn't considered contagious in the same way as classic sexually transmitted infections. You can't "catch" BV like you would a cold; it doesn't leap from one person to another through casual contact. However, your risk does increase with sexual activity, especially if you have new or multiple partners, or engage in sex with other women.

So, while you can't technically pass BV back and forth like a game of microbial ping pong, certain sexual activities—especially those involving vaginal contact or sharing unwashed toys—can disrupt the balance of bacteria and set the stage for BV to develop.

Can Men Get Bacterial Vaginosis?

Men cannot develop bacterial vaginosis, as BV is a condition specific to the vaginal environment. However, men can carry the bacteria associated with BV on their genitals and potentially pass them between female partners during sexual activity. This is one reason why BV can recur even after successful treatment—sexual partners may be unknowingly sharing bacteria back and forth.

For women who have sex with women, it's also possible to transmit BV-related bacteria through sexual contact, especially when sharing sex toys or engaging in activities without proper protection. Practicing good hygiene, using barriers during sex, and ensuring that both you and your partner are treated—if needed—can help reduce the risk of reinfection.

Furthermore, certain genetic and lifestyle factors can put women at higher risk of getting bacterial vaginosis and having recurring cases.

Risk Factors for BV

Genetics

  • If you are black, your risk for BV is twice as high as white women (source). However, this could be more related to the amount of physiological stress black women experience vs. white women.

Lifestyle

  • Having multiple sexual partners, a new partner, or a partner who has bacterial vaginosis (BV). BV can also be spread through oral-genital contact, sharing sex toys, and using fingers during sexual activity.
  • Not using condoms.
  • Use douches, vaginal deodorants, scented soaps in or around your vagina, or bubble baths.
  • Hormonal changes during pregnancy or reproductive years.
  • Have an IUD, especially with irregular bleeding.
  • Have recently used antibiotics.
  • Regular cigarette smoking.

Stress and Poor Diet

  • An increase in stress due to physiological stresses has been linked to a higher risk of BV. Stress hormones can upset the balance of bacteria and weaken the immune system's response (source).
  • A diet low in probiotic-rich foods has been identified as a potential risk factor for BV recurrence.

The good news is that you can control or eliminate most of these risks to reduce your chance of getting BV. By changing your hygiene habits, sexual activity, and diet, you can decrease your risk of bacterial vaginosis. Unfortunately, reducing risk factors alone may not stop you from getting BV.

Potential Complications of Bacterial Vaginosis

While bacterial vaginosis (BV) is a common condition, it's essential to be aware of potential complications if left untreated. Understanding these complications can help you prioritize seeking timely medical attention. Here are some complications associated with BV:

  • Increased Risk of STIs: Individuals with BV may have a higher risk of acquiring sexually transmitted infections (STIs) such as chlamydia and gonorrhea.
  • Pelvic Inflammatory Disease (PID): In some instances, BV can contribute to the development of pelvic inflammatory disease, an infection of the uterus and fallopian tubes that may lead to infertility.
  • Pregnancy Issues: While uncommon, pregnant individuals with BV may have an elevated risk of complications, such as premature birth or miscarriage.

Do I have BV?

If you think you might have bacterial vaginosis, contact your local OBGYN and schedule an appointment as soon as possible. However, before your doctor's visit, it's essential to prepare best to have a more accurate exam and test results.

What not to do if you suspect you have BV – dos and don'ts:

  • Don't have sex until you finish your treatment.
  • Don't douche or use vaginal deodorant sprays—they might mask odors that help doctors diagnose BV, irritate your vagina more, and make symptoms worse.
  • Do take all the medicine prescribed even if symptoms go away.
  • Do tell any female partners so they can get treatment.
  • Schedule an appointment with your doctor when you are not on your period.

How to Avoid Bacterial Vaginosis (Again)

To help prevent getting BV again, it's important to make some changes to your lifestyle and hygiene. Lowering vaginal pH can be helpful because an acidic environment is less welcoming to harmful bacteria. You might want to ask your healthcare provider about using vaginal boric acid.

Keeping the microbiotic balance of your vagina in check is crucial since infections often happen when bad bacteria outnumber the good. This imbalance can occur after taking antibiotics or due to other conditions that deplete your helpful or protective bacteria.

Your vagina's pH is delicate, and several things can disrupt the balance between good and bad bacteria.

How to Prevent Bacterial Vaginosis

Around five out of every hundred women reading this likely have bacterial vaginosis. It's an extremely common vaginal infection and, unfortunately, not entirely avoidable.

Most women will experience bacterial vaginosis at least once in their lifetime, with certain life stages and lifestyle factors increasing your vulnerability. While you might not be able to stop bacterial vaginosis, there are things you can do to lessen your chances.

Preventing bacterial vaginosis starts with understanding your body's unique microbiome. Like your gut, your vagina has its own delicate ecosystem of bacteria, where healthy species of lactobacilli typically maintain a healthy balance.

The natural dominance of healthy species like Lactobacillus typically keeps everything in check. But sometimes, harmful bacterial species (such as Gardnerella vaginalis) can take over, creating an overgrowth. If this happens, it can disrupt your vaginal pH.

Your vaginal health hinges on maintaining a precise pH level. Typically, a healthy vaginal environment sits at 4.5 or lower on the pH scale—think of this as the "sweet spot" that keeps harmful bacteria in check.

However, when this balance shifts and the pH rises, it creates an environment where bacterial vaginosis can flourish. As soon as the pH increases above 4.5, lactobacilli, which helps maintain acidity, begins to die off, allowing anaerobic bacteria to overgrow.

So, at its core, the prevention of bacterial vaginosis begins with taking preventative measures that encourage healthy vaginal bacteria to thrive and prevent harmful bacterial overgrowth so your vaginal pH doesn't become too high.

To do this, there are things you need to do and things you need to avoid.

Remember, while these strategies can significantly reduce your risk, bacterial vaginosis can still occur. If you experience symptoms like unusual discharge, odor, or discomfort, consult your healthcare provider for a prompt and accurate diagnosis.

Things TO DO to Help Prevent Bacterial Vaginosis

Wear Breathable Underwear/Clothing

Choose cotton underwear that allows air circulation. Moisture-trapping fabrics create a breeding ground for bacteria, so opt for breathable materials that keep you dry and comfortable. Cotton allows your skin to breathe, reducing the moisture that harmful bacteria love to call home. Think of it like giving your vaginal ecosystem some much-needed ventilation.

Change Out Of Sweaty Clothes ASAP

Swap out sweaty clothes or wet swimsuits immediately. Prolonged moisture creates the perfect environment for bacterial overgrowth. Bacteria thrive in warm, damp environments, so the longer you sit in wet workout gear or a soggy swimsuit, the more you're inviting unwanted bacterial guests to set up shop.

Practice Smart Sexual Hygiene

Semen has a higher pH level that can disrupt your vaginal balance. Ideally, you should use condoms, practice safe sex, and urinate after sexual activity to help flush out potential bacteria.

But what if you are in a monogamous relationship where you don't want to use condoms? Does your body ever "adjust" to your partner's sperm?

The short answer is complicated. While your body does have incredible adaptive mechanisms, it doesn't necessarily mean your vaginal microbiome will permanently adjust to your partner's specific biological chemistry. Each sexual encounter can potentially introduce changes to your delicate bacterial balance.

Take a Probiotic Supplement for Vaginal Health

This is one of the best preventative steps you can take to keep your vaginal microbiome balanced. However, you can't grab just any probiotic supplement. For example, the probiotic you take for your gut might not have the specific strains of bacteria needed for vaginal health.

You should take a probiotic supplement specifically designed for vaginal health or check the label of your probiotic to ensure it contains targeted strains of Lactobacillus.

A few to look for are: Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, Lactobacillus crispatus, Lactobacillus gasseri, and Lactobacillus acidophilus, which are all known to support a healthy vaginal microbiome.

Manage Underlying Health Conditions

Certain medical conditions like obesity and diabetes, especially if your blood sugar isn't managed, can increase your risk of bacterial vaginosis. So can impaired immune function and some STIs such as chlamydia or gonorrhea.

Avoid or Limit Antibiotic Use

Courses of antibiotics are known to kill off good bacteria. While they're sometimes necessary to treat infections, they can disrupt your vaginal microbiome.

The type of vaginitis most likely to occur due to antibiotic use is a yeast infection, but bacterial vaginosis can also develop if the antibiotic causes your protective bacterial balance to be thrown off.

Manage Stress Levels

Stress can weaken the immune system and make the vagina more susceptible to infection. While it is impossible to avoid stress (especially as a woman), you should do things to keep stress in check.

Things to AVOID to Prevent Bacterial Vaginosis

Harsh Hygiene Products

Your vagina actually does a pretty good job of cleaning itself. While personal hygiene is important, using harsh, scented soaps is not necessary and can even be a culprit of disrupted vaginal pH balance.

These products strip away protective bacteria and can alter your vaginal pH, creating an environment where harmful bacteria thrive. Stick to mild, unscented, and pH-balanced cleansers specifically designed for intimate areas.

Douching

We don't care what your grandma or some holistic social media influencer tells you; you should avoid douching completely. It's one of the most damaging things you can do for your vaginal health.

Douching literally flushes out the good bacteria that protect you, creating an environment where harmful bacteria can rapidly multiply. Do not douche!!!

Unprotected Sex

Unprotected sex, especially with multiple partners, can introduce all kinds of new bacteria that throw off your vagina's natural balance, but it's not just the bacteria.

As mentioned above, semen can also be a BV trigger. Since semen has a higher pH, it can make your vaginal environment less acidic, creating the perfect conditions for harmful bacteria, like Gardnerella, to thrive.

Wiping From Back to Front

Always wipe from front to back after using the restroom. Wiping from back to front can transfer bacteria from your rectum directly to your vaginal and urethral areas, dramatically increasing your risk of bacterial vaginosis and urinary tract infections.

Taking Long Baths

Prolonged exposure to water, especially bubble baths or bath products with fragrances and chemicals, can disrupt your vaginal pH and bacterial balance. If you love baths, keep them short, avoid scented products, and rinse with clean water afterward.

Smoking

Smoking doesn't just damage your lungs. It can also wreak havoc on your vaginal health. Tobacco use can alter your immune response, reduce blood circulation, and create inflammation that makes you more susceptible to bacterial vaginosis. The chemicals in cigarettes can also change your vaginal environment, making it easier for harmful bacteria to grow.

When to Take Extra Precautions

Anyone that hopes to avoid vaginal infections like bacterial vaginosis should follow the do's and don't guidelines above. However, there are some life stages and situations that require extra vigilance in preventing bacterial vaginosis.

Here are some specific times when you'll want to be particularly proactive about your vaginal health:

  • During reproductive years (ages 14 and up)
  • When going through menopause
  • During pregnancy
  • Other scenarios that cause significant hormonal changes
  • Having poor lifestyle habits like smoking or excess alcohol consumption
  • Anytime you have a new sexual partner
  • If you are sexually active with multiple partners
  • If you have frequent intercourse (even with the same partner)
  • If you experience recurring BV infections
  • When taking a course of antibiotics
  • During times of chronic stress or lack of sleep
  • If you have a compromised immune system

Beyond these commonly known risk factors, there are some less-discussed risk factors that might also increase your chance of getting bacterial vaginosis.

For instance, certain ethnicities show higher susceptibility to BV. While the exact reason is unknown, studies show that black women have a higher risk of bacterial vaginosis compared to white women.

The type of birth control you use can also play a role. Copper IUDs, in particular, might slightly increase BV risk compared to other contraceptive methods. Some studies suggest this could be due to changes in vaginal inflammation or immune response triggered by the device.

A Note on Pregnancy

If you're pregnant, it's especially important to take extra care. About 1 in 4 pregnant women will get BV due to all the hormonal shifts happening in the body. These changes can throw off your vaginal pH and disrupt the balance of good and bad bacteria, making you more susceptible to infections like BV. So, if you're expecting, pay close attention to any symptoms and keep up with healthy habits—your body (and your baby) will thank you.

woman getting an exam at an OBGYN for BV

What Doctor to See for BV

If you're experiencing symptoms of bacterial vaginosis, an OB/GYN (obstetrician-gynecologist) is your best bet for expert care. These specialized physicians are the most educated when it comes to vaginal health, reproductive systems, and addressing intimate medical concerns like bacterial vaginosis.

An OB/GYN specializes in the entire female reproductive system and has extensive training in diagnosing and treating conditions just like bacterial vaginosis. They understand the complexities of vaginal health that a primary care doctor might overlook.

For example, it's not uncommon for a woman to be misdiagnosed with another type of vaginal infection if they go to urgent care or use telehealth services. While your symptoms might seem straightforward, many vaginal infection symptoms overlap. An OB/GYN can provide comprehensive testing, accurate diagnosis, and targeted treatment that considers your entire health profile.

If you do not have a history of recurring vaginal infections or are not at high risk for an STI and can't get an appointment with an OB/GYN, other medical professionals can certainly help. Your primary care physician, a nurse practitioner at an urgent care clinic, or a general practitioner are all qualified to diagnose and treat bacterial vaginosis.

They can perform the necessary tests, prescribe antibiotics, and provide initial guidance.

However, for women experiencing recurring bacterial vaginosis or more complex symptoms, are sexually active, or have additional health concerns, scheduling with an OB/GYN is strongly recommended.

How an OBGYN Can Help You

Your vagina is important, so you should stay on top of your vaginal health. Listen to your body; if something is off, you must treat it as soon as possible. Your OBGYN can help you keep your vagina happy and healthy.

Because bacterial vaginosis can look like other infections, like yeast infections, an OBGYN can help you know what you have. They may perform a pelvic exam and take a sample of your vaginal discharge, which they will look at under a microscope. It's important to know exactly what you have so your doctor can give you the right treatment.

For example, yeast infections can be treated with OTC medicines, while bacterial vaginosis cannot. Even so, it would be best to see your local doctor. For those who live in Brentwood or Franklin, TN, Cool Springs OBGYN is currently accepting new patients. They would be more than happy to see you.

Don't self-diagnose or use OTC treatments, at-home remedies, or homeopathic medicines—even boric acid suppositories—unless your OBGYN tells you it's ok.

Receiving the right treatment can help you get rid of your BV. If left untreated, BV can lead to premature birth in pregnant women, increase your risk of getting STIs, and lead to pelvic inflammatory disease (PID).

If you're pregnant, it's important to address BV—whether or not you have symptoms. Your provider can prescribe medication that's safe to use during pregnancy. Treating BV lowers the risk of complications such as premature birth or having a baby with low birth weight. Taking care of BV early helps protect both your health and your baby's well-being.

Also, if you keep getting BV, you should tell your OBGYN so they can figure out the best plan of attack to help you beat chronic BV. They know all the tricks and latest treatments that will work best for your lifestyle.

For example, your OBGYN might suggest taking a stronger dose of antibiotics, using a gel or cream instead of a pill, taking a daily probiotic, or something else.

See a Gynecologist in Cool Springs and Brentwood, TN, for BV Tests and Treatment

To see how you can get rid of your BV for good, please schedule an appointment at Cool Springs Gynecology and speak with Dr. Lodge and his team in Brentwood, TN. Our experienced team will help you learn about options that fit your needs best.

FAQ – Bacterial Vaginosis (BV)

There are multiple risk factors for bacterial vaginosis. Anything from genetics, sex partners, lifestyle, diet, and stress levels can trigger BV. Your OBGYN can help you discover the reasons why you keep getting BV.

Typically, BV causes a fishy-smelling, thin white or gray vaginal discharge. If you have unusual spotting, talk with your doctor to discover possible reasons.

Doctors recommend not having sex until you finish your treatment for BV, even if symptoms go away.

The only way to prevent getting BV from sex is to properly use condoms, properly use dental dams, use new condoms every time you share a toy with a female sex partner, limit the number of sex partners you have, and regularly test for STDs.

Any treatment you use for your BV should be prescribed by your OBGYN—natural, otc, or otherwise.

While some research claims boric acid suppositories can treat recurring bacterial vaginosis, at-home treatments can lead to more issues. Please consult a doctor before using any treatment for BV symptoms.

For years, it was believed that bacterial vaginosis wasn't sexually transmitted and that men couldn't pass it to women. However, new research is changing that belief.

A groundbreaking study published in The New England Journal of Medicine found that BV can indeed be passed from male partners. The clinical trial, known as the StepUp study, suggests that male partners can harbor and reintroduce the bacteria that cause BV and contribute to recurrence.

Their findings demonstrate that treating male partners alongside women reduced BV recurrence by 60%— so much so that the study was stopped early because the results were so precise.

While BV is still not officially classified as a sexually transmitted infection (STI), this study shows that male partners can play a significant role in its recurrence, and treatment of both partners may be key to keeping it from coming back.

No conclusive research explains how women get BV from sex with men. But the difference in pH levels of your partner(s) sperm and your vagina could be one reason. However, women can pass BV to each other through sex. If you have BV and a female sex partner, she should be tested as soon as possible.

Yes! In fact, unprotected sex is one of the leading causes of bacterial vaginosis. Semen is alkaline (basic), while the vagina is naturally acidic, which helps to maintain a healthy balance of bacteria. Semen exposure can temporarily shift the pH towards alkaline, potentially disrupting this balance and allowing harmful bacteria to overgrow, leading to BV.

This is most likely to occur with a new partner or if you have multiple sexual partners at once. However, even with a long-term, monogamous partner, some women experience recurring BV infections.

Yes, it's possible. Bacterial vaginosis occurs when the natural balance of bacteria in the vagina is disrupted. This can happen when any new bacteria are introduced, regardless of the source of introduction.

Fingers can introduce bacteria during activities like inserting tampons, using suppositories, or touching the genital area. Washing your hands before these activities can significantly lessen the risk; however, because the vagina maintains a delicate balance, even clean hands can sometimes introduce bacteria that may throw things off.

The question of whether male partners should be treated for bacterial vaginosis is often debated. This is mainly because men typically don't show clear symptoms. Currently, treating male partners isn't usually recommended or thoroughly studied. However, practicing good sexual hygiene and using barrier protection can help reduce the risk of passing the infection back and forth.

Many home remedies have been used for centuries to prevent and treat bacterial vaginosis, but clear recommendations are still lacking. Some studies suggest that probiotics, available in supplements and certain yogurts, can be beneficial. While there is some research on using boric acid, official guidance remains unclear. It's important to speak with your healthcare provider to determine whether these home remedies are safe and suitable for you.

If you have more questions about women's health or bacterial vaginosis, call Cool Springs OBGYN in Brentwood, TN, at (615) 690-6600