What is Bacterial Vaginosis?

A naturopath’s guide for understanding and treating BV

A few months ago, Annie Stewart, a degree qualified naturopath and co-founder of Nunie answered some of the most common questions about bacterial vaginosis (BV).

Annie was THOROUGH! There’s so much useful info below, and honestly thank goodness because not enough people are talking about BV.

1. What is BV? 

Bacterial Vaginosis (BV) is a common vaginal condition that occurs when the balance of natural bacteria shifts, resulting in a decrease of beneficial Lactobacillus bacteria, which normally maintain an acidic environment, and an overgrowth of anaerobic bacteria like Gardnerella and Atopobium. This imbalance is what leads to BV. 

2. What are the symptoms? 

Symptoms of BV can vary, but the most common signs include: 

● A thin, grayish-white vaginal discharge 

● A strong, fishy odor, particularly after sex 

● Vaginal itching or irritation (less common) 

● Burning sensation during urination 

It’s important to note that some women with BV may not experience any symptoms at all.

3. How does someone get it? 

BV can be triggered by various factors, including sexual activity (though it’s not classified as an STI), antibiotic use, pH imbalances, hormonal changes, and lifestyle factors. 

While antibiotics are often used for treatment, 60% of people experience a relapse within 6-12 months. 

4. Does getting bacterial vaginosis mean a partner has been with someone else? 

There’s a common misconception that a new case of Bacterial Vaginosis (BV) is an indicator of infidelity, fuelled by memes and online discussions. While introducing new bacterial species through a new partner can contribute to changes in the vaginal environment, it is not the only cause of BV or disturbances in the vaginal microbiome. 

Hormonal changes are one of the most frequent causes of BV that I see clinically. These changes, whether related to life stages such as pregnancy, breastfeeding, perimenopause, or menopause, or driven by stress or contraceptive use, can disrupt the balance of beneficial bacteria in the vagina, increasing the risk of BV. Variations in oestrogen levels and menstrual cycles significantly affect the composition of the vaginal microbiome.

Several other factors can also challenge the vaginal microbiome and elevate the risk of BV, including: 

● Diet: Dietary trends like carbohydrate restriction (e.g., keto) can alter the vaginal environment, and blood glucose imbalances can further disrupt it. 

● Smoking: Tobacco use has been linked to an increased risk of BV. 

● Medications: Antibiotics, immunosuppressants, hormonal therapies, herbal antimicrobials, and some intravaginal applications can all impact vaginal health.

● Hygiene and Fabrics: Certain fabrics and hygiene practices can affect the vaginal environment. 

● Vaginal pH Disruption: Lubricants, saliva, ejaculate, menstrual blood, douching, and even swimming can disturb the pH balance in the vagina. 

● Tissue Trauma: This can result from sexual activity, hormonal changes, or overall health status. 

● Ethnicity: Some ethnic sub-groups are less likely to have a Lactobacillus-dominated microbiome, increasing their risk of BV. 

5. What are some things to look out for if you have recurring BV, and how do you treat it? 

If you're dealing with recurrent Bacterial Vaginosis (BV), it's important to understand both the factors that contribute to its persistence and how to effectively treat it. Conventional treatment typically involves antibiotics like metronidazole or clindamycin, but this approach can sometimes leave you more vulnerable to future infections by wiping out beneficial vaginal bacteria. 

To break the cycle of recurrent BV, it’s essential to identify and address your triggers. These key factors not only contribute to the persistence of BV but also provide a foundation for effective treatment: 

Triggers and Lifestyle Factors: 

● Hygiene Products: Avoid harsh soaps, vaginal douches, and synthetic fabrics, as these can disrupt the vaginal pH and microbiome. 

● Sexual Practices: Unprotected sex, especially with new or multiple partners, can introduce bacteria that upset the vaginal balance. Consider using barrier methods and addressing potential microbial imbalances with your partner. 

● Oral Sex: The oral microbiome can transfer bacteria to the vaginal area, potentially triggering BV, especially if your vaginal environment is already sensitive.

Health and Hormonal Changes: 

● Hormonal Fluctuations: Changes in hormone levels—due to menstrual cycles, pregnancy, breastfeeding, perimenopause, or menopause—can affect the vaginal microbiome. Hormonal contraceptives can also play a role.

● Diet and Nutrition: A diet low in fresh fruits, vegetables, and prebiotic fibres, or high in processed foods, can negatively impact vaginal health. Incorporating prebiotics and fermented foods can support beneficial bacteria. 

● Stress Levels: Chronic stress can weaken the immune system and disrupt the balance of bacteria in the vagina, making you more susceptible to BV. 

● Medications and Smoking: Antibiotics, immunosuppressants, smoking, and certain hormonal treatments can alter the vaginal microbiome, increasing the risk of recurrent BV.

Immune and Digestive Health: 

● Immune System: A compromised immune system can hinder your body’s ability to maintain a healthy balance of vaginal bacteria. 

● Gut Health: Since the gut and vaginal microbiomes are interconnected, digestive health issues can contribute to recurrent BV.

Addressing these factors holistically—by supporting your hormonal balance, diet, stress management, and overall health—is crucial for managing and preventing recurrent BV. Additionally, using natural, pH-balanced products that support the vaginal microbiome can help reduce the likelihood of imbalance. If symptoms persist, it’s important to consult with a healthcare provider for a comprehensive approach to treatment. 

6. What happens if I don’t treat my bacterial vaginosis? 

The consequences of untreated BV can be significant, including an increased risk of STIs, complications in pregnancy and fertility, and a higher chance of developing a yeast infection. Additionally, BV often brings about feelings of shame and stigma, affecting one’s quality of life. 

7. Should my partner be treated if I have recurrent BV, even if they have no symptoms? 

Emerging research suggests that the microbiomes of sexual partners, whether male or female, can significantly influence the recurrence of BV. 

In female-to-female relationships, both partners can potentially reinfect each other because the vaginal environment is naturally conducive to the growth of BV-associated bacteria. It’s important for both partners to be mindful of their vaginal health to prevent this cycle of reinfection. 

For male partners, the penile microbiome was traditionally considered less relevant due to the dry nature of the penile environment, which is less hospitable to bacterial overgrowth compared to the vagina. However, recent studies have revealed that the penile microbiome can indeed

contribute to BV recurrence. Research indicates that women with BV are less likely to experience treatment failure if their male partners also undergo treatment. 

Additionally, a recent Australian study suggests that combining oral and topical treatments for male partners might further reduce the risk of reinfection. While these approaches are not yet included in standard practice guidelines, they represent a promising direction for holistic management of BV. Addressing male penile and seminal microbiome health, reinfection cycles, and the use of barrier methods are crucial steps, especially when sex is a contributing factor to BV recurrence. 

The idea of Nunie was actually born out of this very research. We recognised the importance of including partners in the treatment process for women experiencing the recurrent nature of vaginal infections. Our goal was to create a product that felt less “medicinal” and more aligned with intimacy and pleasure. Nunie’s Whipped Sex Butter was designed to support both partners, making the treatment process a shared experience that’s as nurturing as it is effective. 

8. When should I see a doctor? 

It’s important to see a doctor if you suspect you have Bacterial Vaginosis (BV), especially if it’s your first time experiencing symptoms. Early diagnosis and treatment are crucial to avoid potential complications. Here are specific situations where you should definitely consult a healthcare provider: 

First-Time Symptoms: If you notice symptoms like a thin, greyish-white vaginal discharge, a strong fishy odour, or any unusual vaginal discomfort, it’s important to see a doctor for an accurate diagnosis. BV symptoms can sometimes overlap with other conditions, such as yeast infections or sexually transmitted infections (STIs), so a professional evaluation is necessary. 

Recurrent BV: If you’ve been treated for BV before but the symptoms keep coming back, it may time to elicit the help of a naturopath. Recurrent BV can indicate an underlying issue that needs to be addressed, such as imbalances in the vaginal microbiome, lifestyle factors, or the influence of a sexual partner’s microbiome. 

Pregnancy: If you are pregnant and suspect you have BV, you should see a doctor promptly. BV during pregnancy can increase the risk of complications such as preterm birth and low birth weight, so timely treatment is essential. 

Unusual Symptoms: If you experience additional symptoms like pelvic pain, fever, or unusual bleeding, it’s important to seek medical attention immediately. These could be signs of a more serious infection or condition that requires prompt treatment.

Sexual Health Concerns: If you’re worried that your BV may be linked to a new or multiple sexual partners, or if you’re experiencing symptoms alongside concerns about sexually transmitted infections, a visit to the doctor is crucial for comprehensive screening and advice.