What Is Bacterial Vaginosis? And Why Do I Keep Getting It?
Something is up with your vagina: there’s more discharge than usual, it smells, and everything itches. Not only is your self-confidence approaching lows usually reserved for the dreaded cystic pimple, but you’re also uncomfortable! Is it a yeast infection? Maybe, but don’t reach for the Monistat just yet. You could have BV (or bacterial vaginosis, if you want to get clinical). Don’t panic—BV isn’t serious, it just means the delicate bacterial ecosystem inside your vagina is out of balance. Here are the facts:
BV is an infection caused by changes in the vagina’s healthy bacteria—most often when a strain of bacteria called Gardnerella vaginalis outnumbers another strain Lactobacillus, causing the vagina’s normal pH levels to shift. Normal vaginal pH is somewhere between 3.5 to 4.5, explains Lauren F. Streicher, M.D., an OB-GYN and medical director of Northwestern Medicine Center for Sexual Medicine and Menopause. If those levels rise, it means there’s not enough Lactobacillus and too much of the less-friendly bacteria. Put more usefully, it causes that itching, discharge, and odor that makes BV so uncomfortable. (Yeast infections on the other hand, are caused by an overgrowth of fungus called candida albicans—not bacteria.)
If you get BV, don’t take it personally—it’s the most common vaginal infection in women 15-44. A 2004 survey by the Centers for Disease Control and Prevention estimated 21.2 million (that’s nearly 30 percent) of women ages 14–49 have experienced BV. So yeah, you’re not alone.
It’s important to note that BV is not an STI—though it can increase your chances of getting one, according to the CDC. It is, however, what doctors call “sexually associated,” meaning it can flare up due to sex (more on that later).
Periods and sex are normal; so while getting BV is certainly a headache, you shouldn’t freak out over either for causing the bacterial imbalance. Think of it this way: If your vagina is a tropical paradise whose ecosystem gets hit by a rainstorm, is the storm your fault? No. Are you thrown off by it anyway? Yes. “It’s really about upsetting the normal vaginal flora, however that happens,” says Dr. Streicher.
One thing you can (and should) avoid doing: Douching. It’s like a destructive tsunami for your vagina, throwing your vaginal pH out of whack and potentially even pushing harmful bacteria into your uterus where they can cause more serious problems.
BV can be confused for a yeast infection. But while it’s true that they are similar below-the-belt issues, they’re ultimately different conditions with slightly different symptoms. First, let’s talk discharge: BV causes a watery grayish discharge while a yeast infection causes a white, thick discharge. “Odor is also really critical,” Dr. Streicher says. “There is a very specific fishy odor that generally goes along with BV.” You might notice a slight odor with a yeast infection, she says, but it’s “not foul” like the one that accompanies BV.
So, if your discharge is watery as opposed to white and thick, and smells like Pike Place Market on an August afternoon, it’s probably BV, and not a yeast infection. “But you know what we always say,” Dr. Streicher says. “If you’re not sure, you should go to the doctor.”
Sometimes, BV resolves itself. Maybe you get a day or two of funky smell after your period, but it goes away—meaning your Lactobacillus were able to repopulate on their own, Dr. Streicher says.
If that’s not the case and you’ve noticed a smell and itch for more than a day or two, you need to see your gyno for an antibiotic. Unfortunately, there are no over-the-counter products like Monistat that will do the trick. (Monistat is a treatment for yeast infections—it won’t do anything to stop the itching and clear up your condition if what you really have is BV.) “There are oral medications and vaginal preparations,” that you can get from your doctor, Dr. Streicher says. The newest option is a one-time antibiotic powder that you sprinkle on yogurt, she says. “It does seem to work better than the others in terms of recurrence,” says Dr. Streicher.
If BV is a recurring problem, you can try to prevent it by keping your vaginal pH in balance with a product like RepHresh gel, an over-the-counter vaginal gel. However, “RepHresh is not to treat BV. It’s to try and get ahead of it,” says Dr. Streicher, a spokesperson for the brand. Taking a probiotic may also be helpful, according to the Mayo Clinic. (Dr. Streicher recommends vaginal probiotics.)
You’ve probably heard that taking an antibiotic can cause a yeast infection. It’s true: lactobacilli (the good bacteria that helps keep your vaginal pH in balance) also prevent an overgrowth of yeast, explains the Mayo Clinic. But there’s a difference between antibiotics that typically cause yeast infections—prescribed for issues like bladder and upper respiratory infections—and ones prescribed for BV, Dr. Streicher says. The first kind are broad-spectrum antibiotics, she explains, which can kill off lactobacilli along with the bad bacteria. Antibiotics prescribed for BV, are more targeted, going after gardnerella vaginalis, the “bad” bacteria that trigger a case of BV.