Last updated by Dr Sarah Brewer on
Bacterial Vaginosis (BV) is the most common vaginal condition in women, and causes unpleasant symptoms of smelly discharge, soreness and irritation. Unfortunately, even when treated with antibiotics, it usually comes back quickly unless you know how to cure bacterial vaginosis for good. This involves using probiotic supplements that keep the microbes which cause bacterial vaginosis at bay. Here, I’ve reviewed what I believe, from working in sexual health clinics for over 20 years, are the best natural approaches to treating bacterial vaginosis.
- What is bacterial vaginosis?
- How common is bacterial vaginosis?
- What are the symptoms of bacterial vaginosis?
- What causes bacterial vaginosis?
- What happens if bacterial vaginosis is left untreated?
- Diagnosis of bacterial vaginosis
- Should your partner receive treatment?
- Self-help remedies for bacterial vaginosis
- Restore acidity to treat bv
- Replenish probiotic bacteria
- Replenish bowel probiotic bacteria
- Garlic for bacterial vaginosis
- Immune Support for bacterial vaginosis
- Vitamin D and bacterial vaginosis
- Echinacea for bacterial vaginosis
- Daily hygiene for bacterial vaginosis
What is bacterial vaginosis?
Bacterial vaginosis is an imbalance in the bacteria normally found within the vagina so that levels of beneficial, lactic-acid producing probiotic bacteria (Lactobacilli) are reduced or absent, and there is an overgrowth of smelly bacteria (such as Gardnerella and Bacteroides) which are usually only present in small numbers.
These ‘smelly’ anaerobic bacteria thrive in the absence of oxygen by breaking down proteins to form chemicals known as amines which produce a characteristic ‘fishy’ odour, cause irritation and an unpleasant discharge.
As bacterial vaginosis is not a true infection, but an imbalance of bacteria that are normally present, it can be treated using natural remedies. Sometimes specific antibiotics are needed to get on top of the imbalance, but it is likely to recur unless you also adopt the measures below.
How common is bacterial vaginosis?
Bacterial vaginosis affects at least 1 in 3 adult women at some point in their lives. Worldwide, between 10% and 50% of women are affected in different countries at any one time, making it the most frequently occurring vaginal condition in women. As well as affecting women of childbearing age, it is also common after the menopause when levels of beneficial Lactobacilli bacteria naturally fall.
Bacterial vaginosis is twice as common as thrush (Candida yeast overgrowth) and 2 out of 3 women with bacterial vaginosis wrongly diagnose themselves as having thrush as symptoms are similar.
What are the symptoms of bacterial vaginosis?
Mild bacterial vaginosis may not cause troublesome symptoms in as many as one in two affected, initially, but bacterial vaginosis can progress to result in:
- Increased water vaginal discharge which is often thin and white-grey in colour
- Unpleasant ammonia-like odour that has been likened to rotting fish
- Irritation, soreness and discomfort in and around the vagina.
These symptoms are often mistaken for vaginal candida (thrush) and will partially respond to antifungal treatments before recurring. If you think you have recurrent thrush, it’s worth considering whether or not you could have bacterial vaginosis.
The offensive smell of bacterial vaginosis worse when the discharge mixes with alkaline fluids. This occurs during and after menstruation, when the smell may seem worse, and after having unprotected sex as blood and semen are both alkaline. The smell can also worsen if the discharge mixes with alkaline urine. Panty liners are essential when you have a discharge, so you can freshen up easily as often as necessary during the day. No woman should be without them!
Always Dailies are slim, discreet and feature odour neutralisation technology – eliminating smells rather than masking them. As they are unscented they will not cause further irritation.
What causes bacterial vaginosis?
What triggers the bacterial imbalance is poorly understood. It is related to loss of normal vaginal acidity which, in turn, can result from hormonal and lifestyle changes. Once intimate pH balance is disturbed, acid-loving Lactobacilli disappear and the growth of less beneficial bacteria is encouraged.
Hormonal factors affect vaginal acidity and glycogen levels which normally promote the growth of beneficial Lactobacilli. As a result, bacterial vaginosis often arises spontaneously before and during menstruation, then resolves mid-cycle, although recurrences are common.
Factors that are associated with an increased risk for developing bacterial vaginosis are:
- Prolonged periods
- Hormonal changes associated with the menopause
- Use of an intra-uterine device (IUD or the coil)
- Frequent douching (washing out normal, harmless bacterial)
- Low vitamin D levels
- Smoking cigarettes which reduces immunity; one study also found that passive smoking increased the risk of having bacterial vaginosis
- Having Herpes simplex virus type 2
- Taking broad-spectrum antibiotics which kill healthy Lactobacilli, too.
Bacterial vaginosis is NOT caused by poor hygiene – in fact excessive washing may alter the normal acidity and balance of bacteria, especially if you use perfumed soaps and products. Whatever you do, don’t douche! Regular, non-excessive washing with products designed to support a healthy bacterial balance is the key to solving bacterial vaginosis (see below).
Whether or not bacterial vaginosis is sexually transmissible is up for debate. You don’t have to be sexually active to develop it, but being sexually activity increases the chance of developing the imbalance. Men can experience irritation after exposure to the bacterial vaginosis discharge during sex unless they use a condom.
Interestingly, hormonal methods of contraception appear to protect against bacterial vaginosis as these hormones help to maintain normal vaginal acidity and raise glycogen levels to fuel the growth of beneficial probiotic bacteria.
What happens if bacterial vaginosis is left untreated?
Bacterial vaginosis can resolve on its own, but will almost always recur. If left untreated, persistent bacterial vaginosis can increase the risk of developing pelvic inflammatory disease and affect future fertility. One study found that bacterial vaginosis is significantly more likely in infertile women than in a similar group of pregnant women.
During pregnancy, BV is a recognised potential trigger for miscarriage during the first three months of pregnancy, for early labour and for premature birth. If you are planning a pregnancy, it is a good idea to have a full check-up before trying to conceive, to exclude bacterial vaginosis, as the bacterial imbalance does not cause appreciable symptoms in around fifty per cent of women who are affected.
Researchers now also suspect that having bacterial vaginosis may increase the change of developing cervical cancer by 50%. The link may be due to inflammatory changes, or to the fact that having bacterial vaginosis increases the chance of acquiring cervical human papillomavirus (HPV) which is also a known risk factor for cervical cancer.
There is also evidence that having bacterial vaginosis may increase the risk of acquiring HIV when exposed to the virus, too.
Diagnosis of bacterial vaginosis
As mild bacterial vaginosis has similar symptoms to candida yeast infection – soreness and itch – it’s important to get the diagnosis right.
Bacterial vaginosis is diagnosed by detecting the typical changes in acidity (pH) of vaginal discharge using acid-sensitive litmus paper. Discharge may also be mixed with an alkaline substance (eg potassium hydroxide) to release the classic, amine fishy odour – this test is commonly referred to as the ‘sniff test’.
Laboratory cultures look for the presence of a bacterium called Gardnerella vaginalis which is almost always present in bacterial vaginosis, although this not the most accurate way to confirm the diagnosis as Gardnerella are often also present in women without obvious bacterial vaginosis.
The best way to confirm the diagnosis is to examine fresh discharge under a microscope, with the addition of stains to show the balance between ‘good’ and ‘bad’ bacteria. This is the standard way to detect bacterial vaginosis in sexual health clinics.
Self-tests are also available to help diagnose whether or not you have bacterial vaginosis.
Canestest is a convenient way to tell if your symptoms are due to a bacterial imbalance, or to thrush. Simply unwrap the swab and gently insert the yellow tip into the vagina. Rotate the swab, then remove. After 10 seconds, check the tip of the swab to see if it has changed to blue or green (probably bacterial imbalance).
A similar test available in the US is Monistat Complete Care.
Specific antibiotics (clindamycin, metronidazole, tinidazole) are often prescribed (as oral tablets or an internal vaginal cream/gel) to treat profuse bacterial vaginosis but this is usually only a temporary solution.
The bacterial imbalance of bacterial vaginosis persists and comes back despite these antibiotics in 11% to 29% of women, and recurs in 72% within a few months of treatment.
Should your partner receive treatment?
Bacteria associated with bacterial vaginosis are found in the normal male genital tract, and their presence could potentially increase the chance of a partner experiencing recurrent bacterial vaginosis after antibiotic treatment. However, a recent review of 7 trials, involving over 1000 people, found that giving antibiotic treatment to the sexual partners of women with bacterial vaginosis did not increase the rate of clinical or symptomatic improvement, and did not decrease the recurrence rate, compared with inactive placebo. While your male partner may be offered treatment, it is not guaranteed to make a difference.
If your partner is female, then it’s important that you both receive treatment. A review in the BMJ journal found that at least one in 4 and probably as many as 1 in 2 lesbians have bacterial vaginosis, and that both partners were affected in 87% of cases. Overall, lesbians were 2.5 times more likely to have BV than heterosexual women.
Self-help remedies for bacterial vaginosis
You can overcome bacterial vaginosis without resorting to antibiotics if you take steps to restore the natural acidity of vaginal secretions, replenish probiotic bacteria (locally and in the gut) and correct any vitamin and mineral deficiencies that can reduce immunity – especially low vitamin D levels which are associated with bacterial vaginosis.
Restore acidity to treat bv
The first step is to restore the acid balance of the vagina which will allow healthy bacteria to flourish. A number of products are available to help prevent and treat bacterial vaginosis. Most contain lactic acid, while some also contain glycogen to provide fuel to promote the healthy growth of the normal bacteria (but cannot be used by anaerobic bacteria).
Canesbalance Bacterial Vaginosis Vaginal Gel contains lactic acid and glycogen to relieve unpleasant odour and abnormal discharge, restrict the growth of ‘bad’ bacteria and support the growth of ‘good’ bacteria.The gel is easy to insert using the hygienic single-use internal applicators. A similar product in the US is Lactobor.
Balance Active BV Gel contains lactic acid and glycogen and is clinically proven to restore and preserve the natural pH balance in the vagina, to neutralise abnormal odour, relieve discomfort and discharge, and to both treat and prevent bacterial vaginosis. The gel is easy to insert using the hygienic single-use internal applicators.
Replenish probiotic bacteria
A gold-standard Cochrane review concluded that intravaginal probiotics (gelatin tablets containing lactobacillus) was significantly more effective in treating bacterial vaginosis than oral antibiotics (metronidazole) with a 20% greater chance of treatment success. Similarly, Taking oral lactobacillus as well as metronidazole was 33% more effective than metronidazole alone.
Canesflor probiotic vaginal tablets help to replace missing Lactobacilli to restore a healthy balance and reduce the chance of recurrent bacterial vaginosis or yeast infections. Canesflor contains a clinically tested strain, Lactobacillus plantarum P176530, shown to prevent thrush and BV. Not less than 108 colony-forming units per vaginal tablet.
Balance Active BV Vaginal Pessaries offer another insertion method – the pessary slowly dissolves. After washing your hands, insert one pessary as far as is comfortably possible using your fingers. Use one a day – best used overnight, although you can use during the day, instead.
Probiotic pessaries, which boost the growth of probiotic bacteria within the vagina are also available if you prefer.
Replenish bowel probiotic bacteria
If you are lacking probiotic bacteria in the vagina, then you are almost guaranteed to have insufficient levels within the bowel, too. It is better to take a wide spectrum probiotic product that replenishes the bacteria in the gut. These will quickly find their way to the vagina to help resolve the imbalance once bowel balance is restored.
Analysis of data from 12 trials, involving over 1,300 women, found that taking probiotic supplements significantly improved the cure rate for bacterial vaginosis by 53% to 60%, compared with women who did not take oral probiotics.
Garlic for bacterial vaginosis
For those with recurrent bacterial vaginosis, garlic has beneficial antiseptic and antifungal actions. Garlic extracts increase the activity of immune cells that target bacterial infections and overgrowth. It is so effective that garlic was once known as Russian penicillin after it was used to treat soldiers when the Russian army ran out of antibiotics during World War II.
Garlic contains a powerful antioxidant, allicin, which is formed when the clove is cut or crushed. Black garlic is produced by fermenting fresh garlic under controlled conditions of high temperature and humidity to convert ‘smelly’ sulphur-containing compounds into stable, odourless substances.
In research involving 120 women with bacterial vaginosis, half the women took garlic tablets, and half took oral metronidazole for seven days. Garlic produced a therapeutic effect in 63% of cases, compared with 48% for metronidazole, and was associated with significantly fewer side effects.
Immune Support for bacterial vaginosis
If your general immunity is low, a multivitamin and mineral supplement providing around 100 per cent of as many micro-nutrients (including iron) is worth considering. Click here to see my post on the best multivitamins.
Vitamin D and bacterial vaginosis
Vitamin D has many beneficial effects on immune function. Lack of vitamin D is common and deficiency is associated with bacterial vaginosis. This is one reason why pregnant women are now advised to take a vitamin D supplement.
A study involving 208 women with confirmed, asymptomatic bacterial vaginosis looked at the effects of taking 2000 IU vitamin D for 15 weeks, compared with inactive placebo. In the group who took vitamin D, the cure rate was 63.5% from this intervention alone, while in the control group the bacterial vaginosis resolved in only 19.2 per cent during the 15 week trial. After taking account of all confounding factors, the researchers concluded that the odds of having persistent bacterial vaginosis was 10.8 times lower in those taking vitamin D supplements than in those not taking it.
One of the best ways to take vitamin D is as a spray under the tongue for rapid absorption. Click here to read more about vitamin D.
Echinacea for bacterial vaginosis
Herbalists often recommend an immune-supporting supplement such as Echinacea to help boost white cell function. Although this may well be effective, no clinical trials have explored this. Studies have shown that Echinacea can boost the effectiveness of antifungal creams used to treat vaginal Candida (thrush) however, so if you continue to have problems with persistent bacterial vaginosis, this herbal medicine is worth trying.
As a traditional herbal medicine, Echinacea is licensed to relieve symptoms of cold and flu. Although these are viral infections, research shows that Echinacea also has antibacterial properties, and stimulates the activity of immune cells that absorb and neutralise both bacterial and viral infections.
Herbalist A.Vogel has a long history of producing evidence-based herbal medicines made from fresh rather than dried herbs. Echinaforce Echinacea Tablets are made from fresh Echinacea purpurea leaves and roots, and are made to rigorous Swiss GMP standards.
Daily hygiene for bacterial vaginosis
Avoid using soap around this delicate area.
Do not use bath additives (eg bubble bath) or shampoo your hair in the bath as detergents can affect normal vaginal acidity and bacterial balance.
Avoid douching which will flush out beneficial bacteria and immune factors and make bacterial vaginosis worse.
Avoid using feminine deodorants that aren’t specifically designed to protect normal acidity – but even these can worsen irritation if you have bacterial vaginosis.
Either boil your underwear, or hot iron the gussets to ensure all microbes, including spores, are killed – modern low temperature wash cycles will not eradicate these germs.
SebaMed feminine Intimate Wash is a mild, organic based cleanser that is alkali-free and pH 3.8 for optimum bacterial balance. It contains soothing aloe vera and chamomile extracts (bisobolol) and is dermatologist recommended for even the most sensitive skin.
Faith in Nature Organic Feminine Wash is enriched with organic aloe vera and essential oils. It is pH balanced for use on even the most sensitive skin. Scented with rose, violet and vanilla extracts it offers natural odour control.
If you’ve tried any of these products, or found anything else that helps, please let me know via the comments box below. Thank you.