Bacterial Vaginosis

Bacterial Vaginosis or “BV” is an annoying condition that manifests with several symptoms:

• Vaginal discharge, usually with a “fishy” odor
• Vaginal irritation
• Mild pelvic discomfort

BV can be acute or recurrent and can be very debilitating when it does not respond easily to treatment.

How did I get this?

• BV is caused by an overgrowth of bacteria that are usually present in small amounts in the vagina.
• The healthy vaginal environment or “microbiome” supports the growth of healthy bacteria called Lactobacillus that produce acid. This healthy acid production suppresses growth of problematic bacteria that cause BV.

Things that can lead to the development of BV:

• Douching
• Vaginal intercourse (which does not directly cause an infection, but can create an environment that allows bacterial growth)
• Heavy periods that require prolonged use of menstrual pads that trap moisture
• Soaps or body wash with fragrance or antibacterial component that suppress healthy Lactobacillus
• Use of other over the counter treatments that suppress normal Lactobacillus

“The vagina is a self-cleaning oven.” We often use this analogy to remind people that the vagina has the ability to self-clean and douching or using other products after intercourse or menstrual bleeding IS NOT NECESSARY and can actually cause more problems.

What do I do if I think that I have BV?

• First, if it is the first episode of symptoms, make an appointment for an evaluation with your Gynecologist to confirm the diagnosis. Other conditions such as vaginal yeast, chlamydia, gonorrhea, atrophic vaginitis and trichomonas can cause similar symptoms.
• If you have BV, your health care provider will treat you with appropriate antibiotics, usually Flagyl (Metronidazole) or Cleocin/Clindesse (Clindamycin) vaginally or orally.

What can I do to prevent it?

• The main mode of prevention is to not overuse vaginal over-the-counter treatments, avoid douching and avoid antibacterial soaps & body washes in the pelvic area.
• Over-the-counter acidifying treatments such as RePhresh and Boric Acid suppositories can be helpful in stopping progression of symptoms if used early and can also be used in a suppressive way to prevent recurrent infections. I recommend using either treatment three times a week, on Monday, Wednesday, Friday for 6-12 weeks in cases of recurrent BV to try to promote growth of healthy Lactobacillus.
• Oral Pro-biotics may also help to support a healthy vaginal microbiome, although these treatments are unproven
• Using menstrual pads that prevent moisture may also be helpful.

What if it won’t get better?

• Dealing with recurrent BV can be a very tricky and frustrating situation. If you have recurrent symptoms, you need to have a long conversation with your Gynecologist about treatment options.
• There are some other pharmacologic treatments that may yield better results if standard treatments fail
• Specially prepared, compounded treatments can be made which will treat symptoms more effectively. We work directly with a local compounding pharmacy to provide these options
• In cases where there is a component of hormone deficiency and vaginal atrophy, adding vaginal estrogen can be helpful

At MORE, we are committed to providing comprehensive treatment and long-term options for dealing with acute & recurrent Bacterial Vaginosis infections. We can usually find some combination of treatment options to deal with your symptoms and get you back to feeling like yourself!

Author

Susan Lacy MD FACOG Dr. Susan Lacy is the founder of Modern Gynecology & Reproductive Health & MORE Aesthetics.