Bacterial vaginosis (BV) — when we lose the balance


Bacterial vaginosis (BV) — when we lose the balance

It’s pivotal to keep the balance — we hear or say it to ourselves for the umpteenth time. But the edge we’re walking on is slippery and we’re one moment’s distraction or a subtle push away from falling over. The metaphor is clear — keeping the balance of vaginal microbes is essential to the undisturbed functioning of the reproductive system. Nevertheless, changes in the vaginal environment might result in bacterial vaginosis (BV).

Jagoda Olczyk

Published: 15.06.2021 9 minreading time

BV bacterial vaginosis illustration

Illustration: Jarek Danilenko

Stinging and itching private parts, painful urination, atypical (yellowish, greenish, white or grey) vaginal discharge with a funky, fishy smell. Anything sounds familiar? I’m asking because, although I wish you all perfectly healthy vaginas, bringing you pleasure only, many of us have to deal with this infection. So for those acquainted with BV and those who are afraid of it: a hefty amount of knowledge about bacterial vaginosis.

Bacteria living in our vaginas

We know that there are thousands of microbes inhabiting our body. The skin, digestive tract, mucosae — these are the places in which, to put it simply, good and bad bacteria live. Apart from a layer of mucus and epithelial cells, our vaginas are protected by bacteria. More than 70% of them are Lactobacilli. During the reproductive years, in every gram of vaginal discharge (in the relevant stages of the menstrual cycle) there might be even 10 million of those!

These microorganisms are the true guardians of the vaginal microflora because they help keep the acidic pH. What’s interesting, in people from various ethnic groups lactic acid might also be produced by other types of bacteria. In the vaginal environment of white and Asian people Lactobacilli constitute the majority. However, a similar bacterial makeup can be found in only 60% of black or Latino people. So the pH of our vaginas depends both on our race and the stage of reproductive life we’re in.

Survival of the fittest

If our vaginal pH is right (3.6 to 4.5), it prevents the excessive growth of other microbes, such as Gardnerella vaginalis, Veillonella, Echerichia coli, or Prevotella, to name but a few. Under these enigmatic Latin terms hide anaerobic bacteria. Truth be told, they live in the digestive system from the moment of our birth and are harmless in small concentrations, beneficial even, but the problem arises when they start to replicate uncontrollably. Then, the only thing they think of is relocating to a more spacious, warm, and wet neighbourhood — and such conditions are to be found in the vagina. Due to the excess of pathogens, the once dominating Lactobacilli begin to disappear and the pH rises dramatically. The defence system is turned off and bang! vaginal infection served. The cooperation or rivalry of the microbes happens, of course, out of our sight but — although bacterial vaginosis (BV) can sometimes have an asymptomatic course — in many cases the organism drops us various hints.

Most common bacterial vaginosis symptoms

It’s important to monitor our vaginal discharge throughout the entire menstrual cycle. The significance of self-checks is unparallelled if we want to keep everything in order down there. The smell, colour, and consistency of the vaginal discharge are often prominent giveaways of the condition of our vagina. When we’re suffering from the symptomatic variation of bacterial vaginosis (BV), we’re usually dealing with a white-grey vaginal discharge with that funky (fishy) odour. Additional symptoms include itching or stinging of the vagina and vulva, as well as painful sex and urination (which stems from the fact that the “bad” bacteria colonising our vagina are often transferred to the urethra).

Bacterial vaginosis vs our minds

As always in discussing issues connected to the health of our vagina or breasts we don’t ignore the impact they might have on our psyche. In many cases, the effects of vaginal infections impinge on our emotional and social state. Recurrent bacterial vaginosis (BV) still makes some of us feel dirty and ashamed. More often than not, it makes us give up sex life, especially its oral variant. The subject of vaginal infections should not be a taboo anymore. Nevertheless, it’s no secret that talking about it might be intimidating. Despite all that, if you’re suffering from BV or any other infection, try talking about it with your partner. It’s all about your health and wellbeing. And if you’ve built your relationship on honesty and care, it’s the time to show yourselves some of that support and understanding :)

It’s not always easy to find the source of bacterial vaginosis, although the amount of situations in which you can get it is in surplus. So, just to be prepared for anything, let’s say some more about the causes of BV.

What prompts the growth of bacteria?

We talked about ratios at the beginning of this article but it’s good to know that the amount of microbes in the vagina (and the entire organism) changes constantly — sometimes naturally and regardless of us and sometimes due to our own inadequate actions. Actually, it’s not quite clear why one person suffers from recurrent vaginal infections and the other doesn’t. At the same time, doctors list a number of internal and external factors conducive to the infection.

People with vaginas of all ages might get bacterial vaginosis (BV), but it’s the sexual activity in the reproductive age that makes it easier for the infection to develop. The risk factors of going down with bacterial vaginosis rise with the number of sex partners. Having sex with multiple people at a time without barrier contraception might distrupt the balance of the vaginal flora and increase our susceptibility to sexually transmitted diseases, such as: chlamydia, gonorrhoea, or HIV.

Whether we use protection and care for proper hygiene before and after sex is equally important to maintaining adequate hygiene during menstruation, when the blood renders our vaginal pH more basic and, as a result, makes it more susceptible to infections. The infection risk increases when we replace hygiene products not often enough or our menstrual cycle gets disturbed, especially when the bleeding lasts longer than usual. People whose prolonged menses are the side effect of using intrauterine devices (IUD) might also be more exposed to getting bacterial vaginosis. Many doctors point out, however, that the impact of hormonal birth control on the vaginal flora is not yet thoroughly examined.

Upon entering the perimenopausal phase, it’s advisable to stay sharp. It’s the time when the production of estrogen, which prompts the growth of Lactobacilli, drops. This, in turn, results in more permanent changes in the vaginal pH (from acidic to basic). Additionally, vaginas become less moisturised — which renders them more susceptible to microtraumas and causes the vaginal lining to contract during menopause. And this is the perfect situation for an infection to wreak havoc inside our vaginas. Surely, hormonal changes occur in pregnant women as well. As we can guess, many of them can also get bacterial vaginosis. It also happens that the aforementioned bacterium, Escherichia coli penetrates the birth canal which may lead not only to inflammation but also to premature childbirth or low birthweight.

What disrupts the vaginal bacterial flora

  • Inadequate hygiene (including douching and using cleansing washes with poor composition);

  • eating habits;

  • functioning of our immune system and the changes thereto after a disease;

  • antibiotics;

  • smoking cigarettes;

  • lifestyle;

  • stress.

As usual, the causes are plentiful and sometimes it’s easy to lose the balance trying to navigate them. So it’s worth getting to know the ropes slowly, getting acquainted with the “enemy”, and determining the best defence strategy.

What to avoid and what to take care of

Given the fact that bacterial vaginosis (BV) is such a common and tricky infection, it might prove useful to make a simple list of how we can minimise the risk of developing it.

  • during sex use barrier contraception and avoid having multiple partners at a time. And before you get into the fun part, keep in mind that it’s worth taking a moment to discuss your sexual history with your new sex partner (I mean the history of tests for sexually transmitted infections);

  • don’t choose flavoured or scented condoms and lubricants. Strawberry taste or smell might be tempting but such products contain sugars and other chemical substances influencing the vaginal pH. Vaseline and oily lubricants are officially banned! They might damage latex condoms. If you’re reaching for lubricants, choose water-based ones;

  • it’d be nice to make a habit of washing your private parts before and especially after sex — rinsing the perineum (starting from the pubis downwards) and urinating will sucessfully prevent any bacteria from getting into the urethra;

  • don’t fall for the old myth that douching is the best method to get rid of an infection. Excessive douching might disrupt the natural bacterial flora of the vagina, which — as you already know — increases the risk of getting an infection. Vagina can cleanse itself. An ordinary bath or a shower will do just fine :);

  • to wash your private parts use only water or delicate odourless washes which don’t contain chemical substances that could sterilise or irritate your vagina. I highly recommend the natural Your KAYA intimate wash equipped with antibacterial lactic acid!;

  • replace your hygiene products regularly during menstruation. Trust me, odourless pads and tampons made of organic cotton are way better than those containing chlorine and made of synthetic materials — but you know this by now :) If you get infections regularly, avoid tampons whatsoever. They might irritate the vaginal mucosa. Maybe try a menstrual cup instead? Check out our menstrual cup size guide;

  • opt for breathable underwear made of natural materials. Let your synthetic, lacy undies, just like eating sweets with palm oil, be just an occasional whim. Thongs are also not recommended as they’re true carriers of anal bacteria to the vaginal area. Baggy and gauzy clothes are also advisable to wear at home! And for the night — loose pyjamas without underwear. Maybe we don’t give it much thought but our vaginas also need some rest after several hours in clothes.

As I mentioned before, bacterial vaginosis (BV) can also affect us if our immune system is weakened or we lead an unhealthy lifestyle. Which is why the last point on this list should be the most holistic advice ever: take care of yourself :)

Diagnosis and treatment for bacterial vaginosis (BV)

Many cases of bacterial vaginosis are easily cured. In some people, however, this infection stays for longer or reoccurs many times. Don’t get all skeptical about the symptoms and don’t you try alleviating them with over the counter treatment or home remedies. If you suspect that you have bacterial vaginosis don’t hesitate to call your gynaecologist. The first appointment is usually an empirical treatment (an interview instead of an immediate diagnosis), the second one — getting a sample of the vaginal discharge for testing. Culture tests take about a week and if the smear shows an increase in anaerobic bacteria in your vagina and the presence of clue cells (vaginal epitel cells covered in bacteria), an appropriate treatment is implemented. Depending on the type and progression of the symptoms the therapy might include oral or topical antibiotics with the additional application of probiotics.

As the beginning of this article states, balance is the basis of adequate organism functioning. A broader introduction of the issue of bacterial vaginosis to the general social awareness is key to minimising the risks of getting BV and reducing the stress that surrounds it. We’re happy to be part of the educational squad, sharing this knowledge with you :) [Accessed: 30.04.2021] [Accessed: 30.04.2021] [Accessed: 30.04.2021]

Bacterial vaginosis, [Accessed: 08.04.2021].

Bacterial vaginosis and pregnancy, [Accessed: 08.04.2021].

J. Brown, K. Hess, S. Brown i in., Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection Among a Cohort of Women in the United States, „Obstetrics & Gynecology” 2013, vol. 121, i. 4, p. 773-780, [Accessed: 08.04.2021].

T. Cornforth, Preventing Bacterial Vaginosis. Plus Coping Tips Every Women Should Know, med. rev. L. Ansell, [Accessed: 08.04.2021].

A. Druet, Bacterial Vaginosis: a common reason for irregular vaginal discharge, [Accessed: 07.04.2021].


Jagoda Olczyk

Although she graduated in journalism, the fascination with the plasticity of the language and curiosity have been present in her life for a long time. Jagoda also has her rituals: the downward dog and self-observation of the cycle.

See other articles

Expert check

lek. Karolina Rasoul-Pelińska
See other articles

Intimate health

Chlamydia trachomatis — don’t catch me if you can

A silent dictatress. It emerges out of the blue, doesn’t show any signs of its presence, but unfortunately knows exactly where to strike. Today, we’re discussing Chlamydia trachomatis — because we keep our friends close and enemies… well, we dissect them ;)

Dominika Olchowik