What is Bacterial Vaginosis?
Bacterial Vaginosis, otherwise known as BV, is an infection brought on by the disturbance of bacteria in the cervix, uterus and vagina.
The vagina contains thousands of naturally occurring ‘good’ bacteria, known as lactobacilli, which work to fight off harmful bacteria and prevent infections. Alongside regular secretions (discharge) which help to clear out old cells and keep the vagina clean, the lactobacilli maintain the vagina’s slightly acidic pH level and prevent harmful bacteria from multiplying. Bacterial Vaginosis is triggered when lactobacilli levels drop and the vagina’s pH level becomes more alkaline, allowing for the growth of abnormal bacteria.
The vagina’s lactobacilli can be disturbed by several factors. These include douching, using scented ‘feminine hygiene’ products, engaging with multiple sexual partners, smoking and having a copper IUD. Because BV can be triggered without engaging in sexual activity, it is not considered a STI.
Bacterial Vaginosis is a common vaginal infection, estimated to affect 1 in 3 women at least once in their lifetime.
BV is most easily identified by changes in vaginal discharge. While normal discharge will tend to be cream, in colour, with a thick, sticky consistency and generally odourless smell, BV discharge will be whitish or grey, thinner than usual and have a noticeably fishy odour. This characteristic odour is usually worse after sex.
There may also be a burning sensation while urinating and occasionally itching – although these symptoms are more widely associated with thrush.
If visiting your GP, the most common prescription to treat a case of BV will be 400mg of the antibiotic Metronidazole, twice a day for 5 to 7 days.
However, not all cases of BV need to be treated with antibiotics and occasionally a mild flair-up can be treated with natural remedies or may even disappear on its own.
Below are some suggestions of ways to treat BV naturally. It is important to note that while much research has been done on each of these methods, not all have been proven as an effective treatment and are therefore included in a more critical light. The general advice for anyone experiencing symptoms mentioned above would be to seek a secondary medical opinion, although monitoring the early symptoms of BV and employing the natural treatment measures below may occasionally help to clear mild infections.
1. Leaving the Vagina Alone
In some minor cases, Bacterial Vaginosis can clear up on its own, without intervention or the need for antibiotic treatment.
The vagina contains more bacteria than anywhere else on the body (second only to the bowel), many of these being probiotic strains (good bacteria) which work to outnumber other potentially harmful bacteria. During a bout of BV, the vagina’s lactobacilli (good bacteria) have been substantially diminished, and so need to restore their balance in order to correct the infection.
As a highly intelligent microbiome, in certain cases the vagina can restore lactobacillus levels itself, but this is dependent on the environment being able to return to its naturally acidic pH level of 4.5 or lower. If you are experiencing very mild BV symptoms, such as a slight change in discharge or a faint smell, then it can be advised to leave the vagina alone as much as possible while you keep an eye on any further changes. It is very easy to overcompensate for a case of BV by immediately washing with strongly scented soaps - but this often increases the prominence of the infection by further destabilising pH levels.
If symptoms remain mild (e.g. the smell doesn't become noticeable through clothing/underwear, discharge begins to return to normal and there is no pain or itching), then you may be able to manage this minor infection by continuing to wash as normal (once or twice a day) using water to clean the vagina and avoiding excessive scrubbing. As the natural pH of water is around 7.0, you could use washes with a pH of between 4-5, however, as the NHS website states, ‘washing with water and a plain soap should be all you need to keep your vagina healthy.’
Overall, immediate and natural actions you can take to treat mild early-onset BV include avoiding any excessively perfumed products, wearing loose-fitting, breathable underwear (like cotton briefs) and leaving your vagina alone outside of normal bathing routines.
However, as previously reiterated, it is extremely important to note that these actions are only advised when the episode of BV is very minor or during the first few days of monitoring the infection. If you are experiencing an immediate and noticeable smell when checking your underwear, if the change in your discharge continues for any longer than a couple of days or if you experience any form of pain or itching, it is integral to seek medical advise as soon as possible as you may well need to start a course of antibiotics.
Furthermore, if you encounter any symptoms of BV during pregnancy then always seek medical advice immediately. An increase in harmful bacteria in the vagina during pregnancy can potentially lead to complications such as miscarriage, premature labour and low birthweight, so if you spot BV symptoms during this period always seek advice from your GP.
As the key factor contributing to the onset of BV is a drop in lactobacilli levels, it makes sense that taking probiotics containing lactobacilli would help to restore the level of ‘good’ bacteria in the vagina and cure your BV.
There are both oral and suppository options when taking probiotics. The suppository option involves the insertion of a lactobacilli-containing probiotic into the vagina, while the oral option is a tablet taken with water. Both these options should generally be administered once a day for 2 months. The suppository option releases the lactobacilli directly into the epithelial cells of the vagina, while the oral tablet secretes the bacteria though the cell walls of the rectum after passing through the digestive tract.
However, despite the availability of these treatments, there is little to no evidence to demonstrate that probiotics are an effective treatment for BV. In various studies reviewed by Senok et al. and published in the medical journal Cochrane, there was found to be no conclusive evidence that probiotics are either superior to or enhance the effectiveness of antibiotic treatment. In addition, there is insufficient evidence to recommend the use of probiotics either before, during or after antibiotic treatment as a means of ensuring successful treatment or reduce recurrence
Like probiotic use, the reason why consuming (or applying) yoghurt to the vagina is thought to help cure BV is also due to its probiotic qualities.
One study which investigated the link between yoghurt consumption and BV prevalence found that women who drank a yoghurt drink containing lactobacillus once a day for 4 weeks had a higher BV cure rate than those who didn't. Of the 17 women in the ‘yoghurt’ control-group who tested BV positive at the start of the trial, all 17 were BV-free at the end. This is compared to just 11 out of 17 women in the ‘non-yoghurt’ control group.
The study cites that the reason this was possible is due to the fact that like probiotic tablets, which work in essentially the same way, the lactobacilli in the yoghurt are able to survive gastrointestinal transit and ultimately increase lactobacillus levels in the vagina – curing the episode of BV.
However, just like in the case of probiotics, this study is non-representational and as the NHS inform website states, ‘there's currently no evidence that probiotics, such as those found in some yoghurts, are able to treat or prevent BV’.
More research is needed to determine whether probiotics or yoghurt have a definitive effect on the treatment of BV, thus if you are experiencing symptoms it is always advisable to seek medical advice over attempting to cure the infection yourself.
4. Lactic Acid Gel
Lactic Acid gels are not antibiotic and can be bought as an over-the-counter treatment in most pharmacies.
Having an acidic pH quality, they work by restoring the natural acidity of the vagina, encouraging the regrowth of lactobacilli through the active ingredient of glycogen, which provides nutrients to the acidic bacteria.
Alongside the restoration of a normal pH balance, the lactic acid also works to neutralise the unpleasant odour caused by BV and ultimately eradicate the abnormal fishy-smelling discharge.
There may be a slight stinging sensation after inserting a lactic acid gel, but generally there are little to no side effects using this natural BV treatment method.
Vaginal correction treatments such as lactic acid are a relatively new way of treating BV and as with probiotics and yoghurt, the evidence of their effectiveness is still being researched.
5. Removing a copper IUD
Finally, for women who recurrently develop Bacterial Vaginosis and have a copper IUD, it may be advisable to remove the IUD after a thorough medical consultation.
In a pivotal study published in the journal of Sexually Transmitted Diseases in 2013, it was found that women who chose the Copper Intrauterine Device (IUD) as a form of contraception were more likely to experience Bacterial Vaginosis than women who used other contraceptives or none at all.
The reasons for this are twofold - owing both to the heavier and more irregular bleeding patterns brought on by a copper IUD. As blood has a neutral pH, heavy bleeding can reduce the acidity of the vagina and lead to diminished lactobacilli levels. When this happens frequently, the vagina may not have the ability to fully restore its bacterial balance – leading to the onset of BV.
Furthermore, menstruation is the time when the vagina’s lactobacilli and the body’s hormonal levels are most off-kilter, thus small pH changes (due to douching, sex etc.) can have a greater negative effect. As the copper IUD can contribute to irregular bleeding patterns, these more frequent fluctuations can result in increased bacterial instability. This latter point is particularly prevalent during the first 6 months of copper IUD insertion as the body is still getting used to the contraceptive device.
For women who regularly contract BV and have the copper coil, seeking out alternative methods of contraception may be recommended.
However, as with any change in contraceptive method, if you are considering this option it is in your best interest to seek the advice of your GP beforehand to discuss in detail alternative modes of birth control. For anyone that does go ahead with removal, it is integral to continue the use of condoms to prevent any unwanted pregnancies.