Bacterial vaginosis (BV) is a common vaginal condition resulting from an imbalance of naturally occurring bacteria in the vagina. It is not a sexually transmitted infection, though it is more common in those who are sexually active. The unique physiological changes after childbirth can make the postpartum period a particularly vulnerable time for this condition.
Understanding Postpartum BV
The time after childbirth brings significant hormonal and physical changes, creating an environment where bacterial imbalances can occur. After delivery, estrogen levels drop, and the presence of lochia—the normal discharge of blood and mucus—can alter the vaginal environment. These factors can disrupt the vagina’s normal acidity, allowing for an overgrowth of certain bacteria.
This shift involves a decrease in beneficial lactobacilli and an increase in anaerobic organisms like Gardnerella vaginalis. The loss of lactobacilli is central to the development of BV and its characteristic signs.
The most common symptom of BV is a noticeable change in vaginal discharge, which is often thin, watery, and grayish-white. A distinct, strong fishy odor is also a hallmark sign that may become more apparent after sexual intercourse. While some women may experience itching or a burning sensation during urination, these symptoms are less common, and about half of all women with BV experience no symptoms at all.
The Diagnosis Process
Due to the overlap of symptoms with other conditions, obtaining a professional diagnosis is an important step. Self-treating based on symptoms alone can be ineffective if the underlying issue is not BV.
A visit to a healthcare provider for suspected BV begins with a discussion of your symptoms and health history, followed by a pelvic exam. To confirm a diagnosis, the provider will collect a sample of vaginal fluid using a simple swab.
This fluid sample is then analyzed for specific markers of BV. One method is to test the pH of the fluid; in cases of BV, the pH is elevated above 4.5. The sample may also be examined under a microscope for “clue cells,” which are vaginal epithelial cells coated with bacteria and are a definitive sign of bacterial vaginosis.
Standard Treatment Approaches
Once a diagnosis of bacterial vaginosis is confirmed, the standard course of action involves prescription antibiotics to restore the natural balance of vaginal flora. It is important to follow the prescribed treatment plan to fully resolve the infection.
The most frequently prescribed antibiotics for BV are metronidazole and clindamycin. These medications are available as oral tablets or as a topical gel or cream administered directly into the vagina.
Completing the full course of antibiotics as prescribed is necessary for effective treatment. Symptoms may start to improve quickly, but stopping the medication early can lead to a recurrence of the infection.
Considerations for Breastfeeding Mothers
For mothers who are breastfeeding, a diagnosis of BV can bring questions about treatment safety. It is reassuring to know that effective and safe options are available that do not require pausing nursing.
Antibiotics like metronidazole are commonly prescribed for BV and are considered safe to use while breastfeeding. These medications can be taken as oral pills or used as a topical gel, and your doctor will determine the best format for your situation.
The BV infection itself is localized to the vagina and is not transmitted through breast milk, posing no direct risk to a nursing infant. Open communication with your healthcare provider will ensure you receive an appropriate treatment plan.