Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance of naturally occurring bacteria in the vagina. It affects many women and can cause uncomfortable symptoms. Understanding BV, its causes, and management is important for vaginal health. This article explains what BV is, its connection to sexual activity, other influencing factors, and treatment options.
What is Bacterial Vaginosis?
Bacterial vaginosis occurs when certain bacteria in the vagina overgrow, disrupting the natural balance of “good” bacteria, primarily lactobacilli. About 35% of individuals with a vagina will experience BV at some point, making it the most common vaginal issue for women aged 15 to 44.
Many individuals with BV do not experience symptoms; up to 84% may be asymptomatic. When symptoms do occur, they can include an unusual vaginal discharge that may appear off-white, gray, or greenish. A characteristic symptom is a strong, fish-like odor, often more noticeable after sexual intercourse. Other symptoms are vaginal itching, irritation, or a burning sensation during urination.
BV and Sexual Transmission
Bacterial vaginosis is not classified as a sexually transmitted infection (STI) like chlamydia or gonorrhea, because it results from an imbalance of bacteria already present in the vagina. While sexual activity does not directly transmit BV like a typical pathogen, it can influence the vaginal environment and increase the risk of developing the condition. For instance, having a new sexual partner or multiple partners is associated with a higher likelihood of BV.
Men do not develop BV themselves, as the condition is specific to the vaginal microbiome. However, men can carry BV-related bacteria on their penis or within the urethra after sexual contact, potentially transferring them to a female partner. The exact mechanism by which sexual activity contributes to BV is not fully understood, but it is thought that introducing new bacteria or changes in vaginal pH during sex can disrupt the delicate balance. While male partners are not typically treated for BV, recent research suggests treating them for recurrent BV might reduce recurrence rates in women, indicating a more complex relationship than previously thought.
Factors Influencing BV Development
Beyond sexual activity, several non-sexual factors can also disrupt the vaginal microbiome and contribute to bacterial vaginosis. Douching, the practice of rinsing the inside of the vagina, is a significant risk factor. It can upset the natural balance of vaginal bacteria and the vagina’s acidic environment, increasing BV likelihood. Studies show that individuals who douche frequently are more prone to developing BV.
The use of perfumed feminine hygiene products, such as scented soaps or tampons, can also irritate vaginal tissues and disrupt the delicate bacterial balance. Hormonal changes, such as those occurring during menstruation or pregnancy, can also influence vaginal flora and increase susceptibility to BV. An individual’s natural predisposition or genetic factors might also lead to a reduced number of protective lactobacilli bacteria, making them more susceptible to BV.
Managing BV and Preventing Recurrence
Treating bacterial vaginosis typically involves prescription antibiotics, administered orally or as a vaginal gel or cream. Common antibiotics include metronidazole, clindamycin, and tinidazole. It is important to complete the entire course of medication as prescribed, even if symptoms improve, to ensure full eradication of the bacterial overgrowth and reduce recurrence risk.
Preventing BV recurrence often involves adopting practices that support a healthy vaginal environment. Avoiding douching and using mild, unscented soaps for external genital hygiene can help maintain the natural pH and bacterial balance. Wearing breathable cotton underwear may also be beneficial. Consistent use of condoms during sexual activity can help maintain vaginal health and may reduce recurrence, especially with new or multiple partners. For individuals with frequent recurrences, healthcare providers might consider extended courses of antibiotics or adjunctive therapies like boric acid suppositories, which can help rebalance vaginal acidity.