Bacterial Vaginosis (BV) is one of the most common vaginal conditions globally, characterized by a shift in the delicate balance of the vaginal microbiome. This change involves a decrease in beneficial bacteria and an overgrowth of other organisms, often leading to unpleasant symptoms. Many people are concerned about whether an uncircumcised partner increases the risk of developing or reacquiring BV.
Defining Bacterial Vaginosis
Bacterial vaginosis is an ecological disorder where the normally Lactobacillus-dominant vaginal flora is replaced by a high concentration of mixed anaerobic bacteria. These organisms proliferate and disrupt the natural environment. The healthy vaginal environment is typically acidic due to the lactic acid produced by the Lactobacillus species.
This polymicrobial shift results in the symptoms of BV, though many individuals remain asymptomatic. When symptoms occur, they commonly include a thin, gray or whitish-green vaginal discharge. This discharge is often accompanied by a characteristic “fishy” odor, which can become more noticeable after intercourse or during menstruation. Some individuals may also experience mild irritation, itching, or a burning sensation during urination.
Sexual Activity as a General Risk Factor
While BV is not classified as a traditional sexually transmitted infection (STI), sexual activity is strongly associated with its acquisition and recurrence. Having a new sexual partner or multiple partners increases the risk of developing BV. This link is due to several non-specific changes that occur during sexual contact.
Sexual intercourse can mechanically introduce new bacteria, altering the existing microbial community. Furthermore, the presence of semen, which is naturally alkaline, can temporarily raise the vaginal pH level. This disruption in the acidic environment creates conditions more favorable for the overgrowth of the anaerobic bacteria associated with BV.
How Circumcision Status Affects BV Risk
The anatomical status of a male partner’s genitalia influences the concentration of bacteria associated with BV. The foreskin creates a unique microenvironment, known as the subpreputial space, which is dark, warm, and moist. This space is less exposed to air, promoting an anaerobic environment conducive to the growth of BV-associated bacteria (BVAB).
Studies indicate that uncircumcised males often harbor a higher concentration of these BVAB on the surface of the penis. The presence of the foreskin acts as a reservoir for these organisms, which can then be transferred during intercourse and contribute to the dysbiosis in the female partner.
Male Colonization and Partner Recurrence
The significance of the male partner’s status often shifts from initial acquisition risk to the problem of recurrence. Men exposed to BVAB typically remain asymptomatic because the penile anatomy does not host the same microbial imbalance found in the vagina. However, they can become colonized and carry the bacteria on their genital skin, effectively becoming a reservoir.
This asymptomatic carriage can lead to a cycle of reinfection, where the male partner reintroduces the BVAB after the female partner has completed antibiotic treatment. Approximately 50% of women experience a return of the condition within six months. Research shows that when the male partner of a woman with recurrent BV receives concurrent antibiotic treatment, the recurrence rate for the female partner is reduced. Partner therapy targets the BVAB reservoir on the male genitalia, suggesting that addressing male colonization is an effective strategy for managing persistent BV.