Bacterial Vaginosis (BV) is the most common vaginal condition, resulting from a disruption of the natural vaginal microbiome. This imbalance occurs when protective, acid-producing Lactobacillus bacteria decrease, allowing an overgrowth of other types of bacteria. For individuals actively trying to conceive (TTC), preventing BV is important for optimizing reproductive health and maintaining a stable environment before and during early pregnancy.
Understanding the Risk of BV During Conception
Maintaining a healthy vaginal environment is important because a BV infection can create conditions hostile to conception and early gestation. The shift from a healthy acidic vaginal pH of about 3.8–4.5 to a more alkaline pH, which happens with BV, can inhibit sperm motility and viability. This change in the chemical environment makes it more difficult for sperm to successfully navigate the reproductive tract towards the egg.
BV is also associated with chronic inflammation within the reproductive system, which is not ideal for preparing the body for pregnancy. The overgrowth of certain bacteria can ascend into the uterus and fallopian tubes, potentially increasing the risk of pelvic inflammatory disease (PID). PID can lead to scarring and blockages in the fallopian tubes, which would impede the egg and sperm from meeting.
While BV may not significantly affect the initial chance of conception for all women, its presence is associated with greater risks once a pregnancy is established. Studies have shown that BV is linked to a two-fold increased risk of miscarriage in the first trimester, particularly in those undergoing fertility treatments. Untreated BV may also increase the risk of later complications, such as preterm labor and delivery, making prevention a priority before and after a positive pregnancy test.
Daily Practices for Maintaining Vaginal pH
One of the most effective preventative measures is avoiding practices that disrupt the delicate balance of the vaginal microbiome. Douching, for instance, is strongly linked to BV recurrence because it flushes out the beneficial Lactobacillus bacteria, raising the vaginal pH. The vagina is a self-cleaning organ, and internal cleansing with water or commercial products is unnecessary and often counterproductive.
When cleansing the external genital area, use only mild, unscented soap or plain warm water, avoiding harsh chemicals, perfumes, or deodorizing products. It is important to wipe from front to back after using the restroom to prevent the transfer of bacteria from the anal area to the vagina. This simple hygiene practice reduces the introduction of non-vaginal flora that can contribute to an imbalance.
Choosing breathable clothing materials helps reduce the risk of infection by controlling moisture. Wearing cotton underwear instead of synthetic fabrics prevents heat and moisture buildup, which encourages the growth of harmful bacteria. Changing out of wet or sweaty clothes promptly limits the opportunity for an overgrowth of non-beneficial organisms.
During the fertile window, couples trying to conceive should use pH-neutral, fertility-friendly lubricants.
Nutritional Support for Flora Balance
Supporting the vaginal flora from the inside out involves targeted nutritional choices that promote the growth of protective bacteria. Probiotic supplements containing specific strains of Lactobacillus, such as Lactobacillus rhamnosus and Lactobacillus crispatus, are particularly helpful. These strains have been shown to colonize the vagina after oral ingestion, helping to restore and maintain a healthy acidic environment.
Incorporating fermented foods into the diet also provides a natural source of beneficial bacteria. Plain yogurt and kefir with live and active cultures are excellent sources of probiotics that can contribute to a balanced gut and vaginal microbiome. A healthy gut-vagina axis supports overall flora balance, making it easier for the body to fight off dysbiosis.
In addition to consuming probiotics, diet can limit the food source for harmful bacteria. Reducing the intake of processed foods and sources of high sugar minimizes the fuel available to non-beneficial organisms. Certain micronutrients, like Vitamin D and Vitamin C, also play a role in supporting the immune system and the integrity of the vaginal tissue, further aiding in BV prevention.
Recognizing Symptoms and Safe Treatment Options
Since prevention is not always absolute, it is important to recognize the signs of BV and seek immediate medical care, especially when trying to conceive. Symptoms often include a thin, gray or whitish discharge and a noticeable “fishy” odor, which may become stronger after intercourse. Some individuals may also experience mild itching or burning, although about half of those with BV have no noticeable symptoms at all.
If symptoms appear, consult a healthcare provider for a proper diagnosis. Prescription antibiotics, such as metronidazole or clindamycin, are the standard treatment options for BV. These medications are available in oral tablet or vaginal gel/cream forms and are considered safe to use during the preconception period and pregnancy when prescribed by a doctor.
Completing the full course of prescribed medication is necessary, even if symptoms resolve quickly, to eradicate the infection completely and reduce the chance of recurrence. Self-treating with unverified remedies, like boric acid vaginal suppositories, should be strictly avoided when trying to conceive or pregnant, as their safety profile during gestation is not established. A healthcare professional can confirm the diagnosis and ensure that the treatment plan is safe for the individual’s reproductive goals.