7 Things Women Should Know About Bacterial Vaginosis

by | 05/09/20 | Vaginal Infections

Is your vagina smelling a bit funky? It might be bacterial vaginosis. Your vagina has a delicate ecosystem full of good bacteria called lactobacilli. These little guys keep things in check and makes sure your vagina is happy and healthy.

But what happens when these good guys can’t keep the ecosystem in check anymore? That’s when you get bacterial vaginosis.

Fact #1: Bacterial vaginosis is caused by an unbalanced vaginal ecosystem

The vagina usually has a pH level between 3.8 and 4.5. This acidic environment is required in order for the good bacteria, the lactobacilli, to live and keep other bad bacteria out.

The lactobacilli themselves create this environment by producing lactic acid. This is where the acidity comes from.

If the pH is more than 4.5 then you have a problem. At this pH, the lactobacilli aren’t able to keep out other bad bacteria, like Gardnerella vaginalis. This bacteria is the usual culprit when you get bacterial vaginosis.

But that’s not all, when you get an infection with Gardnerella vaginalis, it likes to call its friends and invites a whole bunch of other bacteria to join them.

The infection then becomes what we call polymicrobial – involving many different species of bacteria.

Fact #2: If your vagina smells bad, it might be bacterial vaginosis.

Foul selling vaginal discharge, this is the most common sign of bacterial vaginosis. This increase in discharge will be grey in colour and may have tiny bubbles in it.

You may initially notice this discharge after penis-in-vagina sex in particular. Because semen is alkaline, when it mixes with the discharge, it creates a chemical reaction that produces a very fishy smell – due to the volatile amines released.

Some people may experience burning urination or painful sex, but it’s rare. Bacterial vaginosis doesn’t tend to cause vaginal or vulva irritation.

Fact #3: You may be doing something to cause bacterial vaginosis without even knowing it

Now that we know bacterial vaginosis is caused by messing up the vaginal pH, here are some things that you may be doing every day that are doing just that.

The most common and most fixable thing you’re doing wrong is douching. Douching is when you purposefully wash or clean out the inside of your vagina with water. Some people even use other products like vinegar, baking soda or over the counter “feminine” or intimate hygiene products. Please do not do this!

As I have said before, and will continue to say: the vaginal is SELF-CLEANING.

This means that you don’t have to do anything to keep your vagina clean. This is why vaginas make discharge, to get rid of anything that needs to get out. You are wasting your money on things that are only going to harm you.

Bubble baths, bath oils, bath salts and bath bombs may also interfere with your pH.

Other reasons may include: recent antibiotic use, low levels of oestrogen (such as in menopause, chemotherapy, and other medical conditions), and using the Copper-IUD.

Fact #4: Getting a diagnosis can be quick and easy

If you suspect that you may have bacterial vaginosis, or you have just noticed a change in your normal discharge, it’s time to see your doctor.

Bacterial vaginosis can be diagnosed relatively easily in the doctor’s office. The doctor will take your medical history and explore your concerns, perform a physical exam (including a pelvic exam) and may take a swab of the discharge.

Some doctor’s offices have microscopes available, so that they can quickly look at the discharge taken with the swab. When using the microscope, they will be looking for special clue cells which indicate that there is bacterial vaginosis.

They will also test the pH of the discharge. If the pH is more than 4.5, it usually means that you have bacterial vaginosis.

Another test they can do is called a whiff test. Yes, it’s exactly what you think it is! They add a drop of 10% KOH to the slide with vaginal discharge on it and smell it! If it smells fishy, its bacterial vaginosis.

Only if you keep getting recurrent cases of bacterial vaginosis, the doctor will have to send a swab sample to the laboratory for cultures.

Fact #5: Treatment is cheap and readily available

Bacterial vaginosis is treated with a specific antibiotic that works for anaerobes. The antibiotic usually used is metronidazole. Metronidazole comes in two different formulations: oral tablets or a vaginal gel/cream.

The tablets are MUCH cheaper and easier to take, but they do tend to have bad side effects for some people. They may make you feel sick, with nausea, vomiting, diarrhoea and dizziness. This doesn’t happen to everyone and it varies in severity for each person.

The other problem is that it has a bad reaction with alcohol, so you cannot drink alcohol at all while taking your course of antibiotics.

The decision of which to use is usually up to you and what you prefer. If the infection doesn’t resolve after one course of treatment, the antibiotic course can be repeated again or another type of antibiotic can be used – called clindamycin.

Fact #6: If you keep getting bacterial vaginosis, despite treatment, your partner may be the culprit

Bacterial vaginosis is not considered a sexually transmitted disease but that doesn’t mean that you cannot get it from sex.

Whether your partners have penises or vaginas, you can get bacterial vaginosis from your partner. There have been studies done looking at women with recurrent infections, and they decided to test their penis-owning partners. They found that their urethras were colonised with the same bacteria even though they didn’t have an active infection.

It has also been found that women who have sex with women (WSW) have higher rates of bacterial vaginosis than heterosexual couples. Why is that? We still aren’t sure. It could be a number of reasons.

In my personal opinion, it absolutely makes sense that WSW would have higher rates of infection. People with penises don’t tend to get the infection while it is common with people with vaginas. This means that the odds of one of you having bacterial vaginosis is high.

Another point to consider is the use of sex toys and manual stimulation. If one sex toy or set of fingers are used by one person, then put into the vagina of the other person, that bacteria are going to be transferred easily.

This is why safer sex practices are so important, even with women who have sex with women.

If you would like to know more about how to protect yourself from bacterial vaginosis and other sexually transmitted infections, you’re in luck! I have created a Mini eBook called The Ultimate Guide to Safe Sex for Women Who Love Women. AND I’m giving it away ABSOLUTELY FREE for a limited time only! Safer sex is so much more than just condom use.

Inside this guide you will find everything you need to know and more! It contains all my tips and tricks that will keep sex fun AND protected.

7 Things Women Should Know About Bacterial Vaginosis


Fact #7: The treatment required for bacterial vaginosis can cause yeast infections

The antibiotics used to treat bacterial vaginosis, namely metronidazole and clindamycin, can cause vaginal yeast infections! I know, vaginas are such sensitive creatures…

This may feel like you are just replacing one infection with another, but have no fear! The way around this is just to give you the treatment for the yeast infection at the same time. Controlling the yeast at the same some while you kill off the bacterial vaginosis can help to get your vagina happy and healthy again.

This may sound like a lot of strain to put your body through, but this is why prevention is so much better than cure.

In summary

I’m sure by now that you understand the importance of respecting your vagina and the great job it does keeping itself clean. If you interfere, it can really throw a fit when the pH is messed with.

If you REALLY feel the need to wash your vulva, use only hypoallergenic bar soaps or don’t use soap at all. Avoid liquid soaps and body washes.

Never wash the inside of your vagina.

Take care of yourself.

7 Things Women Should Know About Bacterial Vaginosis

Make sure to share this post with your family and friends if you think there’s a good chance it could help them too. Thank you!

Disclaimer: This blog consists of only my opinions and doesn’t reflect the opinions of the Department of Health of South Africa or The Southern African Sexual Health Association. All information is accurate and true to the best of my knowledge, but it’s possible that there may be omissions, errors or mistakes. While I am a registered medical practitioner, I am not YOUR doctor. The information presented on this blog is for entertainment and/or informational purposes only and shouldn’t be seen as professional medical advice. If you rely on any information presented, it’s at your own risk. Please consult a professional before taking any sort of action.

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