Bacterial vaginosis (BV) is just one of the many unpleasant conditions that people with vaginas can experience, but it's especially annoying when it's recurring. BV that keeps coming back could be connected to your sex life, hygiene routine or something else.
The vagina contains many bacterial organisms that help keep it healthy, says Jodie Horton, MD, urogynecologist and chief advisor for Love Wellness. But if that bacterial balance goes out of whack, BV can happen.
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"The most dominant bacteria are lactobacilli, which help maintain a healthy vaginal pH between 3.8 to 4.5 and keep the organisms in balance," Dr. Horton says. "BV occurs when lactobacilli decreases and there's an overgrowth of bacteria called Gardnerella vaginalis or Prevotella."
And BV is a common condition for people with vaginas who are of reproductive age — in fact, it may affect as many as 50 percent of people assigned female at birth (AFAB), according to the National Institutes of Health.
Fortunately, you can take steps to prevent and treat it. Here's everything you need to know about the condition, including how you get BV, why it can recur and how to prevent it.
Managing your stress levels, practicing safe sex, wearing breathable underwear and simplifying your vaginal hygiene routine can all help reduce recurring BV.
Symptoms of BV
Some people with vaginas may not experience any discomfort from BV, while other people may deal with a variety of symptoms, per the Mayo Clinic.
Here are some of the most common signs of the condition:
- Thin, gray, white or green vaginal discharge
- Foul-smelling or fishy vaginal odor
- Vaginal itching
- Burning during urination
BV in Men
BV is a condition unique to people with vaginas. But some research suggests that people with penises can spread BV or other bacterial infections to partners who have vaginas.
For instance, a December 2013 study in Sexually Transmitted Diseases found that people assigned male at birth with a history of an inflammatory urethra condition (called nongonococcal urethritis) were more likely to carry BV-causing bacteria on their penises.
Bacterial Vaginosis Causes
So, how do you get bacterial vaginosis? Here are common causes of the condition (and the potential reasons why you keep getting BV infections):
1. Your Vaginal Hygiene Routine Is Too Complicated
A vaginal hygiene routine with too many or the wrong products can affect your pH balance and lead to an infection. Really, all you need is water to clean this area of your body.
"Feminine hygiene products like soaps, douching and sprays can change the pH of the vagina and [lead to] an overgrowth of bacteria, causing vaginal infections like bacterial vaginosis," Dr. Horton says.
Fix it: Dr. Horton recommends stripping down your vaginal hygiene routine. Here are her tips:
- Avoid products with perfumes and dyes
- Use a pH-balanced cleanser or water to wash your vulva
- Avoid douching, because the vagina is self-cleaning
2. Sexual Activity
BV isn't a sexually transmitted infection, but it typically occurs in people with vaginas who are sexually active, according to the Centers for Disease Control and Prevention. And having multiple sexual partners or a new sexual partner can increase your chances of getting BV.
Research has also shown that you can have recurring BV with the same partner. Indeed, a small March 2016 study of 35 people AFAB in PLOS One noted that those who had sex with the same partner before and after treatment for BV were two to three times more likely to experience BV again.
However, larger studies are needed to better establish this link.
Oral sex has also been linked to an increased risk of BV. According to an August 2020 study in PLOS Biology, BV-causing bacteria can be transferred via saliva into the vagina.
Fix it: This doesn't mean you have to deprive yourself of sex — rather, remember to prioritize safety.
For instance, using condoms every time you have sex and limiting the amount of sexual partners you have can help lower your chances of recurring BV infections, per the New York State Department of Health.
You can also use dental dams and condoms on sex toys if you are having sex with a partner who also has a vagina.
It's also important to be mindful of the link between semen and BV. Semen can alter the pH level in your vagina and contribute to a higher rate of bacteria growth, according to the Mayo Clinic.
3. You're Stressed Out
Yes, you read that right — stress can cause BV.
High levels of the stress hormone cortisol can negatively affect your overall wellbeing, which includes vaginal health. This physical stress can throw your vaginal pH levels out of balance, which can lead to BV, per Stony Brook Medicine.
Fix it: Managing your stress may help you avoid health issues like BV. To help, try techniques such as:
- Deep breathing
- Practicing gratitude
- Using meditation apps
- Eating nutrient-rich foods that nourish you
4. You're Wearing Underwear That Isn't Breathable
Your underwear may be another one of the reasons why your BV keeps coming back.
Non-breathable fabrics like nylon, for example, can block air movement in the vaginal area, which can lead to increased bacterial growth, per the Mayo Clinic.
Fix it: Opt for breathable, natural undies made of fabrics like cotton or bamboo, Dr. Horton says. "And at night, don't wear underwear to give the vagina a chance to breathe," she says.
Dr. Horton also suggests changing your underwear often and wearing panty liners (you should also change these often) if you have increased discharge.
"Also consider using hypoallergenic laundry detergent, which decreases the risk of vaginal irritation," she says.
5. You May Not Actually Have BV
BV is just one type of vaginitis, which is a group of inflammatory vaginal conditions. That's why some symptoms of BV and yeast infections (another kind of vaginitis) are similar, like having vaginal discharge, per the Mayo Clinic.
Here's how you tell the difference: BV is usually accompanied by discharge that is thin, gray or yellow with a foul, fishy odor. Yeast infections instead cause thick, white discharge with minimal or no odor.
Fix it: The best way to determine if your symptoms are BV (and get the treatment you need) is to visit your doctor, who can perform a pelvic exam and take fluid samples to give you a diagnosis, per the Mayo Clinic.
Even though BV and yeast infections share similarities, they can be treated differently, according to the Mayo Clinic. As a result, it's important to visit your doctor to get the right diagnosis so you can properly heal your symptoms.
How to Treat BV
Now you know the major bacterial vaginosis causes. But how do you take care of it if an infection arises?
First, there are several risks associated with recurring BV, according to Baylor College of Medicine, so it's important to see your doctor if you're experiencing symptoms. This includes an increased risk for developing conditions such as:
- Pelvic inflammatory disease
- Pregnancy complications
- Infection after surgery
Fortunately, you can lower your risk for these issues and banish BV with treatment. Dr. Horton says treatment options include:
- Oral medication (typically an antibiotic)
- Prescription-strength vaginal gel or cream
- Vaginal suppositories
Still, it's common for BV to recur within three months to a year, even after treatment, per the Mayo Clinic. If that's the case for you, talk to your doctor about long-term treatment options like extended-use antibiotics.
Dr. Horton also recommends using boric acid vaginal suppositories to help treat recurrent BV and maintain normal pH levels, as well as taking a probiotic to help keep vaginal bacteria levels in check.
How to Prevent BV
In addition to minimizing your risk of BV by avoiding over-cleaning your vagina, using protection during sex, managing stress and wearing the right undies, there are a few more general precautions you can take.
For instance, Dr. Horton suggests taking a probiotic to keep your vaginal pH levels in balance. Besides supplementing BV treatment, this could also help prevent another infection after you've healed.
Your diet may also help you ward off recurrent BV. Eating probiotic-rich foods that contain lactobacilli may help increase the amount of good bacteria in your vagina, according to the Mayo Clinic. These foods include:
- National Institutes of Health: "Beneficial bacteria prevent recurring bacterial vaginosis"
- Mayo Clinic: "Bacterial Vaginosis"
- Baylor College of Medicine: "Recurrent Bacterial Vaginosis"
- Sexually Transmitted Diseases: "Bacterial Vaginosis–Associated Bacteria in Men": Association of Leptotrichia/Sneathia spp. With Nongonococcal Urethritis
- CDC: "Bacterial Vaginosis – CDC Fact Sheet"
- Mayo Clinic Health System: "6 contributors to bacterial vaginosis"
- PLOS One: "Women’s Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence"
- Mayo Clinic: "Mayo Clinic Q and A": Vaginal infections have similar symptoms, require different treatments
- PLOS Biology: "Glycan cross-feeding supports mutualism between Fusobacterium and the vaginal microbiota"
- Stony Brook Medicine: "3 Ways that Stress Affects the Female Reproductive System"
- New York State Department of Health: "Bacterial Vaginosis: What Women Need to Know"
- U.S. Food and Drug Administration: “FDA 101: Dietary Supplements”
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.