If you notice something doesn’t quite feel right down there, your mind probably jumps straight to a yeast infection. It makes sense, since yeast infections are super common: At least 75 percent of women experience at least one in their lifetime.
But the most common vaginal infection is actually a bacterial imbalance called bacterial vaginosis (BV for short), which affects nearly 30 percent of women ages 15 to 44. Unlike yeast, where you get that thick (and super uncomfortable) cottage cheese-y discharge, BV often comes with a thin, white or gray discharge and a fishy, sour smell.
But what exactly causes BV-and more importantly, what can you do about it? We pinged the pros for everything you should know about the condition.
What causes bacterial vaginosis?
Bacterial vaginosis is an overgrowth of the bacteria that are always present in your vagina. “One of the risk factors for BV is sexual activity and multiple partners,” says gynaecologist Dr Monica Svets. It's sometimes referred to as a sexually transmitted infection (STI) but it’s actually not totally clear what role sex actually plays in the condition's development. Experts believe that having sex can mess with your vagina’s natural flora (the yeast and bacteria that live in there) and pH levels, which eventually allows for overgrowth.
So what’s the difference between a yeast infection and BV?
A yeast infection occurs when the balance of yeast and bacteria in your vagina are out of whack, causing an overgrowth of a type of yeast called candida. BV, on the other hand, happens when the balance of two types of bacteria-lactobacilli (the good kind) and anaerobes (the bad kind)-are thrown off.
A healthy vaginal environment is pretty acidic, with a pH range of 4 or 4.5, says Dr Svets, but the family of bacteria that cause BV like higher pH levels, around 6 or 7.
“With a yeast infection, there is a drop in the pH of the vagina, and with bacterial vaginosis, there is a rise in the pH of the vagina,” explains gynaecologist Dr Suzanne Fenske.
Anything that can tip the vaginal environment up the pH scale can up the risk of bacterial overgrowth, and thus, BV. This includes blood (many women have a change in flora during their period), sex, ejaculate, douching, and using scented laundry detergent, perfumes, or soaps.
Exposure to a sexually transmitted infection and smoking can also alter the balance of bacteria in the vagina, increasing the likelihood of BV, adds Dr Fenske.
What are the symptoms of bacterial vaginosis?
Here’s the bummer: 84 percent of women with BV don’t have any symptoms at all.
But if you do have symptoms, the main ones to look for include a thin, white or gray vaginal discharge, itching in or around the vagina, and a strong fishy smell, says Dr Svets. The bacteria that lead to BV are odor-producers-so when there’s a wealth of them, it will get a bit funky down there. (While there are a few things that can lead to vaginal odour, that fishy smell is pretty unique to BV.)
It’s also possible to notice more intense symptoms like abdominal pain or pelvic pressure (almost similar to what you’d feel if you had a UTI). This could be from BV travelling up, causing pelvic infections, says Dr Svets-which is why treating it effectively is key.
How is bacterial vaginosis treated?
To actually know if you have BV, you need to make an appointment with your doc to ID the condition. Most commonly, antibiotics-usually vaginal or oral metronidazole or clindamycin-are used, says Dr Fenske. A vaginal metronidazole suppository (you use it for five nights) is often your best option. Just note that oral metronidazole cannot be combined with certain medications and alcohol, as it can cause unpleasant side effects like of nausea and vomiting.
No matter what you choose, don’t just wait it out. When left untreated, BV has been associated with both pre-term labour in pregnant women (that’s why some docs screen for it) and intrauterine infections. Your risk of STIs, including HIV, also spikes.
Above all, be patient. “BV is a pain in the butt,” says Dr. Svets. “It can be recurrent and often times, you chase it.” In part, the infection comes back time and time again because the bacteria that causes it is always there, and you’re likely not going to stop doing at least some of the things that up your risk for it-namely having sex and getting your period.
So, on top of treating the issue with antibiotics, making some lifestyle changes-especially if you suffer from repeat cases-can make a difference, says Dr Svets. Using dye-free products, unscented soaps, natural lubes, and wearing breathable, cotton underwear will help keep the bacteria in your vagina’s microbiome happy.
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