What is Bacterial Vaginosis?

Corey Whelan

Written by Corey Whelan

Bacterial vaginosis, often referred to as BV, is a common type of vaginal infection that can affect women of any age. If you’re approaching or in menopause, however, you may be especially vulnerable to this condition, along with its associated symptoms. Keep on reading on to find out why bacterial vaginosis may seem more prevalent during perimenopause and menopause and what you can do to manage it.

What Causes Bacterial Vaginosis?

Your vagina has a complex ecosystem all its own, which is known as the vaginal microbiome. Like your gut microbiome, your vaginal microbiome contains a myriad of healthy bacteria and other microorganisms. The balance between “good” and “bad” bacteria in the vaginal microbiome, however, is delicate and is affected by hormonal fluctuations in estrogen and progesterone.1 So, it makes sense as to why women transitioning through menopause, for example, may be more at risk for this type of an imbalance.

Fluctuating hormones can occur in response to a woman’s menstrual cycle, which is why bacterial vaginosis is commonly experienced during the reproductive years.2 And as mentioned, as women enter perimenopause and menopause, estrogen levels again fluctuate and then drop significantly. This alters the vaginal microbiome, making the vagina more susceptible to infection, as well as a pH imbalance.

A healthy vaginal microbiome is dominated by the Lactobacillus strains of bacteria. Lactobacillus bacteria are helpful in producing antimicrobial compounds, including lactic acid and hydrogen peroxide to acidify and normalize the vaginal pH, keeping harmful microorganisms in the vagina at bay.3 These “good” bacteria require estrogen to thrive and maintain dominance. When estrogen drops, so do the beneficial levels of vaginal Lactobacillus. This raises the vagina’s pH, creating an environment conducive to the growth of harmful bacteria.4 Because of this, bacterial vaginosis, and other types of vaginal infections, along with their symptoms, may result.

How Do You Get Bacterial Vaginosis?

Declining estrogen levels experienced during perimenopause leading into menopause create an environment conducive to bacterial vaginosis, but this isn’t what necessarily causes this infection. The underlying reasons as to why certain women experience BV and others don’t are not fully understood.

There are, however, known risk factors that may make women more vulnerable to experiencing this type of infection. They include: 5

  • Douching
  • Having an IUD (intrauterine device)
  • Having multiple sex partners
  • Having a new sex partner
  • Having a female sex partner
  • Not using condoms or dental dams
  • Pregnancy
  • Hormonal contraception

Is Bacterial Vaginosis an STD?

It’s not likely, but possible, to experience BV during times when you’re not sexually active. It’s important to note, however, that BV is not considered to be infectious; therefore, bacterial vaginosis is not classified as a sexually transmitted disease (STD) or infection (STI). It is, however, known to be linked to sexual activity.6,7

Researchers believe that having sex with a new partner of any gender can potentially alter the vaginal microbiome, by increasing the diversity and quantity of BV-causing bacteria. An occurrence of bacterial vaginosis is often the result of these changes.8

Bacterial Vaginosis Symptoms 

In many instances, bacterial vaginosis is asymptomatic. In fact, up to 84% of women with BV have no symptoms.9

Itching, burning, and soreness are also not usually linked to BV, but can occur. If you experience any symptoms related to bacterial vaginosis, they are more likely to include10:

  • An off-white, greenish, or greyish vaginal discharge
  • A fishy odor that may be stronger after sexual activity

Bacterial vaginosis can be a confusing infection to self-diagnose, as most-all of its symptoms may be associated with another common vaginal infection, yeast infections. The actual infection you have does affect the treatment option you will be given. For that reason, it’s important to check-in with your healthcare provider for diagnosis and treatment, especially if this is the first time, you’re experiencing any of these symptoms.

Since bacterial vaginosis, as well as other types of infections, such as chlamydia, are often asymptomatic, it’s a good idea to see a gynecologist regularly if you’re sexually active, to ensure you’re maintaining your vaginal health and sexual wellness.

Bacterial Vaginosis Prevention, Diagnosis, and Treatment  

You may be able to prevent some instances of BV if you avoid douching and use condoms during sex. However, it may still be possible to get BV even when taking these precautions. Male or female condom use is a must to minimize BV risk in the event you have multiple partners.

Some research indicates that eating probiotic yogurt or taking probiotics containing the beneficial strain of Lactobacillus bacteria, may help the vaginal microbiome remain healthy and balanced. This could, in turn, be helpful for preventing BV, especially in women prone to recurrent infections.11

How to Diagnoses Bacterial Vaginosis

To diagnose bacterial vaginosis, your healthcare provider will check your vagina for signs of discharge. They will likely also conduct a pelvic exam as well as do a vaginal swab test that provides information about your vaginal pH and the presence of bacteria.12

Bacterial Vaginosis Treatment

If your healthcare provider confirms BV, the treatment usually consists of oral and/or vaginal antibiotics. Taking all your medication as prescribed is important, even if symptoms abate. Recurrence of bacterial vaginosis is also possible, and common.13 For that reason, your healthcare provider may wish to reexamine and retest you in several weeks or months if symptoms persist or recur.

Bacterial vaginosis sometimes resolves on its own. It’s important to remember that symptoms don’t always occur with this infection, so feeling better is not always an indication that your BV has cleared.

If left untreated, BV can increase your chances of getting more serious STDs, including HIV, chlamydia, and gonorrhea.14

Remember, taking care of your vaginal health is just as important as taking care of the rest of your physical health. The best way to avoid bacterial vaginosis and its potential complications is to see a healthcare provider regularly, especially if you have symptoms.

**Disclaimer: The individual appearing in the photo associated with this post is a  model and is being used for illustrative purposes only.**

Resources

  1. https://www.verywellhealth.com/bacterial-vaginosis-menopause-5271402
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859802/
  3. https://www.frontiersin.org/articles/10.3389/fcimb.2021.631972/full#:~:text=The%20vaginal%20microbiome%20is%20an,which%20produce%20various%20antimicrobial%20compounds.
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770522/
  5. https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis
  6. https://www.medicalnewstoday.com/articles/is-bv-a-sign-of-cheating#is-it-an-sti
  7. https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis#:~:text=Is%20bacterial%20vaginosis%20(BV)%20an,makes%20bacterial%20overgrowth%20more%20likely.
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743080/
  9. https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis
  10. https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis
  11. https://www.healthline.com/health/vaginal-health/probiotic-vaginal-health#the-microbiome
  12. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285#:~:text=Your%20doctor%20may%20examine%20the,test%20strip%20in%20your%20vagina
  13. https://www.frontiersin.org/articles/10.3389/fcimb.2021.631972/full#:~:text=The%20vaginal%20microbiome%20is%20an,which%20produce%20various%20antimicrobial%20compounds.
  14. https://www.publichealth.va.gov/infectiondontpassiton/womens-health-guide/bacterial-vaginosis.asp#:~:text=Most%20often%2C%20BV%20does%20not,the%20uterus%20or%20fallopian%20tubes.

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