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Ask Gynae Geek: your most Googled questions about bacterial vaginosis, answered

Gynae Geek x Stylist is our new regular column, bringing you myth-busting information about women’s health every single week. Here, gynaecologist Dr Anita Mitra breaks down everything we need to know about bacterial vaginosis.

What is bacterial vaginosis? What are the symptoms, and how is it treated? Scroll down for the answers to all of our most Googled questions.

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What is bacterial vaginosis?

This can be a distressing infection, which, just like thrush, causes a really irritating discharge that can also be recurrent. It’s caused by bacteria, as the name would suggest, and is the overgrowth of various types of ‘unhealthy’ bacteria that take over the vagina and halt the growth of the healthy Lactobacillus.

What are the symptoms of bacterial vaginosis?

The main symptom is a discharge. This can be thin or creamy in consistency, in varying shades of white, grey, green or yellow, and it has a characteristic smell, often described as ‘rotten fish’. Contrary to popular belief, it’s not caused by poor hygiene. In fact, excessive hygiene can actually cause it by washing away healthy bacteria, and this is something I’ve seen countless times. Common sense tells us that if something smells, that’s because it’s dirty and needs washing. This is absolutely not the case for your vagina.

What causes bacterial vaginosis?

Many women tend to get it just at the end of or after their period because that’s the time when oestrogen levels are at their lowest, which means the Lactobacillus don’t have much support to grow, so the bad bacteria can break free and take over. This is also the reason we see higher levels in women who have gone through the menopause. Smokers are also known to have higher rates of bacterial vaginosis, and there is no known ‘safe’ level of smoking, so if BV is a problem for you and you do smoke, quitting is the only way to know if it’s going to help you.

There’s also a common misconception that BV is a sexually transmitted infection, which it isn’t. However, semen does make the vagina less acidic and can slow the growth of healthy Lactobacillus, which may be why so many women report getting it after having a lot of sex. 

What is the treatment for bacterial vaginosis?

Treatment is with antibiotics – either oral tablets or vaginal cream – although recurrence rates are high. Using condoms doesn’t seem to help many people in my experience, so what’s a girl to do? Well, this is where my beloved probiotics come in. The published evidence isn’t as strong as it could be, but (in my opinion) that’s because the patients in the studies didn’t take the probiotics long term, so most studies have shown good cure rates but still high recurrence. For recurrent bacterial vaginosis you need to continue taking the probiotic long term because there’s probably a tiny population of the BV-causing bacteria that live dormant in your vagina, taking over whenever the opportunity presents itself and resulting in further episodes. By feeding your vagina with Lactobacillus on a daily basis, you have the best chance of stopping this from happening.

There are also a lot of over-the-counter vaginal creams and ‘pH-balancing’ products. For every person who says they work there seems to be another who says they are a waste of money and just make a mess, but I don’t have a problem with them, and if they work for you, that’s fine.

Again, treating your male partner doesn’t seem to help either, and not because he has a dirty penis, as one of my patients was once told.

In reality, there are probably a multitude of factors that cause BV that we’ll never get to the bottom of, but it does seem that some women are just more likely to get it due to their genes, so if that’s you, please don’t blame yourself and remember it’s not a sign that you or your partner are dirty.

Extracted from The Gynae Geek: Your No-Nonsense Guide to ‘Down There’ Healthcare by Dr Anita Mitra (Harper Thorsons, £14.99)

Images: Getty, Unsplash / Lead design: Alessia Armenise

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