Bacterial Vaginosis: a Common WSW Diagnosis.

What is Bacterial Vaginosis and why do my partner and I keep getting it?

Bacterial Vaginosis (BV) is an overgrowth of bacteria in the vagina.

BV is not traditionally considered a sexually transmitted disease (STD) but it is commonly found in women who have sex with women (WSW) and can be transmitted between two women.

The vagina naturally has many bacteria residing in it and the balance (flora) of them are all in harmony. With BV, one kind of bacteria (usually Gardnerella) overgrows and changes the natural pH of the vagina, making it more alkaline.

Sometimes this doesn't cause any symptoms. However, commonly it causes vaginal discomfort, including discharge, odor (oftentimes described as "fishy"), itching, and pain with sexual penetration.

The cause of this bacterial shift is not well understood. It can be caused from using scented products meant to "clean" the vagina, such as douches. It can also be caused by irritation from scented body wash, using loofahs, etc.

Many times, women mistakenly self-diagnose BV as a vaginal yeast infection.

They end up treating their symptoms with an over the counter anti-fungal but are frustrated when their symptoms do not improve. Sometimes women even call their health care provider over the phone and describe their symptoms, thinking it is a yeast infection, and get treated with a prescription anti-fungal. This, of course, does nothing to treat the underlying issue: bacterial vaginosis.

The standard treatment for BV is an antibiotic, either taken by mouth or administered to the vagina itself in a cream or gel. 

Unfortunately, sometimes antibiotics can cause yeast infections so in fixing one problem, you end up with another.

Let's talk about vaginal hygiene for a moment. Here are some recommendations for keeping the vagina's natural pH at a healthy level, helping you avoid bacterial vaginosis (BV):

  • Do not wear underwear at night. This allows the vagina to "air-out" and breathe.
  • When you do wear underwear, wear cotton, not nylon. Cotton is a more breathable fabric.
  • Throw away your douches. Most of them are scented and are not good for the vagina, and can cause the problem you are trying to prevent or treat.
  • In the shower, wash your vagina with your hand and water. Do NOT use a loofah or a washcloth to clean your vagina.  The vagina is very sensitive and can easily become irritated.
  • Do not use scented soaps or body washes in the shower, and do not use scented lotions anywhere near the vagina. If you feel you must use a soap to feel clean, then use a non-scented soap intended for sensitive skin, but use very sparingly and make sure you rinse with a lot of water.
  • Sometimes even scented laundry detergent or fabric softeners can cause irritation to the vagina, so wash your underwear separately if needed, using non-scented laundry detergent, and do not use dryer sheets or fabric softener.
  • If you use sex toys, wash them in between partners and uses, using a non-scented soap, and be sure to rinse them thoroughly.
  • If you are using condoms on sex toys or have sex with men using a condom, pay attention to your vaginal reaction. Occasionally, women are allergic to latex, or another ingredient in the condom itself. Condoms are always a good idea, and should absolutely be used, but you may need to change brands or even look for a latex-free version.
  • If you shave or groom your pubic hair, do not share your razor with anyone. Shave "with the grain" of the hair, not against it. Sometimes shaving can cause irritation and lacerations and this can be an area where infection can occur. Sometimes waxing or getting laser hair removal is a better option.
  • If you do have sexual partners who are women, consider using barrier methods (such as a dental dam or a condom cut open). It's difficult to prevent cervical mucous or vaginal mucous exchanging between two women who are sexually active. So, if you or your partner are having any symptoms of bacterial vaginosis, then it's better to wait until treatment to resume sexual activity.
  • Call your health care provider if you are having vaginal symptoms. They are trained in recognizing vaginal infections and sometimes it can be a more serious problem causing your symptoms, such as chlamydia, gonorrhea, or another STD that needs to be treated.
  • Taking a daily probiotic designed for vaginal flora can also be beneficial in helping to maintain the normal balance of bacteria in the vagina.

If you are prescribed medication, take all your medication as directed and finish the treatment.

A commonly prescribed medication for bacterial vaginosis, called metronidazole, can make you very sick if you drink alcohol during your treatment. So, avoid alcohol during treatment and for about 3 days after your last dose. Avoid sexual activity/penetration/intercourse during treatment so you don't spread it between partners and give your body a chance to reestablish normal flora.

It's important to treat your bacterial vaginosis if you are having symptoms, and especially if you are pregnant. See the CDC website for further details on the complications that can occur if BV is left untreated.

For more information on bacterial vaginosis, visit the CDC website.