Bacterial Vaginosis: The Infection That Flies Under the Radar

What's that fishy smell? It may be bacterial vaginosis, which occurs when the good and bad bacteria in the vagina get out of balance.

By Barb DePree, MD, NCMP,MMM
I January 29, 2020

The vagina is a pretty amazing organ. It’s also a particular organ, requiring just the right balance of good and bad bacteria to be healthy. When there’s an imbalance, the result is bacterial vaginosis, or BV.

One in three women in the U.S. have had BV. While women of any age can get BV, menopausal women are at higher risk because estrogen and progesterone, which play an important role in maintaining that balance, drop off, paving the way for bad bacteria to multiply.

Symptoms of BV can vary, but the primary symptoms are a fishy odor and a thin white or yellow vaginal discharge. The only way to know for certain if you have it is to see your health care professional, who will do an exam and take samples of the discharge.

BV is treated with antibiotics (one study showed that adding probiotics to the course of treatment reduced recurrence). Left untreated, BV can increase your chances of getting pelvic inflammatory disease and sexually transmitted infections, like gonorrhea, chlamydia, herpes or HIV.

Preventing BV is a bit of a challenge, since anything that disrupts the balance of bacteria in your vagina can increase your risk. Antibiotics, sexual intercourse, douching and smoking fall into that category. Some women just have the bad luck of having naturally lower levels of good bacteria.

Don’t stop having sex (unless your doctor says to), and don’t stop taking prescribed antibiotics. Practice good vaginal hygiene. Use hypoallergenic, fragrance-free soap. Don’t douche; the vagina is self-cleaning, and a douche disrupts the environment for good bacteria. Wear cotton underwear, which breathes. You can also try oral probiotics with Lactobacillus rhamnosus GR, which may reduce the chances that BV will recur.

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through Middlesex, a website she founded and where this blog first appeared. She also is director of the Women’s Midlife Services at Holland Hospital, Holland, Michigan.