What is BV?

Bacterial vaginitis (BV) isn’t, as many women think, an infection with a specific bacteria or yeast. BV refers to an imbalance in the vagina’s own bacterial communities. When beneficial organisms aren’t as robust, it can lead to an overgrowth of the less-than-desirable bacteria in the vagina (Peptostreptococcus species, Eubacterium species, Mobiluncus species, Gardnerella, and Mycoplasma hominis, Gardnerella vaginalis, to name just a few!).

Contributing Factors

• Changes in vaginal pH: A shift in the normal acidic environment of the vagina can create a favorable environment for the growth of harmful bacteria. This can be caused by:
  • Douching: This disrupts the natural balance of bacteria in the vagina.
  • Use of feminine hygiene products: Products with perfumes or harsh chemicals can irritate the vagina and alter its pH.
  • Semen: Semen can change the pH of the vagina, especially after unprotected sex.
• Antibiotic use: Antibiotics can kill off beneficial bacteria in the vagina, allowing harmful bacteria to grow unchecked.
• Sexual activity: Having multiple sex partners or a new sex partner can increase your risk of BV. This can cause changes in the vaginal pH as a result of exposure to semen or saliva (women in heterosexual and same-sex relationships are therefore both susceptible and can ‘ping-pong’ the infection between partners).
• Immunosuppression: A weakened immune system can make it harder for the body to fight off infections, including BV.

Common symptoms include:

• A white vaginal discharge that covers the walls of the vagina
• Vaginal discharge with a foul or fishy odor
• Vaginal pain or itching
• Burning while urinating

An imbalance between good/healthy bacteria and bad/unhealthy bacteria is the cause for the inflammation that causes this condition. Several factors can make a female more prone to the development of bad bacteria such as:

• Gut dysbiosis
• High sugar diet, alcohol consumption, or poorly controlled blood sugar
• Exposure to synthetic chemicals/fragrances that upset beneficial bacteria or vaginal pH
• Repeated antibiotic use
• Stress
• Changes in the vaginal pH that can happen with age.
- Recurrent or broad-spectrum antibiotic exposure — knocks back lactobacilli and can set the stage for dysbiosis.
- High simple-sugar diets and poorly controlled blood sugar — emerging data link diet and carbohydrate intake with vaginal microbiota shift.
- Smoking — associated with higher BV risk in observational studies.
- Obesity and chronic inflammation — systemic inflammation may alter local mucosal immunity.
- Hormonal contraceptives & menstrual products — menstrual blood and some product chemistries can temporarily shift pH and microbes.
- Immune suppression and chronic stress — both change local defenses and pain perception.
- Smoking — associated with higher BV risk in observational studies.
- Obesity and chronic inflammation — systemic inflammation may alter local mucosal immunity.
- Hormonal contraceptives & menstrual products — menstrual blood and some product chemistries can temporarily shift pH and microbes.
- Immune suppression and chronic stress — both change local defenses and pain perception.

Recognizing that multiple factors often stack together helps explain why BV recurs in many people and why a single antibiotic course sometimes fails.

How Is It Treated?

Currently BV is treated in isolation - using an antibiotic cream to remove the overgrowth of harmful bacteria. Metronidazole has an 80 percent cure rate within 4 weeks, but the recurrence rate is disproportionately high: 15 to 50 percent of women who treat BV with metronidazole experience a return of symptoms within 3 months! Antibiotics also remove the healthy bacteria important for vaginal health. We want that vaginal flora to flourish in all the right ways, so that your lady garden can maintain the right pH and you can be BV free.

Microbiome / swab testing — what counts and what it actually tells you

If symptoms are recurrent, severe, or treatment-resistant, clinicians may use one or more of these approaches:

• Wet mount + Amsel criteria (office exam): quick, low-cost, looks for clue cells, pH >4.5, a characteristic odor on KOH and thin discharge — helpful at the bedside.
• Nugent score (Gram stain): lab scoring system that classifies bacterial morphotypes and gives an objective BV score — common in research and some clinics.
• Molecular / PCR panels: detect Gardnerella, Atopobium, Trichomonas, Candida and other targets; more sensitive but can detect organisms in people without symptoms, so results must be interpreted clinically. These tests are useful for mixed or atypical cases but aren’t always necessary for a first uncomplicated episode.
• When to test: consider testing for recurrent/refractory symptoms, suspected trichomonas or mixed vaginitis, or if you need to guide targeted therapy. Routine molecular swabs for one uncomplicated episode are often overkill.

Things that can look like BV (but aren’t)

Several different problems can cause discharge, itching, odor or burning — and they’re often mistaken for bacterial vaginosis (BV). Common look-alikes include:

• Vulvovaginal candidiasis (yeast infection): thick, cottage-cheese discharge, often with intense itching; microscopy or culture usually shows Candida.
• Trichomoniasis: frothy, malodorous discharge and sometimes more pronounced irritation; identified by wet mount, antigen or PCR testing.
• Aerobic vaginitis / mixed vaginitis: an inflammatory pattern driven by aerobes (think E. coli, Strep) with more redness and pain than classic BV.
• Atrophic (menopause-related) vaginitis / GSM: thinning mucosa from low estrogen can cause dryness, burning and a thin discharge — not an infection but it can mimic vaginitis.
• Contact dermatitis or irritant reactions: scented products, washes, or topical ingredients often present with itch/burning and may produce discharge from secondary irritation.
  Because treatments differ (antifungal for yeast, metronidazole for BV, specific therapy for trichomonas, estrogen for atrophy), accurate diagnosis matters. When in doubt, get a proper exam and targeted testing rather than guessing.

What About Probiotics?

Alternative non-antibiotic options such as probiotic products containing lactobacilli, lactic acid, sucrose gel, and combination products with estriol, are starting to get more attention. This is because they are able to target the problem without annihilating the good bacteria.

Estriol in the Silky Peach Cream is definitely part of the process - along with getting the right bacteria in place and making sure the inner sanctum has the right pH to allow the right bacteria to grow. The key to clearing up BV for good is to get to the root cause. If BV has been a naggingly persistent issue, a naturopathic practitioner or homeopathic practitioner will have some good ideas on ways to discover and heal the root cause.

Gut health, fiber, and the vagina — the gut-vagina axis in plain terms

The gut and vaginal microbial communities talk to one another. Species can travel (or share metabolites), and diet shapes the gut community — which in turn influences the vaginal environment. Practical, evidence-informed points:

• Fiber feeds beneficial gut bugs that produce short-chain fatty acids and other metabolites that reduce inflammation systemically — a calmer immune system helps mucosal sites stay balanced.
• High-sugar, ultra-processed diets are linked to less favorable vaginal profiles in observational and emerging interventional studies; cutting back on simple carbs may help in some people.
• Fermented foods and some probiotics can support gut diversity; certain oral probiotics may indirectly help vaginal health (evidence is promising but mixed), and vaginal probiotics are an area of active research.
  Bottom line: improving overall gut health (add fiber, cut excess sugar, include fermented foods) is a sensible, low-risk strategy that may support vaginal resilience alongside other targeted treatments.

Understanding Estrogen

Estrogen plays a crucial role in maintaining the vaginal pH balance. It stimulates the production of glycogen in the vaginal lining, which serves as a food source for beneficial bacteria called lactobacilli. These lactobacilli thrive on glycogen and produce lactic acid as a byproduct. Lactic acid helps lower the vaginal pH, creating an acidic environment that inhibits the growth of harmful bacteria and yeast, thus promoting vaginal health.

What success (or troubles) have you had with BV? We always love to hear from you as we try to save the world, one vagina at a time!