Bacterial vaginosis



A number of people have recently searched the forum for information on Bacterial vaginosis or BV so it seems like a good time to post some information on it.

It is very common indeed and is caused by a change in the types of bacteria found in the vagina from the normal situation where the bacteria in the vagina are mostly of one type called lactobacilli to a situation where the bacteria in the vagina are of many different types. There is a lot of debate about whether BV is one problem or whether it is many different problems that all cause the same set of symptoms.

The symptoms are increased discharge, often with a fishy smell.
It is not usually associated with pain or itching or irritation.

Sadly we don’t know what causes it - there has been lots of research and definitely some women suffer from it more than others but we just don’t know what the trigger is. It is unlikely to be sexually transmitted and studies have shown that treating sexual partners makes no difference to whether the problem comes back.

The main treatment is antibiotics - either taken orally or antibiotic cream in the vagina.

Diagnosis is often based on the characteristic symptoms or by looking at a sample of vaginal fluid under the microscope.

Hope this is helpful and I would be pleased to hear the experience of others or try to answer any specific questions that people might have.

Many thanks



I also heard that treating yourself with a topical lactic acid gel can help this condition - like Balance Activ or similar, because it helps restore the pH in the vagina… you can just buy that over the counter. Have you heard of that @Dr_Paula?


Hello @Katrina

I had heard about Balance Activ and similar products from women talking about them in clinic, but they are not listed in the routine advice that we give out to women with bacterial vaginosis. So when you raised this issue I did some research to try to find academic papers that have commented on its effectiveness. I have spent ages looking but have actually come across very little. I haven’t come across any reviews of the evidence to that say it works and I haven’t come across any papers that say it doesn’t. I am a bit surprised by this as these products have been around for some time and I feel someone must have studied them, but after spending several hours on this and not finding anything, I am opening up this conversation to others.

@Katrina - do you know anyone who has experience of this or similar products?

Some background may be helpful. We know that the acidity of the vagina is important to prevent bacterial growth. This acidity is maintained by lacto-bacilli - these are the dominant, normal bacteria in the vagina. They breakdown the glycogen (a form of sugar) that exists in the dead skin cells of the vagina to produce lactic acid. You have dead skin cells in the vagina because just like anywhere else, the skin cells come to the end of their natural life and are lost from the surface of the skin all the time. In bacterial vaginosis the number of lacto-bacilli are reduced and they are replaced by other bacteria (like Gardnerella vaginalis - which are normally present in very small quantities. It is this imbalance, both the loss of the lacto bacilli and the growth of the others that causes the problems. We don’t know which comes first - does the acidity go down and then the new bacteria grow or do the new bacteria grow first and then this causes the decrease in acidity and the loss of lacto-bacilli. So the products that we are talking about are supposed to work by keeping the vagina acid. But this is a complex system and although this makes sense - it would be good to have some evidence about whether it actually works.

So, on that basis - anyone’s experience would be very helpful.

Sorry to take such a long time to respond to your question - I kept looking for an answer - but as you can see - have not come up with anything yet. I learnt a lot of new stuff about BV in the process though, and it is so common that this seems like a very important subject for discussion.

Many thanks