30 Percent of Women Have This Down-There Infection—and They Don’t Even Know It

Hrecheniuk-Oleksii/ShutterstockWhat is bacterial vaginosis (BV)?

The vagina is a delicate microbiome and everything from your diet to your wardrobe can affect it. Bacterial vaginosis (aka BV) occurs when the normal, healthy bacterial balance in the vagina gets disrupted. Good bacteria—namely lactobacillus—helps keep the vagina slightly acidic, which prevents “bad” bacteria from growing too fast, explains Jill Rabin, MD, co-chief of the division of ambulatory care at the Women’s Health Programs-PCAP Services at Northwell Health in New Hyde Park, NY.

How common is BV?

BV is the most common vaginal infection in women aged 15-44, according to the federal Centers for Disease Control and Prevention in Atlanta (CDC). Roughly 30 percent—close to 1 in 3 women—have BV, but many don’t have a clue.

What causes BV?

“While we don’t know exactly what causes the bacterial imbalance which leads to BV infections, we do know that having a new or different sexual partners, douching, and smoking will increase your risk, says Donnica L. Moore, MD, President, Sapphire Women’s Health Group. (These are things that your vagina secretly wants to tell you.) Some vagina experts want you to stop using bath bombs too. “But most women who get BV infections have none of those risk factors,” Moore says.

Are there any other risks for BV?

Vitamin D, the sunshine vitamin (we get it from exposure to sunlight), may play a role—which is why it’s important to know the signs of vitamin D deficiency. This is how the theory goes: Non-white women seem to be more likely to develop BV than white women, the CDC states. And a preliminary study out of University of Pittsburgh suggests that pregnant women with low levels of vitamin D may be more likely to develop BV possibly because the vitamin may stimulate the immune system to prevent and control bacterial infection. Vitamin D deficiency is more common in African-Americans because dark pigmentation can hamper the amount of vitamin D the body can make when exposed to sunlight. But it’s still a little too early to draw firm conclusions about the role vitamin D status plays in BV.

What are some of the symptoms of BV?

The reason many women don’t know they have BV is because close to 85 percent show no symptoms, the CDC reports. That said, “the most common symptoms are a strong, fishy odor and discharge from the vagina,” says Caroline Mitchell, MD, MPH, director of the Vulvovaginal Disorders Program at Massachusetts General Hospital in Boston, and an investigator in the Vincent Center for Reproductive Biology. These symptoms are fairly general and can point to a number of different conditions. “Some women who have BV report irritation from discharge or moisture in the vagina.” Other BV symptoms may include burning when urinating and itching around the outside of the vagina. “A fishy vaginal odor is not normal, and don’t assume that discharge or irritation is a yeast infection,” Mitchell warns. See your doctor to find out what is really going on down there.

Is BV a sexually transmitted disease (STD)?

Technically no, says Dr. Mitchell. “It isn’t sexually transmitted, but it is sexually facilitated,” she says. “If you have never been sexually active in any way, it is very unlikely that you will develop BV, but as soon as any genital contact occurs, your risk increases.” Researchers are still looking for that “smoking gun” that links genital contact to BV. Since it is not sexually transmitted, your partner doesn’t need protection from BV if you have it, she says. (However, using protection is always wise, given the alarming rise of STDs in general.)

Can hormonal fluctuations affect risk for BV?

Yes, says Dr. Rabin. “When levels of the female sex hormone estrogen drop, so too does the amount of good Lactobacillus bacteria in the vagina, and then BV moves in,” she says. For this reason, “women are at greater risk for developing BV during pregnancy and menopause or perimenopause.” Not sure if you’re reaching menopause? Check out these 10 silent signs of perimenopause.

How is BV treated?

BV is typically treated with a course of antibiotics—given orally or via vaginal creams, Rabin says. Understanding why someone developed BV in the first place can play a role in treatment decisions. For example, “if a woman is in menopause and is a candidate for estrogen replacement therapy, this can also improve the BV.” Treatment is especially important for pregnant women as BV during pregnancy increases risk for premature or low birth-weight babies, she says.

How do you test for BV?

“We can look at a sample of fluid from the vagina under a microscope and tell immediately if it is BV, but doctors don’t have easy access to microscopes anymore,” Rabin says. Other tests include measuring the Ph balance of the vagina as BV often causes a higher-than-normal Ph and/or a test that detects genetic material or DNA linked to “bad” bacteria. Ph balance is just one of the signs that your vagina may need attention.

Is every woman screened for BV?

No, Rabin says. The current body of evidence does not support routine screening for BV in the absence of symptoms. “We only screen women if we see any discharge during an exam or if they tell us they have symptoms.”

Is it dangerous to assume BV is a yeast infection and self treat?

“So many women assume every vaginal issue is a yeast infection,” says Rabin. “Self treating won’t make the BV any worse, but it may mask the symptoms and postpone the proper diagnosis and treatment.” (By the way, here are nine ways to prevent yeast infections.)

What happens if you don’t treat BV?

“BV doubles your risk of becoming infected with HIV, the virus that cause AIDS,” says Mitchell. “We think that BV causes inflammation that makes it easier for HIV to infect tissue,” she says. This same scenario may also explain why BV tends to travel with other STDs. There’s more, she says, “BV can also impair fertility.” The bacteria responsible for BV may also cause pelvic inflammatory disease, which can make it difficult if not impossible to have children. And “if you are pregnant, BV increases your risk for miscarriage and preterm delivery.”

What role can probiotics have in treating or preventing BV?

Probiotics can play a big role in the prevention and treatment of BV especially if you’re taking antibiotics, which can affect bacterial balance or are prone to BV, says Rabin. “Start with an oral supplement of Lactobacillus or a live culture that comes in capsules at a health food store,” Rabin says. ” If that doesn’t work, consider vaginal probiotics with the same ingredients. “For prevention, take the supplements after sex and/or when you are taking an antibiotic,” she suggests. If you are prone to BV, you can take these probiotics prophylactically on a daily or weekly basis. What you eat counts too. Here are 10 foods your vagina needs you to eat.