Bacterial Vaginosis (BV): Symptoms, Causes, Treatment, and Prevention
- Shannon Leach, MSN, ARNP
- Aug 11
- 5 min read
If you've noticed a fishy vaginal odor, unusual discharge, or changes in your vaginal health, you may be wondering if you have bacterial vaginosis (BV).
Bacterial vaginosis is the most common vaginal infection in women of reproductive age. Despite being very common, many women are surprised to learn that BV is not considered a sexually transmitted infection (STI). However, sexual activity and changes in the vaginal environment can increase your risk.
The good news? BV is usually easy to diagnose and treat!
In this article, I'll answer the questions I get asked most often:
What Is Bacterial Vaginosis?
Bacterial vaginosis (BV) occurs when the normal balance of bacteria in the vagina becomes disrupted. A healthy vagina contains large amounts of beneficial bacteria called Lactobacillus. These bacteria help keep the vaginal environment relatively acidic, which protects against infection.When Lactobacillus levels decrease, other bacteria can grow too quickly. This bacterial overgrowth leads to bacterial vaginosis.
Simply put: BV happens when the healthy bacteria in the vagina are outnumbered by other bacteria.
Is Bacterial Vaginosis an STI?
No. Bacterial vaginosis is not classified as a sexually transmitted infection.
However, BV is more common in sexually active individuals and can be associated with:
New sexual partners
Multiple sexual partners
Exposure to semen
Shared sex toys
Female-to-female sexual activity
BV can also occur in people who are not sexually active.
What Are the Symptoms of Bacterial Vaginosis?
Many women have no symptoms at all. In fact, studies suggest that up to 84% of cases of BV may be asymptomatic.
When symptoms occur, they often include:
Fishy Vaginal Odor
The most common symptom is a strong fishy odor.
Many women notice that the odor becomes more noticeable:
After sex
During their menstrual cycle
Immediately after their period
Vaginal Discharge
BV discharge is often:
Thin
Gray or white
Sometimes slightly greenish
Other Possible Symptoms Include:
Mild vaginal irritation
Burning with urination
Discomfort during sex
BV vs. Yeast Infection: What's the Difference?
Many women confuse BV with a yeast infection.
Bacterial Vaginosis
Fishy odor
Thin gray or white discharge
Mild irritation or no irritation
Yeast Infection
Usually no strong odor
Thick, white discharge
Often described as "cottage cheese-like"
Significant itching and irritation
If you're unsure which condition you have, it's best to schedule an evaluation rather than self-treat.
What Causes Bacterial Vaginosis?
Anything that disrupts the natural balance of vaginal bacteria can increase the risk of BV.
Common risk factors include:
New or Multiple Sexual Partners
Every person has a unique bacterial microbiome. Exposure to a new partner's bacteria may affect the balance of vaginal bacteria.
Semen Exposure
Semen is naturally alkaline and can temporarily raise vaginal pH, making it easier for BV-associated bacteria to grow.
Antibiotic Use
Antibiotics don't only kill harmful bacteria—they can also reduce healthy Lactobacillus bacteria.
Hormonal Changes
Hormones influence vaginal health.
Changes during:
Menstruation
Pregnancy
Perimenopause
Menopause
Certain birth control methods may affect the vaginal microbiome.
Douching
Douching can wash away the vagina's protective bacteria and increase the risk of BV.
Scented Products
Products such as:
Bubble baths
Feminine washes
Scented soaps
Vaginal deodorants may irritate the vaginal area and disrupt healthy bacteria.
Smoking
Research has shown that smoking may increase the risk of BV by altering the vaginal environment and reducing protective bacteria.
Do I Need Special Products to Clean My Vagina?
No, the vagina is self-cleaning. Many women are surprised to learn that special feminine washes and cleansers are unnecessary. In fact, they may increase the risk of irritation and infection. For most people, warm water is enough!
Avoid:
Douching
Scented soaps
Vaginal deodorants
Bubble baths
What Happens If BV Is Left Untreated?
Untreated BV can sometimes increase the risk of:
Acquiring sexually transmitted infections
Pelvic inflammatory disease (PID)
Certain infections following gynecologic procedures
BV during pregnancy should also be evaluated by a healthcare provider.
If you are pregnant and experiencing abnormal discharge, odor, or irritation, contact your healthcare team.
How Is Bacterial Vaginosis Diagnosed?
Diagnosis typically involves:
Reviewing your symptoms
A pelvic exam
Testing a vaginal sample
Your healthcare provider may:
Check vaginal pH
Examine vaginal discharge
Perform laboratory testing
Testing is fast and usually can be done during an office visit!
How Is BV Treated?
Bacterial vaginosis is usually treated with prescription antibiotics.
Treatment may include:
Oral antibiotics
Vaginal antibiotic gel or cream
It's important to take all medication exactly as prescribed.
Many women notice improvement within a few days, but the full treatment course should always be completed.
Does My Partner Need Treatment?
This is an area where recommendations have evolved.
For women experiencing recurrent BV, newer guidance suggests treatment for male partners may sometimes be considered, particularly when infections keep returning despite treatment.
The decision should be individualized and discussed with your healthcare provider.
Women with female partners should also discuss whether partner testing or evaluation may be appropriate.
Can BV Be Prevented?
While BV cannot always be prevented, these steps may help reduce your risk:
Practice Safer Sex
Use condoms consistently
Avoid frequent partner changes when possible
Clean Sex Toys Regularly
Proper cleaning helps reduce bacterial transfer between partners.
Consider Probiotics
Some studies suggest certain Lactobacillus strains may help support vaginal health, including:
Lactobacillus crispatus
Lactobacillus rhamnosus
Lactobacillus reuteri
Talk with your healthcare provider before starting supplements.
Maintain Healthy Vaginal Habits
Wear cotton underwear
Change out of sweaty clothing promptly
Avoid scented products
Wipe front to back
Avoid douching
Frequently Asked Questions
Can I get BV from a toilet seat?
No. BV is not spread through toilet seats, swimming pools, or hot tubs.
Can BV go away on its own?
Sometimes mild cases may improve, but symptomatic BV often requires treatment.
Can I use over-the-counter treatments?
Unlike yeast infections, BV generally requires prescription treatment. Some providers may recommend boric acid alongside treatment in specific situations, but boric acid is not considered a proven stand-alone treatment and should never be used during pregnancy without medical guidance.
Do I need testing if I don't have symptoms?
Generally, no. Routine BV testing is not recommended for most people without symptoms unless specific circumstances such as pregnancy apply.
When should I see a healthcare provider?
Schedule an appointment if you experience:
Vaginal odor
Unusual discharge
Vaginal irritation
Burning with urination
Pain during sex
Recurrent infections
Getting the correct diagnosis is important because BV, yeast infections, and sexually transmitted infections can cause similar symptoms but require different treatments.
Concerned You May Have Bacterial Vaginosis?
If you're experiencing vaginal odor, abnormal discharge, itching, irritation, or other vaginal symptoms, the team at Cascade Women's Health can help determine the cause and recommend the appropriate treatment.
Schedule a FREE well-woman exam today to get answers and start feeling better!
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Important Note: The information provided in this article is for educational purposes only. While it was written by a licensed healthcare professional, it is not a substitute for personalized medical advice, diagnosis, or treatment. If you have questions about your health, please schedule an appointment with a healthcare provider who can evaluate your individual needs.
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