Bacterial Vaginosis: What It Is and What You Can Do About It
It’s not the kind of thing people usually bring up in casual conversation. And yet, Bacterial Vaginosis (BV) is surprisingly common. That awkward, fishy-smelling discharge you weren’t expecting? The one you weren’t sure was even worth Googling? For many, that’s where the story with BV starts - quietly, almost dismissively, like an inconvenience rather than a health issue.
But for something so widespread, it’s still wrapped in uncertainty. Is it serious? Is it contagious? Did I cause it? Should I be worried? There’s a kind of fog around it, part embarrassment, part misunderstanding that stops people from getting clear answers.
This guide isn’t here to make things sound more clinical or dramatic than they are. It’s just about clarity. About making sense of something that, while not dangerous in most cases, can still feel intrusive. Because whether it’s your first time dealing with BV or something that’s popped up more than once, feeling unsure or even a little thrown off is completely normal.
And the thing is, sometimes it’s not about fear, it’s about frustration. A condition that seems to come and go, without warning, can wear you down in its own quiet way. So instead of sweeping it aside, let’s lay it out plainly. What BV is, why it happens, how to deal with it, and perhaps more importantly, how to live with it when it’s not quite as simple as a one-off fix.
What Is Bacterial Vaginosis?
Bacterial vaginosis (often shortened to BV) is one of those conditions that many people have heard about vaguely, but few truly understand until they experience it. It’s not an infection in the way we usually think of infections, it’s more of an imbalance. More specifically, it happens when the natural bacteria in the vagina become unbalanced. Now, that might sound abstract or even a bit clinical, but the reality of BV can be surprisingly disruptive for something that’s technically not always harmful.
The vagina naturally contains a mix of bacteria. In a healthy state, so-called ‘good’ bacteria, mainly lactobacilli help keep everything in balance. They maintain an acidic environment that discourages the growth of less friendly bacteria. But when those lactobacilli levels drop, it opens the door for other types of bacteria to grow too much. That shift is what leads to BV.
It’s more common than people think. In fact, it’s the most frequent cause of unusual vaginal discharge in women of childbearing age. It can come and go, too. Some women experience it once, others get it recurrently, which can be frustrating and frankly exhausting.
Crucially, it isn’t a sexually transmitted infection (STI), though it is more common in those who are sexually active. The nuance here matters because misunderstanding BV as an STI can lead to unnecessary worry or shame, neither of which help anyone feel more in control of their health.
The good news is, BV is usually harmless and easily treated. But it’s still worth taking seriously, not just because of the symptoms, but because of how it can affect your confidence or quality of life. There's something quietly unsettling about not feeling "right" in your own body, and BV can certainly cause that.
The Basics and Why It Happens
Pinning down the exact cause of BV isn’t always straightforward. Unlike many conditions, it doesn’t result from a single germ or action. Instead, it's more like a tipping point, the result of a shift in the vaginal ecosystem. Several different factors can throw off the balance, though not all of them are entirely within your control.
One common factor is over-cleaning. Ironically, people often develop BV while trying to be clean. Washing with strong soaps, douching, or using scented products in or around the vagina can disrupt the natural bacteria that are supposed to be there. It’s understandable, there’s pressure everywhere to stay fresh but in reality, the vagina is self-cleaning and doesn't need much outside help.
Sexual activity can also play a role. Again, it’s important to stress that BV isn’t an STI, but having a new sexual partner, or multiple partners, has been linked to a higher chance of getting BV. No one’s completely sure why, some think it might relate to the partner’s bacteria or changes in pH after sex.
Other factors include smoking, using intrauterine devices (IUDs), or even hormonal changes. But sometimes, it just seems to appear without much reason at all. You might do everything 'right' and still find yourself dealing with it, which can feel especially frustrating.
It's also worth noting that BV isn’t rare. In fact, it’s estimated that 1 in 3 women will experience it at some point in their lives. That’s not a niche group, that’s a lot of people quietly dealing with something that isn’t talked about nearly enough. So if it’s happening to you, you’re not alone. And you’re not doing something wrong.
Symptoms and Diagnosis
Most people who have BV notice changes in their vaginal discharge first. That tends to be the most obvious sign that something is off. The discharge might become thin and watery, greyish white, and often has a noticeable, sometimes unpleasant smell, often described as ‘fishy’, especially after sex. It’s not subtle, which is part of what makes it so distressing for many women.
However, not everyone experiences symptoms. Some go about their lives completely unaware they have BV until it shows up during a smear test or sexual health screening. And when there are symptoms, they can sometimes be mistaken for thrush or an STI, which complicates things. Thrush usually causes itching and thick, white discharge, but BV typically doesn’t cause itchiness at all. That’s one key difference.
Diagnosis usually involves a visit to a GP or sexual health clinic. If you do have symptoms, they might take a swab sample to confirm what’s going on. It’s not a complicated test, and the results are generally quick. Sometimes, a diagnosis can be made on symptoms alone, especially if they’re classic.
It’s also worth noting that while BV isn’t dangerous in most cases, there are situations where it needs to be addressed more carefully. In pregnant women, for example, BV can increase the risk of complications like premature birth. It’s rare, but it’s one reason why speaking to a healthcare professional is always wise, even if the symptoms seem mild.
And then there’s the emotional side of things. It’s easy to say “just go to the doctor,” but in reality, people sometimes put it off because they feel embarrassed, or they worry they’ll be judged. But doctors and nurses see these issues all the time, it’s routine for them. You won’t surprise them, and you certainly won’t be the first patient to say, “I’ve noticed a strange smell.”
When to See a GP or Clinic
This part can feel a bit grey, because some people try to manage BV on their own. That’s understandable, especially if it’s not the first time. But in general, if you’re experiencing symptoms like unusual discharge or a fishy smell, it’s worth making an appointment. Even if it turns out to be something else, you’ll have a clearer picture of what’s going on.
You should definitely speak to someone if:
- It's your first time experiencing symptoms like this
- You're pregnant or planning to get pregnant
- The symptoms keep coming back
- Over-the-counter treatments haven't worked
Sometimes people wait it out, hoping it’ll resolve on its own. And occasionally, it does. But BV doesn’t always clear up without treatment, and repeated episodes can affect your confidence, relationships, or just your general comfort. It’s not something you need to put up with.
The actual appointment is usually quick. A nurse or doctor will ask about your symptoms, medical history, and sexual activity, not in a judgemental way, just to get context. They may do an internal examination or take a swab. It’s all relatively standard stuff, though understandably not everyone finds it comfortable.
And if you’ve had BV before, you might recognise the signs straight away. In that case, a pharmacist can sometimes help too, especially if you’re looking for treatment like metronidazole (either as tablets or a gel).
If you’re unsure, it’s always better to check than to second-guess. There’s no downside to knowing more, and sometimes even just hearing “it’s nothing to worry about” can be a relief.
Treatment Options and Recurrence
The standard treatment for bacterial vaginosis is a course of antibiotics. It’s usually metronidazole, either as a tablet taken for five to seven days or as a gel inserted into the vagina. Both are effective, though the oral tablets can sometimes cause side effects like nausea or a metallic taste. Not pleasant, but manageable.
Some people respond really well and don’t have any further issues. Others, unfortunately, find that BV returns. And not just once, it can be a recurring problem, which starts to feel more like an ongoing nuisance than a one-off infection. Recurrence rates are surprisingly high, with some studies suggesting that up to 50% of women experience BV again within a year.
When it keeps coming back, doctors might try a longer course of antibiotics or suggest alternating treatments. But beyond medication, managing recurrence often involves looking at lifestyle factors, though this is where it gets a bit hazy. There’s no guaranteed way to prevent it from returning, which can make people feel powerless.
It helps to avoid douching or scented products, even if they’re marketed as “feminine hygiene” essentials. These tend to do more harm than good. If you’re using an IUD and keep getting BV, your doctor might suggest switching contraception. That’s not a decision to make lightly, but it’s one potential avenue to consider.
There are also probiotics marketed specifically for vaginal health, though the evidence on their effectiveness is mixed. Some women swear by them; others don’t see a difference. It's a bit trial and error, and you may not know what helps until you try.
And through all of this, the emotional toll adds up. Having to explain recurring BV to partners, feeling embarrassed during intimacy, or worrying about odour can take a toll on self-esteem. It’s not “just a discharge”, it’s something that affects how you feel in your body. That part’s often overlooked in clinical explanations.
Living With BV - Self-Care and Prevention
For something so common, there’s surprisingly little practical advice out there for day-to-day living with BV. Medical treatment is one thing, but what about the daily reality, especially when it comes back again and again?
First, it really helps to simplify your hygiene routine. That means using only water to wash your vulva, avoiding any soaps or perfumed products down there. It sounds minimalist, and maybe even counterintuitive at first, but the fewer variables you introduce, the better. Your body, left to its own devices, is generally good at maintaining its own balance.
Underwear choices can make a difference too. Cotton is more breathable than synthetic fabrics, and looser clothing reduces sweating and irritation. Some people find that switching laundry detergents or skipping fabric softener helps, particularly if they have sensitive skin.
Sex can also be a factor. Using condoms might help reduce recurrences, especially with new partners. Again, it’s not because BV is sexually transmitted but semen can change the vaginal pH, and that shift can trigger symptoms. For some people, even sex toys can be a trigger, especially if they’re not cleaned properly or shared without protection.
Stress may play a role as well. There’s limited research here, but it wouldn’t be surprising. Stress affects so many other systems in the body, so why not this one too? Managing stress levels through sleep, diet, or exercise might not cure BV, but it can certainly support overall wellbeing.
And finally, remember this: you're allowed to advocate for yourself. If a treatment doesn’t work, or a doctor seems dismissive, it’s okay to ask for another opinion. Living with BV isn’t just about taking antibiotics, it’s about understanding your body, finding what works for you, and not being embarrassed to talk about it.
Bacterial Vaginosis in Pregnancy
BV in pregnancy deserves special attention. While many cases are mild and manageable, the stakes can feel higher when there’s a baby involved. That alone can create a lot of worry, even when everything turns out fine.
The main concern with BV in pregnancy is the potential link to complications like premature birth or low birth weight. These risks aren’t sky-high, but they are statistically significant enough that doctors generally want to treat BV if it shows up during pregnancy, even if you’re not experiencing symptoms.
The tricky part is that many pregnant women don’t know they have BV unless they’re tested for it, and routine screening isn’t currently standard practice in the UK unless there are symptoms or a history of complications. That means if you’re pregnant and notice an unusual discharge or smell, it’s especially important to speak to a healthcare provider. Better to check than to wonder.
Treatment during pregnancy is still safe. Metronidazole is commonly prescribed, and although some people worry about taking antibiotics while pregnant, the benefits of treating BV tend to outweigh the risks, especially when guided by a doctor.
If you’ve had BV before and become pregnant again, you might be offered early screening in future pregnancies. Some women also choose to follow stricter self-care routines during pregnancy, avoiding anything that might disrupt their vaginal flora.
It’s also worth mentioning that partners don’t usually need to be treated, even during pregnancy. BV isn’t passed back and forth like some infections are, though if you’re experiencing repeated issues, it’s worth having a conversation about sexual practices or contraception.
In the end, pregnancy often amplifies the sense of responsibility we feel for our bodies and for good reason. But that shouldn’t mean spiralling into anxiety. BV is treatable, and the more you understand about it, the more confident you can feel navigating whatever comes next.
