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Bacterial vaginosis

If your vulva smells fishy, it is almost certain that you have bacterial vaginosis (also known as “anaerobic vaginosis”). This is an imbalance in the bacteria in the vagina. All women have harmless bacteria in their vaginal passage. In bacterial vaginosis, some of the bacteria multiply so that more are present than is normal (it is usually the Gardnerella and Mobiluncus bacteria that are the culprits). In other words, bacterial vaginosis is not an infection caught from your partner; it is due to bacteria that are normally present in the vagina.

What is bacterial vaginosis

Every woman has many varieties of harmless bacteria in her vagina. In bacterial vaginosis, some of the bacteria multiply too much, so that more are present than is normal (especially Gardnerella and Mobiluncus bacteria). Bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess.
Bacterial vaginosis is vaginal condition that can produce vaginal discharge and results from an overgrowth of normal bacteria in the vagina. When these multiple species of bacteria become imbalanced, a woman can have a vaginal discharge with a foul odor.
Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms. Any woman with an unusual discharge should be evaluated so that more serious infections such as Chlamydia and Gonorrhea should be excluded.

Fishy smell – Bacterial Vaginosis

Bacterial Vaginosis – symptoms

  • The main symptom is a fishy smell in the genital area. You may notice that the smell is worse after sex and during your period.
  • There is usually a discharge, which is watery and greyish-white in color. The amount of vaginal discharge that is considered normal varies from woman to woman. Therefore, any degree of vaginal discharge that is abnormal for a particular woman should be evaluated. The discharge is often more noticeable after sexual intercourse.
  • Bacterial vaginosis does not cause soreness or irritation.

Many women with bacterial vaginosis actually could have no symptoms at all. If untreated, bacterial vaginosis may possibly increase the risk of pelvic inflammatory disease (infection of the Fallopian tubes that lead from the ovaries to the uterus).

Bacterial Vaginosis – causes

Certain factors have been identified that increase the chances of developing bacterial vaginosis. These include multiple or new sexual partners, vaginal douching, and cigarette smoking. However, the role of sexual activity in the development of the condition is not fully understood, and bacterial vaginosis can still develop in women who have not had sexual intercourse. Another cause is douching (squirting antiseptic or soapy liquid into the vagina).
Some women douche the vagina because they think it is hygienic, but the opposite is true. The vagina cleans itself very effectively and douching makes infections more likely. Some research suggest that bacterial vaginosis is more likely in women who smoke, or who eat a high-fat diet.
It was noticed that putting antiseptic in your bath water, or using bubble baths, can make a bacterial imbalance more likely.

Bacterial vaginosis – treatment

If you think you have bacterial vaginosis, you need to see your doctor because the treatment is available only with a doctor’s prescription.
Treatment for bacterial vaginosis consists of antibiotics. A few antibiotics are routinely used.

Metronidazole (Flagyl) taken by either oral (pill) form or by vaginal gel (Metrogel) is an effective treatment. Also available is the vaginal clindamycin cream (Cleocin). The oral metronidazole can cause some minor but unpleasant side effects. It can cause an
unpleasant metallic taste in the mouth, though this disappears after the treatment is finished. It can also cause a slightly nauseous feeling. But anyway this treatment is believed to be the most effective treatment. Metronidazole cures the problem in 90% of women.


Metronidazole is not used in early pregnancy because of potential adverse effects on the fetus. Metronidazole should also not be used by nursing mothers because of potential adverse effects on the baby. The gels do not typically cause side effects, although yeast vaginitis can occur as a side effect of the medication.

Tinidazole is an antibiotic that appears to have fewer side effects than metronidazole and is also effective in treating bacterial vaginosis.
Recurrence of bacterial vaginosis is possible even after successful treatment. More than half of those treated experience recurrent symptoms within 12 months. It is unclear why so many recurrent infections develop. With recurrent symptoms, a second course of antibiotics is generally prescribed.

Bacterial Vaginosis – Recurrence

Unfortunately, sometimes the cure of bacterial vaginosis may not be permanent. The symptoms return in about half of women. Bacterial vaginosis is most likely to come back in women who did not take the whole course of antibiotic treatment What can be done if you have recurrence:

  • Visit your doctor for a repeat of the metronidazole treatment, or to try another antibiotic.
  • Try acetic acid vaginal jelly, which you can buy from a pharmacy without a prescription (such as Aci-Jel or Balance Activ). These restore the natural acidity of the vagina, which may encourage a return to the natural balance of bacteria.
  • Try yogurt. Make sure the container says “live yogurt”, because this contains live lactobacilli bacteria. It is the friendly lactobacilli bacteria that are reduced in numbers in bacterial vaginosis. Gently smear a small amount of yogurt over the vulva (the area around the opening of the vagina), and also put some inside the vagina. The easiest way to do this is to use a tampon with its applicator. Push the tampon back inside the applicator so you have a space for about a teaspoonful of yogurt. Then insert the tampon in the usual way, which will push the yogurt into the top of the vagina. Remove the tampon an hour later. Do this twice a day for a week.
  • If you have an intrauterine contraceptive device (IUD) and bacterial vaginosis is very troublesome, consider having the device removed. Bacterial vaginosis is more common in women using this type of contraception.
  • Stop smoking, as smoking seems to be linked with bacterial vaginosis.

Pregnancy and Bacterial Vaginosis

In the past, bacterial vaginosis was thought to be just a nuisance, but not harmful in any way. There is now evidence that it doubles the likelihood of a premature birth. So if you are intending to become pregnant, you should have bacterial vaginosis treated beforehand. If you have had premature labor in the past, your doctor will probably test you for anaerobic vaginosis during your pregnancy and treat you with antibiotics if necessary.

Bacterial Vaginosis – What about partner?

Your partner does not need to be treated because bacterial vaginosis has not been proven to be a sexually transmitted infection.

Bacterial Vaginosis – Conclusion

  • Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of normal bacteria in the vagina.
  • Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
  • Symptoms of bacterial vaginosis are vaginal discharge and odor, although 50% to 75% of women with the condition experience no symptoms.
  • In diagnosing bacterial vaginosis, it is important to exclude other serious infections, such as gonorrhea and chlamydia.
  • Treatment options for bacterial vaginosis include oral antibiotics and vaginal gels.
  • Serious complications of bacterial vaginosis can occur during pregnancy, and recurrence is possible even after successful treatment.


Some women get bacterial vaginosis several times. It is not clear why or how this happens.
These suggestions for good vaginal health may help:

  • Wipe from front to back (away from the vagina) after bowel movements to avoid spreading bacteria from the rectum to the vagina;
  • Keep the vulva (outside of the vagina) dry and clean;
  • DO NOT DOUCHE. Douching is never a good idea, especially with bacterial vaginosis;
  • Avoid feminine hygiene sprays, harsh soaps, or soaps with lots of perfume;
  • Avoid clothing that can trap moisture: pantyhose (wear pantyhose with cotton crotch) or latex exercise clothing;
  • Using condoms may decrease bacterial vaginosis recurrence for some women.

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