Bacterial Vaginosis and the Frustrating Reoccurring Cycle

By Beth Adler, ND

Are you tired of being prescribed antibiotics for your Bacterial Vaginosis (BV) infection repeatedly, and instead of the antibiotics helping the infection go away it comes back? Does it seem like you are not being heard and you don’t know what else to do?

Dr. Adler’s Personal Story

I spent three years of my life with a diagnosed BV infection every other week, going to doctor after doctor and then just handing me the same antibiotic. The treatment would work briefly and then the infection would promptly come back.  I felt like I was going crazy. I felt like I constantly smelled and that it was ruining my sex life. 

I kept trying to figure out a way to break the cycle. 

I spent many countless hours scouring Google and chat rooms trying to figure out any hope of stopping the recurrent cycle of BV. I finally flew across the country to see a “specialist” and was told something new for the first time. In my case, it was a combination of my hormones changing (I had been on birth control for 16 years and my body just decided to change one day), and I had also started dating a new partner (which my body seemed to be allergic to). I don’t want to see anyone go through what I went through, and I know it is happening way too often. I saw the chat boards, and there are a lot of people who have had similar experiences to mine. 

This journey is what led me to become a naturopathic doctor today.

What is BV?

Bacterial vaginosis happens when a person’s vaginal flora (lactobacillus spp) is disrupted by an unspecified factor causing the vaginal pH to increase and become too basic on the pH scale. Under normal circumstances, the average pH of the vagina is acidic (about a 4 on the pH scale). Symptoms include fishy odor, increased thin greyish-white discharge, vaginal discomfort, itching, and burning during urination. 

This change in pH can happen for many reasons including, hormone shifts (change in age, pregnancy, many years of exogenous hormone use suppressing the natural hormone cycle, and even the menstrual cycle can be a natural aggravator). Other causes include new sexual partners or increased amounts of sexual partners, swimming in still bodies of water that have bacteria in them, the use of irritating abrasive body care products including (vaginal washes/wipes, vaginal douching, and some lubricants) and poor hygiene (including a reduced amount of showering, and not properly washing sex toys after use).

But why does BV reoccur? 

Once the positive flora is depleted from the vagina, it is more difficult for them to recover and create the amount of hydrogen peroxide needed to fight off further infection. Without the re-establishment of the proper amount of hydrogen peroxide, it is easier for the vagina to slip into a more basic state by more simple triggers. Approximately 30% of women have recurrent BV infections within 3 months of treatment.  

Conventional Treatment for Bacterial Vaginosis

As discussed before the conventional treatment is to prescribe an antibiotic (Metronidazole or Clindamycin either as a topical gel or orally) and then send people on their way. If this is a patient’s first BV infection, and they do not continue to aggravate their infection then this may be a fitting way to treat this infection once and for all. But what happens when this isn’t your first infection, and antibiotics alone are not helping rid this nuisance? 

This is when I turn to combination treatment plus educational treatment. 

Naturopathic Treatment for Bacterial Vaginosis

Naturopathic treatment still includes antibiotic use; however, clinical studies have shown that combining additional treatments with antibiotics helps it to become more efficacious and decreases the likelihood of recurrence. The ideal goal of treatment is to return the vagina back to an acidic pH while simultaneously encouraging the regrowth of lactobacillus spp. (positive flora). 

Vitamin C vaginal suppositories along with Metronidazole gel for 5 days helps to restore the acidic nature of the vaginal pH and helps the lactobacillus in the vagina to create H2O2 (hydrogen peroxide). The H2O2 helps to fight the negative bacteria and restore the pH balance to an acidic state. When the vaginal flora is balanced then the positive flora is naturally able to create H2O2 to fight off infection. It is when this flora gets disturbed that your body is unable to fight off negative bacteria. Studies have shown that this combination of treatments reduces the recurrence of BV by 80%. 

Probiotics specifically made for the vagina, which have the correct vaginal strains (not gastrointestinal strains) are also an important piece of recovering the vagina’s positive immune system balance. We specifically want to find a probiotic that has Lactobacillus gasseri, Lactobacillus rhamnosus, Lactobacillus crispatus, and Lactobacillus rheuterii in it. I prefer Jarro-Dophilus for Women. We can use this orally during the vaginal suppository treatment and once that treatment has been completed, then we can use it as a vaginal suppository for several days. In my clinical experience, this combined method of antibiotics, Vitamin C suppository, and probiotics have helped reduce my patient’s recurrent infections tremendously. It has also improved their quality of life.  

What if it is an imbalance of hormones causing this infection to recur? 

We can look at your hormones individually and come up with a unique individual plan for you to help restore and balance them. 

Other naturopathic methods that have been used in the past include Boric acid vaginal suppositories. I have found that patients have some success with this, but there is less consistent long-term success with Boric acid than with the Vitamin C suppository. Boric acid suppositories seem to be more useful for yeast infections. 

Addressing Lifestyle Factors and BV

It is also important to look at everyday products as well when treating BV. Try to avoid using tampons and pads/pantyliners with chlorine/bleach when possible. Avoid wearing thongs as they are really good at trapping bacteria. A better choice is to wear something that is dye free (white) and can easily breathe (such as cotton). 

Be careful about the type of lubricant you choose.  A lot of lubricants have preservatives in them that can be aggravating to the delicate tissue of the vagina. Avoid using oils as lubricants because they can suffocate the tissue and can degrade condoms. Silicone or water lubricants are best, but it is difficult to find a water lubricant without preservatives in it (some suggestions without preservatives include Lotus fresh for a water lubricant and ID moments for a silicone lubricant).  

Do not use “pH friendly” vaginal washes and do not ever douche with anything. This will likely make the problem worse. Be aware of bathing products (soaps, shampoos, conditioners), hairspray/hair care products, and detergents when you’ve had recurrent infections. Choose products that do not have any added scents or dyes in them. I like Grandmother’s lye soap and Vanicream cleansing bar because they are scent free and hypoallergenic. 

Schedule an appointment with me for a further consult and treatment plan.