How is bacterial vulvovaginitis diagnosed?

In order to diagnose bacterial vulvovaginitis, a doctor may start with a pelvic exam to check for symptoms such as inflammation or a vaginal discharge. Doctors often take a sample of the discharge to test for bacterial imbalances and vaginal pH. If the pH of the vaginal discharge is at least 4.5 and it has a fishy odor, the doctor can diagnose bacterial vulvovaginitis. However, more common gynecological tests such as a cervical Pap smear are not responsive enough to detect the minute bacterial imbalances in bacterial vulvovaginitis.