How can I lower my risk of bacterial vaginosis (BV)?

Dr. Farzanna S. Haffizulla, MD

Bacterial Vaginosis (BV) is a common cause of vaginal in discharge in women and  occurs when the normal protective bacteria are significantly reduced and replaced by "anaerobic" bacteria that can contribute to the malodorous discharge seen in this condition. To lower your risk of "BV," the following behavior patterns should be avoided:

  1. Smoking: cessation of smoking is necessary
  2. Multiple sexual partners or frequent new sexual contacts
  3. Oral-genital sexual activity
  4. Douching

There is some thought about genetic predisposition for "BV" but the data is currently not definitive.

Dr. Shelley C. Giebel, MD
OBGYN (Obstetrician & Gynecologist)

The most important way to protect yourself from bacterial vaginosis (BV) is to maintain healthy bacteria in the vagina. If you take antibiotics or you get sick, realize you are more likely to get an infection in the vagina.

I recommend that if you are plagued with vaginal infections that keep returning, use probiotics (healthy bacteria) every day. Lactobacillus and acidophilus can be found in yogurt, pills or powders. Keep enough healthy bacteria around and the unhealthy won't have an opportunity to grow.

If you already have a vaginal infection, you will need to get treatment before the healthy bacteria will truly help.

Here are some tips that may lower your risk of bacterial vaginosis (BV) or recurrent BV:

  • Don't douche. Douching upsets the normal pH balance of the vagina. Clean the outside of your vagina with warm water only; even mild soap can be irritating or cause infection.
  • Avoid sexual contact with someone who has a sexually transmitted disease; use condoms if you're uncertain.
  • Avoid local irritants such as bubble baths, harsh soaps, feminine hygiene sprays and deodorant tampons, all of which can affect the normal pH of the vagina.
  • Reduce semen exposure (which can affect the vaginal bacteria balance) by using condoms.
  • Don't smoke.
  • Make sure to wipe from front to back (from the vagina back to the anus).
  • Limit your number of sex partners.
  • Wear cotton or cotton-lined panties to keep the area cool.
  • If you develop BV three or more times in a year, talk to your healthcare professional about alternating medications or using intravaginal metronidazole as a prophylactic for three to six months.
  • Some research points to the benefit of consuming foods containing lactobacilli, like certain yogurts and other foods, to help balance the level of bacteria in the vagina.

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Experts are still figuring out the best way to prevent BV. But there are steps you can take to lower your risk.

Help keep your vaginal bacteria balanced. Wash your vagina and anus every day with mild soap. When you go to the bathroom, wipe from your vagina to your anus. Keep the area cool by wearing cotton or cotton-lined underpants. Avoid tight pants and skip the pantyhose in summer. Don't douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may raise your risk of BV. It may also make it easier to get BV again after treatment. Have regular pelvic exams. Talk with your doctor about how often you need exams, as well as STI tests. Finish your medicine. If you have BV, finish all the medicine your doctor gives you to treat it. Even if the symptoms go away, you still need to finish all of the medicine.

Practicing safe sex is also very important. Below are ways to help protect yourself.

  • Don't have sex. The best way to prevent any STI is to not have vaginal, oral or anal sex.
  • Be faithful. Having sex with just one partner can also lower your risk.
  • Be faithful to each other. That means that you only have sex with each other and no one else.
  • Use condoms. Protect yourself with a condom EVERY time you have vaginal, anal or oral sex. Condoms should be used for any type of sex with every partner. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a condom or a dental dam. A dental dam is a rubbery material that can be placed over the anus or the vagina before sexual contact.
  • Talk with your sex partner(s) about STIs and using condoms. It's up to you to make sure you are protected. Remember, it's YOUR body! Talk frankly with your doctor or nurse and your sex partner(s) about any STIs you or your partner(s) have or had. Talk about any discharge in the genital area. Try not to be embarrassed.

This answer is based on source information from The National Women's Health Information Center.

Marcy Holmes, MSN, NP
Nursing Specialist

You may lower your risk of Bacterial Vaginosis (BV) with the following tips:

  • Avoid harsh soaps, use mild fragrance free types if any
  • No douching
  • Use condoms 100% of the time
  • Avoid multiple different sexual contacts, choose monogamy
  • Limit exposure to chemicals in pools/spa's/hot tubs
  • Avoid detergent or fabric softener residue on underwear, extra rinse cycle
  • Avoid thong underwear
  • Use cotton breathable underwear and change daily
  • Drink lots of water to stay well hydrated thru the day
  • Eat healthy balanced high fiber diet for you colon and immune system
  • Take probiotic supplements daily
  • Use Omega 3 fatty acids daily and a rich Multivitamin support daily
  • No deodorant feminine hygiene products or sprays

The vagina has a fascinating ecosystem of organisms supported by hormones and secretions, the lactobacilli organisms and white blood cells in the secretions are intended to provide defense against infections like BV. The bacterial organisms of BV are always around, but the vagina is designed to defend you if it is well estrogenized and colonized with plenty of lactobacilli!

Ideal vaginal pH is about 3.8-4.2, higher pH is alkaline which kills off the protective lactobacilli leaving the BV to take off. Yet, lower pH promotes the helpful lactobacilli and inhibits the bacteria to prevent BV infections. New natural and gentle acidifying vaginal treatments can be found in health food stores as well as drug stores, as well as prebiotic vaginal products that help the lactobacilli to flourish.

In menopause with low estrogen, the pH can also rise and foster the bacteria to proliferate - causing BV. If a woman has low estrogen vagina and higher pH, treating the vaginal tissue with low dose local estrogen therapy is a great prevention for BV in menopause. This can even occur postpartum for some women as well when hormones are low from breastfeeding.

Also, semen is alkaline and seems to promote bacterial abundance and risk for BV seems to coincide with new sexual partner contact. So condoms are often a great prevention strategy to avoid STD’s and contact to alkaline semen if you are prone to BV at any age.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.