Medically reviewed on June 27, 2023 by Morgan Spicer, Medical Communications Manager. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Bacterial vaginosis, also known as BV, is the most common vaginal problem for people assigned female at birth (AFAB) of reproductive age.  BV is a condition that occurs when there’s an imbalance or overgrowth of the natural bacteria found in the vagina. These bacteria are known as the vaginal flora and play an important role in vaginal health.  The vaginal flora is vital for maintaining a healthy pH and preventing the overgrowth of unwanted organisms and yeast.  When the natural balance of bacteria or pH is disrupted, BV may occur. This may occur as a result of sexual activity, douching, antibiotic use, or other reasons. [1,3] Want to know more? Read this overview of BV.
BV symptoms can be very similar to symptoms of other vaginal infections or STDs. It’s important to note that a majority of people with BV do not experience symptoms. [1,3] If someone does have symptoms, they may notice the following [1,3]:
Because these symptoms are commonly experienced with other infections, it’s important to speak to a healthcare provider to rule out other causes and get appropriate treatment. [1,3]
It may not be possible to completely prevent bacterial vaginosis from occurring, but there are steps you can take to potentially limit your chances. [1,3] To recap, BV is caused by an overgrowth or imbalance of naturally occurring vaginal bacteria. These steps may be helpful for maintaining a balanced vaginal flora.
BV is not considered an STD as there are no outside bacteria or organisms causing the infection.  However, being sexually active has been associated with an increased risk of BV.  It’s important to practice safe sex and try to avoid high-risk behaviors. This includes limiting your number of sex partners, using barrier methods such as latex condoms or dental dams, and sanitizing sex toys between uses. [1,4]
Practicing healthy vulvar care is an important part of reproductive health. The vulva includes the area of female sex organs that lies outside of the vagina. This includes the labia, public bone, clitoris, and urethra.  The goal of vulvar care is to keep the vulva dry and free from irritants. Maintaining healthy vulvar and vaginal care can decrease the risk of irritation and infections such as BV.  Some general tips for healthy vulvar care include :
Douching has been shown to increase the risk of BV.  Douching refers to using a stream of water to clean or rinse out the vagina. Many experts recommend that douching be avoided as it may actually rinse away or disrupt the beneficial bacteria found in the vagina.  Douching can throw off pH, introduce new bacteria, or strip away healthy vaginal flora.  Vaginal washes, soaps, or other products can increase your risk of BV and other infections.  The vagina is self-cleaning and doesn’t require the use of any soaps or powders unless you are told otherwise by a healthcare provider.  If you are experiencing an unusual odor or have concerns about your hygiene, seek a medical professional’s opinion.
Wearing cotton underwear may also be helpful for preventing BV. Bacteria tend to thrive in moist environments, but cotton helps absorb moisture, reducing the amount of excess moisture in the vagina and reducing the risk of yeast infections, BV, and other infections. [5,7] It’s best to avoid wearing tight clothing or garments when possible, as this can negate the benefits of cotton underwear. 
Some lubricants can potentially throw off vaginal pH or disrupt the vaginal flora.  The natural vaginal pH is slightly acidic and is typically a pH of 4.5.  Many lubricants are more basic and may cause a pH imbalance.  Not only can pH imbalances be harmful, but some lubricants contain ingredients that may cause irritation to the vagina or vulva.  A study found that some vaginal lubricants may encourage the growth of various bacteria or weaken the vaginal barrier.  Some specific ingredients that may lead to irritation, increased risk of infection, or hormone disruption include [10-12]:
About 30% of BV cases can resolve without medical treatment, however, it’s always best to consult a healthcare provider if you are concerned about BV or other infections.  Treating BV is typically a fast and easy process and requires the use of a prescribed antibiotic such as clindamycin or metronidazole.  Antibiotics may be tablets meant for oral use, or come in the form of vaginal creams. Most rounds of antibiotics will last for seven days and should eliminate the infection completely, however, some people may require another round of treatment. 
It is possible and fairly common for bacterial vaginosis to occur, even after treatment with antibiotics. [1,13] Another round of medicine can be prescribed if someone does have a recurring infection. Recurrent BV is defined as three or more confirmed symptomatic episodes in one year.  There are many reasons someone may have recurrent BV, including :
There are other potential causes for recurring BV, such as genetics, antimicrobial resistance, and more. Speak to a healthcare provider if you’re concerned about recurring infections.
Whether you’re concerned about bacterial vaginosis, sexually transmitted infections, yeast infections, or other conditions, it’s important to feel knowledgeable and protected. Everlywell is here to support your health and wellness, including sexual health. Book a women’s health visit online to discuss any concerns or questions with a licensed healthcare provider, or shop for at-home testing kits to get peace of mind. Want to learn more? Check out the Everlywell Blog.