Bacterial vaginosis (BV) is the most common vaginal infection among women of childbearing age. It develops when bacteria that normally live in the vagina multiply. We don't know why this happens, but we do know that it isn't an infection you pick up from sex partners.

However, it frequently occurs with changes to routines in this part of the anatomy, and it is associated with having a new sex partner or multiple sex partners. Other risks are douching and using an intrauterine device for contraception. Pregnant women are also at high risk.

Symptoms include an abnormal vaginal discharge, sometimes with a strong fishy odor, burning during urination, and itching around the outside of the vagina, but sometimes, there are no symptoms at all.

BV may clear up on its own, but if you have symptoms, it's best to be treated. BV makes you more vulnerable to becoming infected with HIV, the virus that causes AIDS. It also puts you at risk of developing pelvic inflammatory disease after having a hysterectomy or abortion and increases your risk of such sexually transmitted diseases as chlamydia and gonorrhea.

BV is treated with antibiotics, usually oral metronidazole (Flagyl), but my colleague Tieraona Low Dog, M.D. tells me that some women prefer to use topical vaginal preparations such as metronidazole gel or clindamycin suppositories. Flagyl can increase the risk of developing vaginal yeast infections. You may be able to avoid that by eliminating sugar from your diet and adding some raw garlic, a potent antifungal and antibacterial agent.

As an alternative to antibiotics, you can use tea tree oil suppositories or douche with tea tree oil. Make a 10 percent solution (about one and a half tablespoons of tea tree oil to a cup of warm water). Discontinue if you find that this treatment causes irritation.

Dr. Low Dog notes that once you treat BV, it is important to reinstate a healthy vaginal microflora to prevent the overgrowth of the bacteria that cause BV. You can do this best by taking probiotics, either in live culture yogurt or in capsule form.

It's especially important to treat BV when you're pregnant since the infection can lead to premature birth or low birth weight babies.

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