It’s the single most common vaginal condition affecting about one million Aussie women, yet, according to a recent survey, nearly 60 per cent of females aged 18 to 40 have never even heard of it.
To complicate things further, this pesky condition is often mistaken for a similar, well-known one and, if left untreated, can have serious long-term health effects.
Do you know what it is?
It’s called bacterial vaginosis or ‘BV,’ and women’s health expert and GP, Dr Ginni Mansberg, is on a mission to spread the word and dispel the stigma around this very normal, very common and very easily treated condition.
Why don’t we know about BV?
In a chat with Yahoo Lifestyle, Dr Ginni explains the reason why bacterial vaginosis remains a complete mystery to so many women, while its ‘sister condition’ thrush hogs the limelight.
“Thrush has had a really good PR campaign so everyone’s heard of it, and as much as we’re not ‘out and proud’ of [having] thrush we’re not completely embarrassed by it,” Dr Ginni says.
The reason BV and thrush are commonly confused comes down to the fact that many sufferers simply assume they have thrush as it’s the only condition they’re familiar with, despite the symptoms being quite different.
Upping the confusion factor is the tendency for women with BV to self-diagnose instead of seeking medical advice, with 36 per cent admitting they felt uncomfortable talking about their symptoms with their GP according to a 2019 YouGov Galaxy ‘Women’s Health Survey’.
What’s the difference between thrush and bacterial vaginosis (BV)?
While both thrush and BV are non-sexually transmitted infections, they’re caused by an overgrowth of two very different microorganisms that live in the vagina.
BV is caused when the vagina’s naturally occurring bacterial flora, Gardnerella vaginalis, overgrows. The most common symptom is a strong, fishy smell courtesy of what Dr Ginni describes as the ‘uber stinky’ Gardnerella bacteria.
Some women also have a thin, white/grey discharge and, rarely, itching or burning while urinating.
Thrush, on the other hand, is an overgrowth of a yeast called Candida albicans, which occurs when levels of lactobacillus, the natural host bacteria of the vagina, take a nosedive.
Factors that can cause lactobacillus levels to drop include antibiotics, anything that increases estrogen, such as the Pill or pregnancy, or conditions that increase sugar in the body such as diabetes.
Symptoms of thrush include a white cottage cheese discharge and a ‘stingy, itchy’ feeling but rarely any odour.
Is BV dangerous?
Unlike thrush, bacterial vaginosis can cause serious issues if left untreated, including an increased risk of contracting STIs and complications relating to pregnancy or even miscarriage.
“We don’t know why but women who have BV are more likely to pick up sexually transmitted infections, probably because there’s less of the protective lactobacillus ‘army’ in the vagina that does help protect you from viral conditions like the HPV virus, HIV and herpes, and also chlamydia and gonorrhea,” she says.
In pregnant women, BV is linked to premature labour and birth which can put both mums and babies at risk, and since it’s more difficult to treat after a woman conceives, Dr Ginni recommends treating it beforehand.
The effects of vaginal infections like BV extend beyond the physical, however, with 93 per cent of women involved in the YouGov survey saying their vaginal infection had a wider negative impact on their life. More than half said it made then avoid sex or intimacy, feel dirty and unclean and embarrassed and self-conscious.
How do you treat BV?
Dr Ginni’s first step to treating BV is to stop washing your vagina. Really.
“What BV likes is the pH of the vagina to be disrupted. The vagina is naturally very, very acidic, it’s about the same acidity of an orange or a lemon and sits at about a 3.8 [pH level],” she explains.
When the pH level drops and the vagina becomes alkaline, the ‘healthy bacteria’, lactobacillus, which normally keeps everything functioning really well, is left vulnerable and non-lactobacillus bacteria, particularly Gardnerella, take over.
What causes the pH level of the vagina to drop? Over-washing, particularly with soap and shower gel.
“We know from studies that if you use a soap with a pH of seven it will take your vagina about 24 hours to fix itself up and go back to a 3.8. So if you’re washing twice a day, there’s just no hope for your vagina to restore its chemistry,” Dr Ginni says.
But therein lies the rub, so to speak, as women tend to up their washing habits because BV is a very smelly condition, which - you guessed it - only makes things worse.
This vicious cycle is why Dr Ginni calls BV the ‘clean people’s disease’.
“The ironic thing is, the more you wash, the stinkier the vagina. The stinkier the vagina, the more you wash then all of a sudden what was maybe an intermittent, mild problem, becomes a daily horror problem because you’re just over-washing,” she explains.
Along with scaling back washing, Dr Ginni says in most cases a five-day course of antibiotic cream applied directly to the vagina tends to resolve the issue in about 24 hours.
There are also other over the counter products for BV that can also be discussed with a pharmacist.
She advises against having sex without a condom until the treatment is over as semen is slightly alkaline and can disrupt the pH balance.
“BV has a nasty habit of coming back within three months because once those bacteria have been activated they’re still trying to win that little battle,” she warns.
To deal with flare-ups, Dr Ginni gives patients a repeat script for the antibiotic.
As BV and thrush are completely different conditions, using thrush medications to treat BV ‘won’t do anything whatsoever’ explains Dr Ginni.
Are ‘alternative’ treatments safe?
Dr Ginni urges women to avoid the ‘rubbish’ alternate treatments for vaginal conditions like BV that are being peddled by ‘charlatans’ and celebrities such as douching, vaginal steaming and jade or ‘Yoni’ eggs.
“Douching is one of the leading causes of BV. It doesn’t make you clean, it basically gets rid of lactobacillus and makes you more vulnerable to infections,” she warns.
Vaginal steaming, which sees a woman squat or sit over steaming water, is “just ridiculous” and extremely dangerous says Dr Ginni.
“We’ve had lots of medical reports of second-degree burns of the vagina which believe me are uncomfortable and very difficult to treat,” she says.
Jade eggs are egg-shaped stones placed into the vagina which have actually been found to cause rather than cure BV, says Dr Ginni.
How to clean your vagina safely
The safest way to clean your vagina is to not do anything at all.
“Your vagina left to its own devices will do ‘an awesome job’ of cleaning itself and we don’t need to help it along with steam or liquid in a douche or soap, you just don’t need any of that stuff,” she explains.
If you do find things a bit whiffy after a sweaty gym session, for example, Dr Ginni permits the use of a pH-balanced soap or so-called ‘intimate washes’ on any outer areas that have (or have previously had) hair.
To clean the ‘inside,’ which includes the labia, Dr Ginna advises splashing with warm water only - and nothing else.
Stamping out stigma
The most important message that Dr Ginni wants to get out there is that vaginal conditions such as BV and thrush are nothing to be ashamed of and do not mean that the person is ‘dirty’ or ‘gross’.
On the contrary, they’re normal, common and easily treatable if correct medical advice is sought. Many women find the thought of talking about these issues with a doctor, pharmacist or even their friends mortifying but, as Dr Ginni explains, these conversations need to be had.
“We’ve got to be more supportive of each other. Knowledge is power and the more articles like this one get out, the better,” she says.