Dr. Marie's Advice About Bacterial Vaginosis

By Marie Savard MD

About 50% of all cases of vaginitis, an inflammation or infection of the vagina, are caused by bacterial vaginosis. If BV is not treated, it can lead to pelvic inflammatory disease, chronic pelvic pain and possible infertility. It can also lower your defenses against other infections. However in this digital age, when many women are turning to the Internet rather than see a doctor, a recent study found that fully two out of three women with bacterial vaginosis misdiagnosed themselves when they Googled their symptoms.

Hearing that, we decided to ask ThirdAge medical contributor Marie Savard, M.D. to give us a thorough rundown on the symptoms, causes, and treatments of this potentially serious condition. She brings to the topic not only her professional expertise but also her personal experience.

“I had bacterial vaginosis right after I got married,” says Dr. Marie.”Then I had to deal with another bout of BV as a postmenopausal woman, so I know how annoying and embarrassing it can be!”

One cause of BV is intercourse. Your premenopausal vagina is acidic and semen is alkaline so the “good bacteria” in your vagina, lactobacilli, can be overwhelmed if the acidic environment they prefer turns too alkaline. When that happens, “bad bacteria” can start to grow.

The other cause of BV is menopause. With a sharp decline in estrogen, the production of glycogen, the main fuel for the lactobacillus, goes down. Therefore so does the lactobacillus, which is what typically makes the vagina acidic. The new alkaline environment in the vagina is why postmenopausal women can develop BV even if they haven’t had sex.

Dr. Marie says that one of the earliest symptoms of BV is a whitish-gray discharge with a distinct fishy odor. Ironically, the unpleasant smell prompts some women to douche and that only serves to upset the balance of good and bad bacteria even further. “Do not douche!” Dr. Marie says emphatically. “It’s a very bad idea.”

Other symptoms include itching in the vulvar and vaginal area and a burning sensation when you urinate. Even so, some women have no symptoms at first, and this “silent” form of BV may eventually bring on stomachaches or cramps when the infection spreads.

If you suspect you have BV, you can buy an over-the-counter pH test to check your acid/alkaline balance. An abnormally high pH should send you straight to the doctor.

She’ll get vaginal discharge samples for a “whiff test” to detect the tell-tale fishy smell, and also to be tested for the “clue cells” characteristic of BV and for a high pH.

If the diagnosis is BV, your doctor will prescribe medication. However, Dr. Marie advises against oral or “systemic” meds. “I prefer targeted treatments so we don’t upset the balance of bacteria in other parts of the body,” she says.

Here are her recommendations:

Flagyl/Metrogel vaginal suppository

Metronidazole gel intravaginally 

Clindamycin cream intravaginally

Your BV should be cleared up in a week or so with these treatments. “If your doctor wants to prescribe an oral antibiotic, as it commonly done, I’d ask about topical treatments instead,” Dr. Marie warns. “There is no reason to compromise your whole system just to treat your vagina.” She also cautions that one of the often-prescribed antibiotics for BV can make you violently ill if you drink even a small amount of alcohol while you’re taking it.