Bacterial Vaginosis: An Embarrassing Problem
Bacterial vaginosis is a common problem that affects 10-15% of women during their childbearing years. Its incidence can rise to 20% during pregnancy. Most women don’t really talk about it because it is one of those taboo subjects that is a little too embarrassing to discuss. The main problem with bacterial vaginosis is that it causes vaginal discharge that has an offensive, fishy smell. A woman affected can feel very self conscious and think that everyone around her can smell this, even though this is rarely true.
What Causes Bacterial Vaginosis?There are several factors that increase the risk of developing bacterial vaginosis but the underlying cause is an imbalance in the normal bacteria that usually live in the vagina. All of the openings to the body have their own population of commensal bacteria – these are harmless and are often actually beneficial. Having good commensal bacteria helps to fight off infections that try to enter the body from outside. This is why women with bacterial vaginosis are more prone to sexually transmitted infections (STIs) – the condition itself is not an STI, but it reduces the body’s ability to fight off infections such as chlamydia, gonorrhoea and HIV.
Bacterial vaginosis arises when the type of bacteria in the vagina changes. Usually the vagina is populated by several species of bacteria that come under the grouping of lactobacilli. These produce lactic acid and make sure that the secretions and fluid inside the vagina are quite acidic – usually about pH3-4. In women with bacterial vaginosis, the number of lactobacilli decreases, and the pH of the vaginal fluid changes and moves towards a more neutral pH (pH7). One of the simple tests for vaginosis is to check the pH of the vagina with a strip of pH paper – if the pH is over 4.5, and the woman concerned is experiencing a smelly discharge, bacterial vaginosis is usually the cause.
Risk Factors for Bacterial VaginosisThis is not an infection that is passed on. The change in the population of bacteria in the vagina happens because of lifestyle factors. Using strongly scented bubble baths, antiseptic bubble baths or vaginal washes, vaginal deodorants or vaginal douches all tend to destroy the lactobacilli that keep the vagina healthy. It is ironic that most women who notice a fishy smell and a more copious vaginal discharge will try to solve the problem by doing exactly the things that make the problem worse. Even washing underwear in a more powerful detergent can set the problem off, or certainly make it worse.
Symptoms and Complications of Bacteria Vaginosis
In addition to the fishy smell from the vaginal secretions, the discharge can become thinner and greyer and this can be worse the morning after sex. Women who are celibate rarely get bacterial vaginosis, and the disturbance of the vagina, couple with too much washing can be enough to cause symptoms. If the problem gets worse, the vagina and vulva can become very irritated and sore, and lower abdominal cramps can occur. The condition itself is not really too much of a threat to health in women who aren’t pregnant, but it can cause a pelvic infection, and infertility in rare cases. In pregnancy it can increase the chance of a late miscarriage, so treatment for bacterial vaginosis in pregnancy is particularly important.
Treating Bacterial VaginosisPrevention is always better than a cure, so the old saying goes, and it makes sense to be more aware of the natural balance of the vagina and its importance in vaginal health. Avoid using strong chemical washes or antiseptics, do not use vaginal douches and use gentle washing detergents for underwear. Some people swear by using live natural yoghurt, inserted into the vagina for a few minutes twice a day but there is no real evidence that this has any effect.
If the problem does arise and causes embarrassment, the best treatment is an antibiotic to restore the natural balance of bacteria. Metronidazole is often used as this targets the bacteria that have taken over from the lactobacilli. You need to avoid alcohol completely when taking this antibiotic, as this produces an extreme reaction in the body and you will feel extremely ill. Usually a seven day course will clear up the problem, but the imbalance can take a while to go away. Recurrent bouts of bacterial vaginosis can occur and if treatment fails to work, you may need to be referred to a gynaecologist.