Recurrent Bacterial Vaginosis

Bacterial Vaginosis is a very common infection especially in women of reproductive age. Simply put, it is dysbiosis of our vaginal canal in which the known predominant bacteria in our vaginal flora, Lactobacilli, is overgrown by other bacterias. 

This results in our vaginal pH shifting to a more alkaline environment. See, your vagina likes to maintain its environment at a certain pH (3.8-4.5). This is considered acidic. The acidic environment is normally maintained by the Lactic Acid that the Lactobacillus Bacteria produces. If this species begins to decrease, we get a decrease in acidity, and thus it allows other bacteria to overgrow and result in BV.

Some people see a correlation between intercourse and their BV. This is because Semen is more alkaline. So when we introduce semen into our acidic vaginal canal it can increase the pH—> making it more alkaline—> contributing to a environment suited for BV. 

Symptoms: 
Thin, white/grey, or even green discharge
Itchiness 
Uncomfortable urination
A fishy Odor: often worse during your period and/or after intercourse

Treatments: 
Antibiotics: Metronidazole or Clindamycin. 
In the research the use of antibiotics for treating BV is poor. Reoccurrence rates are very high and the suboptimal results with them are widely recognized and accepted. The risks of recurrent antibiotic use can set you on a bumpy path with your health so avoiding falling in this cycle is critical. We want to limit the use to when we really need them so that when we do they work effectively. 

Naturopathic Treatments:
1)Vaginal suppositories of Boric Acid 600mg. Length of treatment depends on your individual case and symptoms. Usually this phase lasts 7-14 days. In my practice I also put control into my patients own hands and guide them to check their vaginal pH at home themselves which can also help guide treatment. 
2) A quality probiotic

Lifestyle guidelines:
No douching (mild soap and water only)
Avoid vaginal applications (creams, soaps, perfumes)
Avoid tight clothing
Cotton underwear
Avoid antibiotics, antifungals 
Avoid using tampons
Allow basic menstrual fluid to flow 
Use condoms during intercourse 
Limit sugar and processed foods

My nerdy note! There is current research being done on the vaginal microbiome. This is beginning to highlight the importance of individualized medicine. In the early literature they are currently finding that among many asymptomatic otherwise healthy and happy vaginas it was found that many of them don’t have lactobacilli as the predominant bacteria and some had minimal to no lactobacilli. At this point the clinical importance of this is not yet understood but I will follow this research as it comes out and it may eventually allow us to alter our treatments to better treat you!