Bacterial vaginosis

At least half of the women who develop bacterial vaginosis don't have any symptoms. If they do have symptoms, the most common one is watery, grayish-white vaginal discharge that has a strong fishy smell. Many women find this very unpleasant. The smell is often stronger after sex or during your monthly period.

Symptoms like itching, burning and vaginal dryness are more likely to be signs of vaginitis (an inflammation of the vagina). In that case, the area around the opening of the vagina is often red and the lining of the vagina is swollen. Vaginitis can also cause symptoms when urinating (peeing) or during sex.

A healthy vagina mostly contains lactic acid bacteria. Together with other germs, they make up the vaginal flora and help to keep the vagina slightly acidic. The right acidity (pH level) protects the vagina from harmful germs. Bacterial vaginosis is caused by an imbalance in this acidic environment: The number of lactic acid bacteria drops, and other bacteria in the vagina can then multiply (grow) a lot. Bacterial vaginosis is usually caused by a type of bacteria called Gardnerella vaginalis.

The risk of bacterial vaginosis is higher in women who are very sexually active and, for example, have a new partner or switch partners frequently.

Hormonal changes or washing your genital area too much can cause an imbalance in the vaginal flora. Both can make vaginosis more likely.

Bacterial vaginosis is one of the most common types of vaginal infection. It is estimated that about 5 out of 100 women have it. The infection clears up on its own in about one third of women. If it causes symptoms, treatment is usually needed.

If there's an imbalance in the vaginal flora, it's easier for other germs to grow there. For that reason, bacterial vaginosis can lead to inflammation in the vagina, and that can lead to infections in the womb (uterus) and fallopian tubes. The risk of getting sexually transmitted diseases increases too.

Vaginal infections can also slightly increase the risk of complications in pregnancy, such as early contractions, miscarriage, or premature birth.

It is not always possible to tell the difference between bacterial vaginosis and other types of vaginal infections based only on the symptoms. To find out if it’s vaginosis, a gynecologist examines the vagina and takes a sample of the discharge. This sample (“smear”) can be used to measure the pH level and find out what types of bacteria it contains. Samples from women with bacterial vaginosis usually have too many gardnerella bacteria in them.

If bacterial vaginosis causes symptoms, it is usually treated with antibiotics to kill the bacteria. The antibiotics can be taken in the form of tablets that are swallowed, or suppositories or creams that are applied directly in the vagina. If the infection keeps returning, it can be a good idea for your partner to be treated for the infection too. But that usually won't prevent future infections.

Another treatment option is suppositories or capsules containing living lactic acid bacteria. These treatments are believed to protect the vaginal flora and restore the correct balance. There's not enough scientific proof that they work, though.

Some women soak tampons in tea tree oil or natural yogurt and put them inside their vagina. The idea is that this will create a more acidic environment there. But there's a lack of research on how effective and safe these kinds of home remedies are.

Doctors generally advise women not to try out treatments on their own. They also recommend only starting treatment for vaginosis if a doctor has confirmed that your symptoms are definitely being caused by this bacterial vaginal infection.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.