Bacterial vaginosis is an imbalance in the vaginal bacterial flora, characterized by an excessive proliferation of anaerobic bacteria at the expense of protective lactobacilli. The most common symptoms are a thin, gray or white vaginal discharge accompanied by a characteristic fishy odor—which is often more pronounced after sexual intercourse. A mild burning sensation during urination or intercourse may also occur. Unlike vaginal yeast infections, intense itching is rare in bacterial vaginosis.
The exact causes remain only partially understood, but several factors disrupt the balance of the vaginal flora and promote bacterial vaginosis. Vaginal douches, scented products, and harsh soaps alter the protective pH balance. Hormonal changes—related to the menstrual cycle, pregnancy, or birth control—alter the vaginal environment. Sexual intercourse with a new partner or multiple partners is also a well-documented risk factor. Chronic stress, by disrupting the hormonal balance, can also weaken the vaginal flora.
This distinction is essential because the treatments differ radically. Bacterial vaginosis is characterized by a thin, grayish discharge with a fishy odor and little or no itching. Candidiasis, on the other hand, produces thick, white discharge with no distinct odor, accompanied by intense itching and vulvar redness. A vaginal swab followed by microscopic analysis or a pH test allows for accurate identification and targeted treatment.
The standard medical treatment involves antibiotics—metronidazole or clindamycin—administered orally or topically, depending on the severity. These treatments must be prescribed and completed in full to prevent recurrence. In addition, a course of probiotics containing lactobacilli —particularly Lactobacillus rhamnosus and Lactobacillus reuteri—accelerates the restoration of the protective flora following antibiotic therapy.
Maintaining gentle intimate hygiene —without douching or using scented soaps—is the most effective preventive measure. Wearing cotton underwear promotes airflow. Practicing safe sex reduces the introduction of external bacteria. A diet rich in fermented foods—such as yogurt and kefir—and low in refined sugars supports the vaginal microbiome. Regular probiotic treatments after a course of antibiotics or during specific hormonal changes help prevent bacterial imbalance.
Yes, but this requires addressing the contributing factors over the long term. Completing the full course of treatment, avoiding irritants, and incorporating probiotics as part of a maintenance regimen are the cornerstones of preventing recurrent vaginal infections. In cases of recurrent bacterial vaginosis—three or more episodes per year—a prolonged treatment regimen under medical supervision may be considered.
Yes. Untreated bacterial vaginosis during pregnancy is associated with an increased risk of preterm birth, preterm rupture of membranes, and postpartum infection. Treatment must be tailored to the trimester and any pregnancy-related contraindications—oral metronidazole should be avoided during the first trimester. Close gynecological monitoring is essential for any pregnant woman experiencing symptoms.
A medical consultation is necessary as soon as the first symptoms appear, especially if this is the first time or if episodes recur. The presence of fever, abdominal pain, or pelvic pain requires an urgent consultation to rule out an ascending pelvic infection. Never treat bacterial vaginosis with unproven remedies without a prior diagnosis: inappropriate treatment can worsen the imbalance and lead to further complications.
