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- Bacterial vaginosis — a shift in the vaginal microflora in which lactobacilli are displaced by other microorganisms.
- The condition is not transmitted sexually, but requires a gynaecologist's examination: similar signs occur in various conditions.
- Douching, scented hygiene products, frequent change of partners, antibiotics, an IUD and a weakened immune system are considered causes of the shift.
- Symptoms: profuse greyish discharge, fishy odour after intimacy or menstruation, itching, burning on urination, discomfort.
- Examination includes a physical examination, microscopy of a smear, determination of acidity, a whiff test and culture to rule out other infections.
What is bacterial vaginosis
Bacterial vaginosis is a condition in which the usual composition of the vaginal microflora changes. There are fewer beneficial bacteria and more of other microorganisms, and this can manifest as unpleasant symptoms.
What happens in the body
The vagina of a healthy woman is inhabited by microorganisms that maintain an acidic environment and protect against the proliferation of foreign microbes. The basis of this protection is beneficial bacteria that produce lactic acid and prevent foreign microbes from taking their place. When there are fewer beneficial bacteria, the vacated niche is quickly occupied by other microorganisms, including those that are usually present in small numbers. Their active proliferation changes the acidity of the environment and the composition of the discharge, and the discharge itself acquires an unusual odour. This condition is not one of the infections that are transmitted sexually, and usually does not directly threaten health. At the same time, the shift in balance can persist for a long time and return after a temporary improvement. If the changes are noticeable, it is reasonable to discuss them with a doctor rather than choosing remedies on your own.
What causes it to develop
- Douching and scented hygiene products: they wash out and irritate beneficial bacteria, freeing up space for other microorganisms.
- Frequent change of sexual partners: this changes the composition of the microflora, and the balance between bacteria is not restored immediately.
- Taking certain antibiotics: such remedies act on a wide range of bacteria and simultaneously suppress the beneficial microflora of the vagina.
- Hormonal changes: pregnancy and menopause change the hormonal background, and with it the living conditions of the bacteria.
- Use of an intrauterine device: it can affect the vaginal environment and contribute to a shift in the balance of microorganisms.
- Weakened immunity: the body's defences are less able to hold back the proliferation of foreign microbes, and the balance is disrupted.
Who encounters this more often
This condition is encountered more often by women of reproductive age whose hormonal background or hygiene habits change. It has been noted that douching and scented intimate hygiene products increase the likelihood of such a shift, since they disrupt the natural protection. Frequent change of sexual partners also affects the composition of the microflora and makes the balance less stable. Taking antibiotics for any reason simultaneously suppresses beneficial bacteria, and afterwards the balance is not restored immediately. Pregnancy and menopause change the hormonal background, and with it the conditions in which the microorganisms of the vagina live. An intrauterine device and weakened immunity are also among the circumstances under which the shift occurs more often. If the changes recur, it is worth discussing them with a doctor rather than trying to solve the issue on your own.
What symptoms can there be?
Bacterial vaginosis can go unnoticed for a long time, so women often do not link changes in how they feel to a disorder. A calm look at your own sensations helps you work out what signs occur with this condition and in which cases urgent help is needed.
How it is noticed at the very beginning
Bacterial vaginosis often manifests mildly or is not felt at all, and then it is discovered by chance during a preventive check-up. The first thing that draws attention is a change in the nature of the discharge: it becomes more abundant and takes on a greyish or whitish tint. Many put this down to tiredness, a change of underwear or the usual fluctuations of the cycle and do not attach any importance to it. An unpleasant fishy odour appears, which is more noticeable after sexual intercourse or menstruation. Itching or irritation in the area of the external genitalia may be added to this. Sometimes burning occurs when urinating, and discomfort is felt during intimacy. If such changes persist for several days in a row, it is sensible not to wait for them to pass on their own, but to discuss them with a doctor.
Signs that occur most often
- Abundant discharge: there is noticeably more of it than usual, the colour shifts towards greyish or whitish, which distinguishes the condition from the usual picture.
- Fishy odour: it intensifies after sexual intercourse or menstruation, because the environment changes and the odour becomes more pronounced.
- Itching and irritation: the unpleasant sensations are concentrated in the area of the external genitalia and interfere throughout the day.
- Burning when urinating: this sign does not appear in everyone, but it noticeably affects everyday comfort and requires attention.
- Discomfort during sexual intercourse: the sensations arise because of irritation of the tissues, and this is another reason not to put off a visit to the doctor.
When to seek help urgently
Examinations and tests
Examination for bacterial vaginosis begins with a gynaecological examination and assessment of the discharge. The doctor then decides which laboratory tests are needed to clarify the composition of the microflora.
How the examination begins
A gynaecological examination with assessment of the nature of the discharge is the first step from which any examination for suspected bacterial vaginosis begins. The doctor examines the mucosa and pays attention to the colour, consistency and amount of discharge, because these signs help to distinguish one condition from another. The specialist may then take a smear to send the material to the laboratory and clarify the composition of the microflora. Microscopy of the smear shows altered microflora that cannot be seen on ordinary examination, and this confirms or rules out the suspicion. In addition, the acidity of the vaginal contents is determined, as a shift in it indicates a disturbance in the balance of bacteria. A test with the addition of a special substance is also carried out to assess the odour of the discharge and obtain another basis for the conclusion. If the picture remains unclear, a culture is prescribed, which helps to rule out other infections and avoid a mistake in management.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: take all records from previous gynaecologists so that the doctor can see how the picture changed during the period of observation.
- Previous smears: the results of microscopy and other tests will help to compare previous values with the current ones and notice shifts.
- Observations: write down how long ago the discharge appeared and how it changed, because this clarifies the timing and nature of the process.
- List of complaints: list everything that is troubling you, including odour and discomfort, so that nothing is left out of the conversation.
- Questions: formulate in advance what you want to clarify with the doctor, and this will make the appointment calmer and more useful.
Which doctor should I see?
Choosing a doctor for bacterial vaginosis usually does not cause difficulties, because this condition is managed by one specialist. Below is an outline of whom to see, what happens at the first appointment and what areas of care make up the treatment.
Which specialist manages this condition
Bacterial vaginosis is managed by a gynaecologist, and it is this doctor you should book an appointment with if you suspect this condition. If there is no specialist nearby, you can start with an appointment with a gynaecologist at the district or regional polyclinic at your place of residence. At the first appointment, the doctor clarifies your complaints and collects information about previous conditions and previous treatment. Then they examine the patient and, if necessary, take a sample for laboratory confirmation, since without it the diagnosis is not considered established. This procedure is needed because similar signs occur in different conditions, and the care in each case differs. If confirmation is obtained, the gynaecologist discusses further steps with the patient and prescribes follow-up. It is not worth delaying the visit: without confirmation of the diagnosis and prescribed care, the unpleasant sensations may persist for a long time.
What the treatment consists of
- Selection of therapy by the doctor: the specialist takes into account the individual characteristics of the patient, so there are no identical prescriptions for everyone.
- Restoration of the natural microflora: this returns the protective properties to the vagina and reduces the likelihood of the unpleasant signs reappearing.
- Avoiding douching and irritating agents: such actions disrupt the environment and hinder recovery, so they are excluded during follow-up.
- Treatment of concomitant diseases: if the patient has other conditions, they are also brought into order, otherwise the care will be incomplete.
- Follow-up with a gynaecologist: the doctor monitors the condition until the symptoms disappear and, if necessary, adjusts the prescriptions along the way.
What depends on the patient themselves
The regularity of follow-up with a gynaecologist largely determines how long the unpleasant signs persist and how soon improvement occurs. If visits are missed or stopped at the first relief, the doctor loses the ability to notice in time that the chosen care is not working. It is important for the patient to follow the specialist's recommendations precisely and not change them at their own discretion, even if the symptoms have eased. Avoiding douching and irritating agents also depends on the patient herself, not on the doctor, and here lapses are especially common. It is worth telling the gynaecologist about all changes in how you feel, including those that seem insignificant or unrelated to the main complaints. If concomitant diseases require separate follow-up, they also must not be left unattended. The practical conclusion is simple: the more calmly and consistently the patient follows the agreements with the doctor, the more predictable the whole situation becomes.
What helps prevent an exacerbation?
Prevention of bacterial vaginosis relies on maintaining the natural balance of the microflora. Some daily decisions depend on the person themselves, and regular monitoring helps to notice unfavourable changes in time.
What is changed in habits
Giving up douching and scented hygiene products directly affects the state of the vaginal microflora. Douching washes out the protective microorganisms and changes the environment, which is usually insufficient to keep conditionally pathogenic bacteria in check. Scented panty liners, intimate hygiene gels and bath foams contain fragrances that irritate the mucosa and disrupt its protective properties. Wearing cotton underwear and loose clothing reduces moisture and overheating in the perineal area, and this noticeably reduces the conditions for bacterial growth. Condoms protect against sexually transmitted infections and thereby reduce the risk of exacerbation. Antibiotics should be used only as prescribed by a doctor, since uncontrolled use suppresses the beneficial microflora. If discharge and odour persist after changing habits, this is a reason to discuss the situation with a specialist rather than change hygiene products at random.
What should be kept under control
- Nature of the discharge: a change in colour, amount or odour serves as the first noticeable signal that the balance of the microflora has shifted for the worse.
- Hygiene products: the composition and fragrances in panty liners, gels and foams should be checked, because irritation of the mucosa maintains an unfavourable environment.
- Taking antibiotics: any prescriptions for other reasons should be agreed with a doctor, as such products affect the microflora of the whole body.
- Underwear and clothing: cotton fabrics and a loose cut reduce moisture and overheating, while tight synthetics, on the contrary, create these conditions.
- Protection during sexual contact: condoms reduce the risk of infections that can provoke an exacerbation and require separate attention.
- Preventive examination: a regular visit to the gynaecologist allows changes to be noticed before they become noticeable and persistent.
How often to see a doctor
A regular preventive examination by a gynaecologist is needed even when well-being remains good and nothing is troubling you. Many changes in the microflora proceed without obvious signs, and they can only be noticed during an examination. The doctor assesses the state of the mucosa, clarifies the complaints and, if necessary, prescribes an examination to understand the cause of the shift. If exacerbations recur frequently, it is reasonable to shorten the interval between visits and discuss this with a specialist. Between visits, it is worth observing the nature of the discharge and noting what changes after a change of hygiene products or taking antibiotics. Such notes help the doctor to understand the situation faster and not to miss important details. A calm and attentive attitude to one's own condition works better than attempts to solve the problem on one's own.
What is worth remembering
This section gathers the main points worth taking away from the material on bacterial vaginosis and helps the reader understand what to rely on when deciding whether to visit a doctor.
Key takeaways
Bacterial vaginosis is a condition in which the composition of the vaginal microflora changes, and this can be noticed by the nature of the discharge and the odour. Many people perceive such changes as a temporary inconvenience and put off a visit to a specialist indefinitely. Meanwhile, it is a timely visit that allows the cause to be identified and the situation not to be neglected. Similar signs also occur in other conditions, so it is not worth determining the source on your own by sensations. Attempts to choose remedies at random often blur the picture and prevent the doctor from seeing the true cause. In bacterial vaginosis, it is important not so much to remove an individual symptom as to restore the normal balance of the environment. A calm and consistent approach works better here than hasty decisions made under the influence of the moment.
