Don’t rush to thrush.
Recurrent yeast infections could in fact be Bacterial Vaginosis (BV).
Why you need to know which it is!
Do you suffer from reoccurring episodes of thrush or BV? Maybe every time you sleep with a new partner? Or after a big weekend? I’m here to tell you why you need to know what type of infection you have, why it’s important and what you can do about it.
After years of thinking it was recurring episodes of thrush that I was suffering from, with the usual suspect of symptoms including burning, swollen, sore, itchy, inflamed… I found out it was a bacterial infection, commonly known as BV. Why was this a problem? Every time I went to the GP or picked up a tube of Canesten cream or a pessary from Boots, I was treating my ‘yeast infection’ or so I thought, with antifungals. BV is a bacterial infection and requires either a prescribed course of antibiotics or other more natural treatments. The only thing I was doing by jamming those pessaries up my yoni was disrupting my vagina microbiome, making it more dysbiotic (an unbalance of the good bacteria) than it already was. I was in a lose/lose situation which I’m sure is all too familiar to some of you.
Let me break down what you need to know if you are reading this and thinking… maybe that’s me??! Firstly, let’s look at the similarities and differences between yeast and bacterial infections.
Symptoms of a yeast infection, also known as a fungal vaginal infection, include a sourdough bread (yeasty) smell but can sometimes be odourless. Discharge is usually white, thick, and lumpy, similar to cottage cheese. Yeast infections present symptoms; treatment includes antifungal medication.
Symptoms of a bacterial vaginal infection and vaginal pH imbalance include a strong, fishy, sour, pungent, metallic smell. Discharge can be white, grey, green, thick like a lotion or watery. BV can often be asymptomatic! Treatment includes antibiotics.
Understanding BV, and why it’s important.
BV is the clinical term used for dysbiosis of the vagina, and many different organisms can play a role. It is characterised by;
An alkaline vaginal pH
Lowered levels of protective Lactobacilli bacteria
Raised anaerobic bacteria
The vagina microbiome requires an acidic environment so that the good bacteria (lactobacilli) thrive and the other more opportunistic and not-so-good bacteria can’t survive. Ideally, you want a vagina pH of 4.5, anything above that and the vagina is too alkaline.
Disruptions of normal vaginal flora (the absence of lactobacilli) have been linked to pelvic inflammatory disease, miscarriages, early pregnancy loss in IVF, preterm delivery, and postpartum complications such as endometritis and wound infections in pregnant women (1,2). Additionally, BV puts you at an increased risk of HIV (3), HPV (4), gonorrhoea and chlamydia infection (5).
Factors which can disrupt the vagina microbiome:
A high-sugar diet, the pH of the vagina decreases with sugar consumption.
Smoking and alcohol consumption (6,7).
Changes in oestrogen can affect the lubrication and bacterial balance of the vagina.
Pregnancy and menopause.
Gut dysbiosis.
Changes in the vaginal pH as a result of exposure to semen. The pH of semen is alkalizing, regular ejaculative sex results in a decrease in acidity within the vagina microbiome, allowing more opportunistic bacteria to thrive.
Unprotected sexual intercourse.
Vaginal douching.
Using lubricants which are not the correct pH.
Inserting a finger or device that isn’t clean.
Exposure to synthetic chemicals, toiletries, and fragrances that upset vaginal pH and bacteria.
Reduced immune function (due to stress, for example).
Medications: oral contraceptive pill, HRT, steroids (8), and antibiotics.
Although BV appears to be more prevalent in women who have multiple, new, or increased number of partners. The risk of BV recurrence following re-exposure to the same sexual partner after treatment increases 3-fold (9,10).
The recurrence of BV in women of reproductive age is very high, with approximately 80% of cases recurring three months after recommended antibiotic therapy (11). The problem with over-the-counter treatment or regular antibiotic use is that it results in extinction events of some of these important microbes needed for the vagina to flourish. BV is treatable with natural methods; regulating the microbial environment with vitamin D and Zinc can be a good place to start.
Some ways in which you can support the vaginal microflora balance:
Balance blood sugar levels by including nutrient-dense, rather than energy-dense foods, including protein for breakfast.
Dehydration can significantly worsen dryness, impacting the production of the cleansing vaginal discharge. Avoid drinking a lot of caffeinated drinks like tea and coffee. Alcohol and high-sugar drinks can also have this effect.
Support hormonal transition (menopause) by including phytoestrogens in the diet, and cruciferous vegetables for healthy hormone detoxification.
Avoid environmental chemicals such as BPA from plastics and pesticides from non-organic produce, as they can negatively impact hormones. Switch to glass, paper, and stainless steel and buy organic food whenever possible.
Heal your gut and rebalance gut flora with beneficial bacteria-rich foods: live active culture yoghurt, sauerkraut, kimchi, and miso. Prebiotic foods: chicory, Jerusalem artichokes, garlic, onions, shallots, leeks, cabbage.
Reduce stress by incorporating self-care practices such as meditation, deep breathing exercises, walking in nature, seeking out happy moments throughout the day, and creative activity.
Sleep quality is essential for our cells to do a clean-up job while we sleep. Try going to bed at the same time each night (ideally around 10 pm) and exposing yourself to natural light first thing in the morning.
Are you worried about your vaginal microbial balance and want to do more?
Testing is available in the UK, and Invivo uses DNA technology such as PCR testing. Talk to your healthcare practitioner about running a Vaginal EcologiXTM vaginal microbiome profile. This will help to ascertain if things are a bit out of balance and enable your healthcare practitioner to tailor interventions that are just right for your microbes.
Understanding your vagina microbiome can help you start to unpack many of those unanswered questions you might have had about your vaginal health. If you suspect you might have BV and conventional treatment options aren’t working, reach out to a healthcare practitioner or book a free discovery call with me.
References:
Lewis F, Bernstein K, Aral S. Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstetrics & Gynecology. 2017;129(4):643-654.
Sobel J, Sobel R. Current and emerging pharmacotherapy for recurrent bacterial vaginosis. Expert Opinion on Pharmacotherapy. 2021;22(12):1593-1600.
Mehta S, Zhao D, Green S, Agingu W, Otieno F, Bhaumik R et al. The Microbiome Composition of a Man's Penis Predicts Incident Bacterial Vaginosis in His Female Sex Partner With High Accuracy. Frontiers in Cellular and Infection Microbiology. 2020;10.
Swidsinski A, Doerffel Y, Loening-Baucke V, Swidsinski S, Verstraelen H, Vaneechoutte M et al. Gardnerella Biofilm Involves Females and Males and Is Transmitted Sexually. Gynecologic and Obstetric Investigation. 2010;70(4):256-263.
Sanchez S, Garcia P, Thomas K, Catlin M, Holmes K. Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: A randomized controlled trial. American Journal of Obstetrics and Gynecology. 2004;191(6):1898-1906.
Ratten L, Plummer E, Murray G, Danielewski J, Fairley C, Garland S et al. Sex is associated with the persistence of non-optimal vaginal microbiota following treatment for bacterial vaginosis: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2020;128(4):756-767.
Fethers K, Fairley C, Morton A, Hocking J, Fehler G, Kennedy L et al. Low Incidence of Bacterial Vaginosis in Cohort of Young Australian Women. Sexually Transmitted Diseases. 2011;38(2):124-126.
Reid G, Witkin S, Vitali B, Crucitti T. Has knowledge of the vaginal microbiome altered approaches to health and disease?. F1000Research. 2018;7:460.
Bradshaw C, Vodstrcil L, Hocking J, Law M, Pirotta M, Garland S et al. Recurrence of Bacterial Vaginosis Is Significantly Associated With Posttreatment Sexual Activities and Hormonal Contraceptive Use. Clinical Infectious Diseases. 2012;56(6):777-786.
Vodstrcil L, Plummer M, Fairley C, Tachedjian G, Law M, Hocking J et al. Combined oral contraceptive pill-exposure alone does not reduce the risk of bacterial vaginosis recurrence in a pilot randomised controlled trial. Scientific Reports. 2019;9(1).
Coudray M, Madhivanan P. Bacterial vaginosis—A brief synopsis of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020;245:143-148.
