Bacterial Vaginosis (BV)
What is Bacterial Vaginosis (BV)?
Bacterial vaginosis is an overgrowth of harmful bacteria (Gardnerella vaginalis) in the vagina causing vaginal irritation.
What causes BV?
It is often the result of either antibiotic or antifungal use that disrupts the good vaginal flora and allows harmful bacteria to overgrow. Hormone imbalance creates a vaginal pH that supports BV growth. The pH of the vagina is naturally between 3.8 and 4.5. The interaction between the vaginal microbiome and your hormones maintains this pH.
What are the symptoms of Bacterial Vaginosis?
The symptoms of BV may include:
- Vaginal irritation
- Foul-smelling discharge, usually thin and greyish-white
- Unusual vaginal odour, sometimes described as a fishy odour
How is BV diagnosed?
Medical doctors can collect a vaginal swab. They send it to a lab for culture to determine which types of bacteria are growing in your vagina. Often, the organism that causes BV is Gardnerella vaginalis.
How do you treat BV?
Medical doctors would prescribe antibiotics to kill the bad bacteria. While this works initially, the problem with this approach is that it does not restore the proper environment in the vagina. Different unwanted bacteria may then overgrow and cause similar symptoms. More than half of those treated this way experience a recurrence within 12 months.
Natural Remedies for BV
The natural treatment for BV offers a more permanent solution because it addresses the underlying cause. It restores a healthy environment in the vagina.
- Clean unwanted bacteria or yeast out of the vagina.
- Restore good bacteria that help to keep the tissue healthy and prevent harmful bacteria from growing.
- Remove sources of vaginal irritation that make the tissue stickier and more susceptible to infection. This may include food allergies, tampons, and latex allergies (condoms), among other things.
- Address any vitamin deficiencies that make the vaginal tissue or immune system unhealthy, such as deficiencies in vitamins A, C, or zinc.
- Ensure healthy functioning of the immune system to ward off any kind of infection.
- Balance your hormones. The environment in your vagina and the health of the vaginal tissue are dependent on hormone balance.
Diet, Sugar Intake & the Vaginal Microbiome: An Underappreciated Factor in Recurrent Bacterial Vaginosis
Many women with recurrent bacterial vaginosis (BV) focus exclusively on antibiotics, probiotics, or vaginal treatments, but diet may also influence whether healthy vaginal bacteria can successfully re-establish.
The vagina is not isolated from the rest of the body. Hormones, blood sugar regulation, immune function, and the microbiome all interact to influence which organisms thrive.
Does Sugar Feed Bacterial Vaginosis?
Unlike vaginal yeast infections, where the relationship with glucose is more direct, BV appears to be influenced more by the overall metabolic environment than by sugar “feeding” Gardnerella directly.
Emerging research suggests that diets with a high glycemic load (GL), those that cause frequent or significant blood sugar elevations, may be associated with reduced dominance of protective Lactobacillus species and increased likelihood of vaginal dysbiosis.
Higher glycemic diets may contribute through several mechanisms:
- Increased inflammatory signalling
- Altered immune responsiveness at mucosal surfaces
- Changes in glycogen metabolism within vaginal tissue
- Disruption of microbial balance that favours less protective bacterial communities
- Hormonal imbalance
Women with impaired glucose regulation, insulin resistance, obesity, and metabolic syndrome appear more likely to experience shifts in vaginal flora and recurrent vaginal infections.
From a practical perspective, this does not mean eliminating carbohydrates completely. Instead, the goal is generally to favour a lower-glycemic-load eating pattern that supports stable blood sugar levels and microbiome diversity.
Examples of lower glycemic dietary strategies include:
- Prioritizing protein at meals
- Choosing fibre-rich vegetables and legumes
- Replacing refined carbohydrates with minimally processed sources
- Limiting sugar-sweetened beverages
The Best Probiotic Strains for Vaginal Flora: Why Strain Matters
Not all probiotics work the same way.
Research increasingly shows that probiotic benefits are strain-specific, meaning one Lactobacillus strain cannot automatically be assumed to provide the same effect as another.
Several strains have been studied specifically for vaginal microbiome support and recurrence prevention:
Lactobacillus rhamnosus GR-1® + Lactobacillus reuteri RC-14®
This combination is among the most extensively studied oral probiotic approaches for vaginal health.
Research suggests these strains may:
- Support restoration of Lactobacillus-dominant flora
- Improve vaginal microbial balance after antibiotic treatment
- Reduce recurrence rates when used alongside standard therapy
- Help normalize vaginal pH
These strains appear to influence both gastrointestinal and vaginal microbial ecosystems, potentially allowing beneficial organisms to colonize the reproductive tract.
Lactobacillus crispatus
L. crispatus is considered one of the hallmark organisms of a healthy vaginal microbiome.
Higher vaginal abundance of L. crispatus has been associated with:
- Lower vaginal pH
- Reduced colonization by Gardnerella and other BV-associated organisms
- Greater microbiome stability over time
Clinical studies evaluating vaginal administration of L. crispatus have shown encouraging effects on reducing recurrence after treatment.
Lactobacillus gasseri
L. gasseri produces lactic acid and antimicrobial compounds that may help maintain the acidic vaginal environment required to suppress opportunistic bacteria.
Lactobacillus fermentum and Lactobacillus plantarum
Smaller studies suggest these strains may contribute to normalization of vaginal microbial patterns and support recolonization after dysbiosis.
A Microbiome-First Approach to Preventing Recurrence
For recurrent BV, restoring vaginal ecology may involve more than antimicrobial treatment alone.
Factors that influence long-term vaginal microbial stability may include:
- blood sugar regulation
- dietary glycemic load
- hormone balance
- targeted probiotic strain selection
- minimizing unnecessary antibiotic exposure
- reducing vaginal irritants
- supporting immune function
Because vaginal microbiome composition varies substantially from person to person, the most effective approach is often individualized rather than one-size-fits-all.
FAQ About BV
Can bacterial vaginosis go away on its own?
Mild cases sometimes resolve without treatment, but BV often persists or returns, particularly if the underlying imbalance in vaginal flora and vaginal pH isn’t addressed.
Is bacterial vaginosis a sexually transmitted infection?
BV is not classified as an STI, though sexual activity can be one factor that influences vaginal flora balance. It can occur in people who are not sexually active. It is caused by a bacterium called Gardnerella, which can be present in small amounts without causing an infection. Only when your vaginal flora is imbalanced and vaginal pH isn’t right does it overgrow and cause infection.
How is BV different from a yeast infection?
BV typically causes a thin, greyish discharge with a fishy odour and is caused by an overgrowth of bacteria (commonly Gardnerella vaginalis), while yeast infections usually cause thick, white discharge with itching and burning, and are caused by an overgrowth of yeast called Candida. The treatments differ, so accurate identification matters.
Why does BV keep coming back?
Recurrence is common with antibiotic-only approaches because they don’t necessarily restore the protective vaginal flora or address factors like hormone balance, diet, or irritants that allowed the imbalance to occur in the first place.
Can diet affect bacterial vaginosis?
Diet can influence the broader microbiome and immune function that support a healthy vaginal environment, though BV itself is a localized bacterial imbalance best assessed on an individual basis.
Book an appointment here or call the office at 416-481-0222 for more information.
by Dr. Pamela Frank, BSc(Hons), ND
Dr. Pamela Frank has been in practice as a naturopathic doctor for over 26 years. Since 1999, she has earned acclaim as a leading naturopath in Toronto, amassing multiple awards.
Dr. Pamela has a special interest in addressing hormone-related complexities, including but not limited to PCOS, endometriosis, acne, hair loss, weight management, thyroid issues, and fertility.
Residing in Toronto with her family and loyal companion, Dolly the rescue dog, Dr. Pamela seamlessly combines her professional commitment with a diverse range of interests.
Beyond her clinical endeavours, she actively engages in kickboxing, leadership roles within Scout Groups, yoga practice, podcasting, and outdoor pursuits such as backcountry camping.
Dr. Pamela’s comprehensive approach reflects not only her dedication to optimal health but also her passion for continual personal and professional growth.
Bacterial Vaginosis & Natural Remedies Research
Probiotics
Supplementation with probiotics may help reduce the risk of vaginal infections. Source: Benef Microbes; 2012 Mar 20:1-5.
Reduction in the symptoms of bacterial vaginosis was seen after 7 days of probiotic administration. Source: Benef Microbes. 2012 Jun 1;3(2):151-5.
Probiotics & Vaginal Health
Women with intermediate vaginal bacteria were given Lactobacillus fermentum 57A, Lactobacillus Plantarum 57B, and Lactobacillus gasseri 57C. Results showed that the vaginal environment was normalized within 28-60 days. Source: Eur J Obstet Gynecol Reprod Biol. 2012 Jun 19
Studies have shown that Lactobacillus strains can disrupt BV and yeast biofilms and inhibit the growth of harmful bacteria. The use of probiotics to populate the vagina and prevent or treat infection has been considered for some time. But, only quite recently have data emerged to show that they work.
Source: Interdiscip Perspect Infect Dis. 2008; 2008: 256490.
Published online 2009 Mar 29. doi: [10.1155/2008/256490]
Vaginal Microbiota and the Use of Probiotics
Sarah Cribby, 1, 2 Michelle Taylor, 1, 2 and Gregor Reid
All studies indicate that the use of probiotics is beneficial for BV, in addition to conventional treatments.
Semergen. 2017 Jul – Aug;43(5):394-398. doi: 10.1016/j.semerg.2016.09.002. Epub 2016 Nov 14.
[Use of probiotics in bacterial vaginosis].
Mur Pérez AM1, Mateo Segura Z2, Ramírez Domínguez N2, Vela Condón P2.
Hormones and BV
This study supports a possible hormonal influence in the natural history of BV. The lower estrogen levels in smokers may help explain their increased risk of BV.
Int J STD AIDS. 2007 May;18(5):308-11.
Bacterial vaginal flora in relation to changing estrogen levels.
Wilson JD1, Lee RA, Balen AH, Rutherford AJ.
Brotman RM. Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective. J Clin Invest. 2011 Dec;121(12):4610-7. doi: 10.1172/JCI57172. Epub 2011 Dec 1. PMID: 22133886; PMCID: PMC3225992.
Srinivasan S, Fredricks DN. The human vaginal bacterial biota and bacterial vaginosis. Interdiscip Perspect Infect Dis. 2008;2008:750479. doi: 10.1155/2008/750479. Epub 2009 Feb 16. PMID: 19282975; PMCID: PMC2648628.
Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol. 2001 Feb;30(1):49-52. doi: 10.1111/j.1574-695X.2001.tb01549.x. PMID: 11172991.
Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect. 2006 Oct;8(12-13):2772-6. doi: 10.1016/j.micinf.2006.08.008. Epub 2006 Sep 11. PMID: 17045832.
Cohen CR, Wierzbicki MR, French AL, Morris S, Newmann S, Reno H, Green L, Miller S, Powell J, Parks T, Hemmerling A. Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2020 May 14;382(20):1906-1915. doi: 10.1056/NEJMoa1915254. PMID: 32402161; PMCID: PMC7362958.
DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested on this website.