At GutBiome Institute, we’re all about balance in the microbiome. But bacterial imbalance doesn’t just occur in your gut; it can happen in your vagina, too, leading to a condition called bacterial vaginosis, or BV. As the recent article in The Atlantic, The Superhero in the Vagina, states, BV puts “millions of women, and their unborn babies, at risk for serious health problems.”

Vaginal yeast infections after antibiotics are a type of dysbiosis (bacterial imbalance), and so is BV. When the normal vaginal flora is altered as a result of antibiotic use, douching, or a change in pH, essential Lactobacillus species that normally repel other species by producing acid may be reduced, leading to overgrowth of a wide variety of bacteria that can run amok in the vagina. Lots of different species have been associated with BV, including Gardnerella, Prevotella, Mycoplasma, Mobiluncus, Bacteroides, and Peptostreptococcus. The decrease in protective Lactobacillus species also leads to increased susceptibility to UTIs, pelvic inflammatory disease, miscarriages, and infertility. This “low Lactobacillus state” that defines BV can also enhance the spread of sexually transmitted diseases, including HIV, because having fewer Lactobacillus species around allows viral replication and shedding to proceed unchecked.

The characteristic BV vaginal discharge is off-white and not as thick or itchy as a yeast infection, although it can have a similar fishy odor. If you’ve been diagnosed with BV, it’s important to consider not reaching for an oral or topical antibiotic like metronidazole — the therapy of choice in most gynecology practices—because while antibiotics will temporarily suppress growth of the less desirable species, they’ll also further reduce the healthy bacterial population, leading to a vicious cycle of recurrence. As with most manifestations of dysbiosis, repopulation of healthy bacteria through dietary changes and a robust probiotic is the key to recovery.

By: Robynne Chutkan, MD, FASGE