Bacterial Vaginosis (BV) is a common vaginal infection that affects women of reproductive age. It results from an imbalance in the vaginal microbiota, where harmful bacteria outnumber the beneficial lactobacilli that usually dominate the vaginal flora. BV is not classified as a sexually transmitted infection (STI), but it is associated with sexual activity. Many women with BV may experience no symptoms at all, but when symptoms do occur, they can cause discomfort and lead to more serious reproductive health problems if left untreated.
Understanding the Vaginal Microbiome and BV
Before diving into the symptoms, it’s important to understand what bacterial vaginosis is and how it affects the body.
A healthy vagina contains a delicate balance of bacteria, primarily lactobacilli, which produce lactic acid and help maintain a slightly acidic vaginal pH (typically around 3.8–4.5). This acidic environment prevents the growth of harmful microorganisms. In BV, this balance is disrupted. The number of lactobacilli decreases, and an overgrowth of anaerobic bacteria such as Gardnerella vaginalis, Atopobium vaginae, and Mobiluncus species occurs.
The exact cause of this imbalance is still under investigation, but it has been linked to:
- Sexual activity (especially with new or multiple partners)
- Douching
- Smoking
- Use of intrauterine devices (IUDs)
Now, let’s focus on the symptoms of BV and how they manifest in women.
1. Abnormal Vaginal Discharge
One of the most common and noticeable symptoms of BV is a change in vaginal discharge. This includes changes in:
- Color: The discharge associated with BV is typically grayish-white or sometimes slightly yellow.
- Consistency: The discharge is usually thin and watery, unlike the thick, white discharge seen in yeast infections.
- Volume: Many women report a heavier than usual discharge that may require frequent use of panty liners.
This change in discharge can be distressing and is often the first symptom that prompts women to seek medical attention.
2. Strong or Fishy Vaginal Odor
Perhaps the most distinctive symptom of BV is a strong, fishy vaginal odor. This odor is especially noticeable after:
- Sexual intercourse, as semen (which is alkaline) can increase the vaginal pH and intensify the smell.
- Menstruation, when the natural increase in pH due to blood can also worsen the odor.
This odor is a result of amines—chemical compounds produced by the overgrowth of anaerobic bacteria.
3. Vaginal Itching and Irritation
Some women with BV experience itching, burning, or general irritation in the vaginal area. This is not always present but may occur in cases where the imbalance is more severe or prolonged. The discomfort might include:
- Mild to moderate itching around the vulva or just inside the vaginal opening
- A burning sensation, especially during urination
- Redness or swelling of the vulva in some cases
However, it’s important to note that itching is more commonly associated with yeast infections, which can make it difficult to distinguish between the two without a proper diagnosis.
4. Burning During Urination
Burning during urination (dysuria) can occur when the urine passes over inflamed or irritated vaginal tissues. While this is not a primary symptom of BV, it can be present and is sometimes mistaken for a urinary tract infection (UTI).
- The burning is typically localized at the vaginal opening, rather than higher in the urinary tract as in UTIs.
- Women may also feel a slight stinging or discomfort during urination if BV is causing irritation to the vaginal area.
5. No Symptoms at All
Surprisingly, more than 50% of women with BV are asymptomatic, meaning they experience no noticeable symptoms. This makes BV difficult to detect without routine gynecological exams or tests. Asymptomatic BV can still pose health risks, particularly for:
- Pregnant women, as untreated BV can increase the risk of preterm birth, low birth weight, and other complications.
- Women undergoing pelvic surgery, where BV can increase the risk of post-surgical infections.
6. Recurrence of Symptoms
Many women with BV report recurrent episodes, even after treatment. Recurrent BV can lead to:
- Repeated changes in vaginal discharge and odor
- Frustration due to the persistence of symptoms
- Emotional and psychological distress, including embarrassment, anxiety, or reduced sexual confidence
Recurrent BV may suggest an underlying imbalance in vaginal flora or reinfection due to behavioral or environmental factors.
How Symptoms Differ from Other Vaginal Infections
Because many vaginal infections present with similar symptoms, it is crucial to distinguish BV from other common conditions such as:
Yeast Infections (Candidiasis)
| Symptom | Bacterial Vaginosis (BV) | Yeast Infection (Candidiasis) |
|---|---|---|
| Discharge | Thin, gray/white, foul-smelling | Thick, white, “cottage cheese”-like |
| Odor | Strong, fishy odor | Typically no odor |
| Itching | Mild or absent | Intense itching |
| Irritation | Possible, but usually mild | Severe irritation and redness |
| pH Level | >4.5 (more alkaline) | <4.5 (acidic) |
Trichomoniasis
Trichomoniasis is a sexually transmitted infection caused by a parasite. It can mimic BV symptoms but also presents with:
- Frothy, yellow-green discharge
- Severe itching and burning
- Vaginal redness and inflammation
- Pain during intercourse
Diagnosis is essential to differentiate these conditions, as treatment varies.
Less Common Symptoms
While the above are the most common symptoms, some women may experience less common manifestations of BV, including:
- Pelvic discomfort: Usually not a primary symptom, but may occur in chronic cases.
- Light vaginal bleeding: Some women notice spotting not related to menstruation.
- Discomfort during sex (dyspareunia): Particularly if the vaginal tissue is irritated or inflamed.
These symptoms are not specific to BV and often require evaluation to rule out other gynecological issues.
When to See a Healthcare Provider
You should see a healthcare provider if you experience:
- A new or unusual vaginal odor or discharge
- Burning, irritation, or itching in the vaginal area
- Symptoms that persist despite over-the-counter treatments
- Frequent recurrences of BV symptoms
- You’re pregnant and suspect BV
- You are undergoing a gynecologic procedure or surgery
Only a healthcare provider can confirm a diagnosis through pelvic examination, microscopy, or lab tests (like a vaginal swab and pH test).
Complications of Untreated BV
Even if the symptoms are mild or absent, untreated BV can lead to complications such as:
- Pelvic Inflammatory Disease (PID): An infection of the reproductive organs that can lead to infertility if untreated.
- Increased susceptibility to STIs: Including HIV, chlamydia, and gonorrhea.
- Pregnancy complications: Including premature delivery and low birth weight.
- Post-surgical infections: Especially after procedures like hysterectomy or abortion.
Emotional and Psychological Impact
Though BV is a physical condition, it can have emotional and psychological effects, especially if the symptoms are persistent or recurring. Women may feel:
- Embarrassed by the odor or discharge
- Anxious about their sexual relationships
- Frustrated by the lack of long-term solutions
- Confused due to overlapping symptoms with other infections
Talking to a healthcare provider and seeking accurate information can alleviate much of this stress.
Conclusion
Bacterial vaginosis is a common but often misunderstood vaginal infection that affects millions of women worldwide. While many women experience no symptoms, those who do commonly report:
- A strong, fishy vaginal odor
- Thin, grayish-white discharge
- Vaginal discomfort or mild itching
- Burning during urination
- Emotional and social discomfort related to symptoms
Recognizing these symptoms and seeking timely treatment is crucial—not only for comfort and well-being but also to prevent potential complications. Accurate diagnosis and proper management can significantly reduce symptoms and improve quality of life.
If you suspect you may have BV, consult with a healthcare professional. BV is treatable, and with appropriate care, most women recover quickly and fully.