Some women get Bacterial Vaginosis (BV) — a vaginal infection that causes discharge and odor — over and over again. It seems like as soon as it clears up, it comes right back. Why does this happen, and how do you stop it? If this sounds familiar, read on.

What actually causes BV?

Your vagina has good bacteria called lactobacillus that keep everything balanced and healthy. Sometimes these are replaced by bacteria that aren't supposed to be there, and that causes BV. It usually happens when the vaginal pH gets "off" or the good bacteria get washed away. Common culprits include:

  • Douching. Douching washes away good bacteria and increases the risk of infections, especially BV. You should never douche.
  • Feminine washes, deodorants, and wipes. There's a whole store aisle built on the myth that your vagina should smell like strawberries. It shouldn't — vaginas should smell like vaginas. If you don't have an infection, your natural scent is normal. These products can change your pH and wash away good bacteria. Use only water to clean the vaginal and labial area; if you really need soap, use a mild one like Dove, and only on hair-bearing areas (never inside the vagina or between the lips).
  • A new sexual partner. Women are more susceptible to BV with a new partner. Some also notice infections after sex because semen has a higher pH than the vagina, and that shift can trigger BV.
  • Same-sex female partners. Lesbian women have about twice the risk of BV, for reasons that aren't fully understood. That said, monogamous same-sex partners tend to have lower BV rates after about 6 months, as their vaginal microbiomes become more similar and healthy.

Should my male partner be treated?

Although BV may be somewhat sexually transmitted, multiple studies show that treating a woman's male partner does not improve cure rates or reduce recurrence. Men can't get BV, so there's no reason to treat a male partner.

How can I reduce my risk of recurrence?

If you think you have BV due to discharge or odor, contact your doctor. And if your symptoms don't resolve with treatment — or resolve and then return — let your doctor know. Some tips to lower the chance of recurrence:

  • Vulvar/vaginal hygiene. Your vagina cleans itself. Use only water in the shower, avoid soaps in this area, don't douche, and skip the feminine-wash aisle.
  • Use condoms. If your BV tends to follow intercourse, condoms keep semen out of the vagina and help keep your pH normal.
  • Consider hormonal birth control. Some women get fewer BV infections on the pill.
  • Probiotics. Studies are mixed, but some women find them helpful. If you try one, choose a product labeled "for women" or "for vaginal health," which contains the specific lactobacillus species that keeps the vagina healthy.

I've tried all that and it still comes back — now what?

For patients who keep getting BV despite these measures, there are preventative medical treatments — meaning you take medication even when you don't have an active infection, to keep it from returning. This is successful for most patients, though some still get recurrences after stopping.

What should I do now?

If you're struggling with recurrent vaginal infections, see your gynecologist. I'm accepting patients in my virtual clinic who live in states where I'm licensed, and I'd love to help.