Something Fishy is Going On Down There… Understanding Bacterial Vaginosis



Bacterial Vaginosis (BV) is a gynecological condition when women develop the wrong kind of bacteria in their vagina. The most obvious symptom is a strong fishy smell that occurs after sex, during a woman’s period, or mid-cycle when she is ovulating.  The strong fishy smell occurs from the bad bacteria when they are exposed to changes in vaginal pH.  If you have these symptoms you should talk to a healthcare provider for medical advice.

Changes in Vaginal pH

 The vagina in women of reproductive age has a low pH of around 4. As women go through menopause, this normal pH rises to around 6. When we are “birthing babies,” the low pH of the vagina helps fight off infections.

However, the vagina is also normally and routinely exposed to a higher pH of 7 or more. This includes:

  • When a woman is ovulating (fertile cervical mucus has a pH of 7-8);
  • When she is having her period (the blood secretions from the uterus are around pH 7);
  • And after intercourse with the presence of semen (at its normal pH of 7-8).

Most women will spend about half their days with secretions coming and going in their vagina that see-saw back and forth from the lower pH of the vaginal secretions themselves to the higher pH of fluids coming from their uterus and cervix or their partner’s semen. This is normal physiology. But for women with BV, the contact with these higher pH fluids causes the abnormal bacteria in the vagina to release proteins making this fishy smell.

Impact of Bacterial Vaginosis

BV impacts 21 million women in the US, and its prevalence is much higher in non-white women (23% of white women versus 51% of black women have had the condition at some time in their life). It can cause preterm delivery in pregnant women, and it can cause increased susceptibility to HIV or other STIs.

Having BV can make women feel very self-conscious, it can also of course make men less than excited about going down on their gal. Many women with BV will end up douching and using other “feminine hygiene” products to cover embarrassing odors, which only makes the BV worse (douching is a risk factor for developing BV).

Understanding Your Body

There is a general lack of knowledge amongst health care providers, as well as the public, with regards to the normal pH changes in women’s vaginas.

The vagina is a very dynamic and resilient organ. It is not a static passive place with “one” pH. There is also significant ignorance in our society about normal vaginal physiology and function. I have even met women who were getting treated for “yeast infection” just to find out that all they had was normal, healthy cervical mucus secretions that occur once a month around ovulation.

One of the best books for understanding your girly parts and how they function is Taking Charge of Your Fertility by Toni Weschler.  It teaches how to understand where you are in your cycle to either prevent or optimize fertility. It is an easy read and should be a must-have for all young women!

Treating Bacterial Vaginosis

If you notice a fishy smell from your personal parts, especially after sex or during your period, seek medical help. It isn’t normal and it ISN’T “you.”

In the meantime, while waiting to get in for an appointment, a product such as Rephresh gel can lower the pH to help speed up the treatment course and combat odors. Plus their companion Rephresh Pro-B Probiotic can repopulate the vagina with healthy bacteria.

A lower tech solution is plain yogurt (make sure it has live, active cultures). Check with your doc to see if they approve before using, but in general eat a lot of the yogurt; soak a tampon in it and apply it or use a vaginal applicator or syringe to deposit 2-3 mls in the vagina.

Be aware that vaginal disease can also occur with keeping the vagina at too low of a pH. This is called Cytolytic Vaginosis which many physicians incorrectly diagnose as BV and therefore, keep instructing the woman to continually use products that lower her natural pH – just making the disease worse. If you aren’t responding to treatment for BV, try another doctor and ask what other conditions may be going on.

Image courtesy of consumerhealthdigest