Overview of bacterial vaginosis
On the list of annoying health woes that go along with having a vagina: Bacterial vaginosis (BV)—the most common vaginal disorder among reproductive-aged women, affecting more than 21 million1 per year, according to the CDC.
BV occurs when there is an overabundance of harmful bacteria (compared to good bacteria) in the vagina, and it’s often accompanied by an unpleasant vaginal odor and discharge.
While BV isn’t typically as uncomfortable as a yeast infection, it does come with significantly more serious consequences if left unaddressed2 such as increased risk of certain STDs, reduced fertility, and early labor, according to the Centers For Disease Control And Prevention (CDC).
Adding to the frustration, BV often recurs after treatment with antibiotics.
The good news: Effective home remedies for BV, along with lifestyle changes that support the vaginal microbiome, are emerging.
When used alone or in conjunction with conventional treatment, these may help treat BV and prevent future “flare-ups.”
Causes and symptoms of bacterial vaginosis
Bacterial vaginosis occurs when3 there is a reduction in the number of beneficial Lactobacillus bacteria in the vagina and a significant increase in anaerobic bacteria, including Gardnerella vaginalis.
“Anything that disrupts the normal ecological environment of the vagina can result in BV,” says Felice Gersh, M.D., OB/GYN, founder and director of the Integrative Medical Group of Irvine. “This large list includes having sexual intercourse, using spermicides and lubricants, douching, taking antibiotic, or using IUDs and other contraceptives," she says. "Anything that lowers one’s optimal immune status can also promote unwanted microbes to proliferate, creating imbalance within the vaginal microbiome.”
Additionally, your gut could be impacting the health of your vagina. “In my practice, I have found that recurrent BV often relates back to the health of the gut microbiome,” says says Wendie Trubow, M.D., functional medicine gynecologist.
- A thin white, yellowish, or gray watery vaginal discharge.
- A strong fishy odor, especially after sex.
- Pain, itching, or burning in the vagina.
- Burning when urinating.
Your doctor will often diagnose you with BV based on these symptoms, and occasionally with a vaginal pH test—a pH of 4.5 or higher is often a sign of BV.
The difference between BV and a yeast infection
Many women understandably confuse BV with yeast infections, but because they have different treatments, identifying what you’re dealing with is a crucial first step.
“Sometimes telling the difference between BV and a yeast infection is clearcut, and sometimes it's tricky,” says Trubow. “Yeast often causes a thick, curd-like discharge, is super itchy, and can smell a bit yeasty. While BV often has a thinner, watery discharge, can also itch, and usually has an odor reminiscent of old fish or smells foul.”
Unlike the bacterial imbalance that occurs with BV, a yeast infection is caused by an overgrowth of yeast in the vagina called Candida albicans.
Many women get yeast infections after taking antibiotics, and some experts link the consumption of simple sugars and refined carbs to yeast overgrowth in the vagina and other areas of the body.
While conventional treatment for BV typically includes an oral or topical antibiotic such as metronidazole or clindamycin, treatment for yeast infections involves an antifungal such as fluconazole.
For both conditions, however, there are a range of natural strategies that can alleviate symptoms and curb risk.
Home remedies for bacterial vaginosis (+ one to skip)
Unfortunately, BV often recurs within three to 12 months, despite antibiotic treatment. And that’s where natural home remedies can help.
“BV can sometimes be treated with all natural regimes and sometimes it requires an antibiotic,” says Gersh. “But often, a combination of the two strategies is most successful.”
While you should consult with your doctor before implementing a DIY protocol, these are the natural strategies that appear most effective for combatting BV, based on current research:
Daily probiotic supplements
Probiotics contain beneficial bacteria meant to bolster your gut microbiome, and this, in turn, may positively influence your vaginal microbiome as well.*
“To support recovery of the vaginal microbiome, I recommend women take probiotics with Lactobacillus strains,” says Trubow, noting that there are benefits to taking both oral supplements and vaginal probiotic suppositories.*
One research review found that receiving Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14 at a dose of at least 10 billion CFU per day for two months helped treat BV and prevent its recurrence.
A nutrient-rich diet
In addition to probiotic supplementation, your overall diet is important too. Focusing on gut-friendly foods is key, as “the microbes of the gut can impact the microbial composition of the vagina,” says Gersh.
Additionally, “BV and yeast infections can be flashing alerts for food sensitivities and system imbalance,” says Trubow. “Fixing the root cause almost inevitably fixes the BV.”
If you think you may have a food sensitivity, consult with your doctor or consider a comprehensive elimination diet to help identify food triggers.
Boric acid suppositories
“I love boric acid capsules and find they work well not only for treatment, but also prevention,” says Trubow, adding that they’ve recently become widely available over the counter and online.
Boric acid suppositories are capsules containing boric acid powder (typically 600 mg, the amount used in studies) that are inserted into the vagina (never consumed orally).
"We typically recommend 10 days of treatment (one suppository per day), but it can begin working in as little as 36 hours," says Trubow.
The exact mechanism by which boric acid helps alleviate BV is unknown, but it does have antiviral, antifungal, and bacteriostatic (i.e. able to inhibit the growth or reproduction of bacteria) activity, and some research suggests that it helps bring the vagina's pH back down to a normal level where harmful bacteria are less likely to thrive.
Boric acid suppositories are also very well tolerated. "They're gentle, nontoxic, and, except for experiencing discharge after insertion, have almost no side effects," says Trubow.
Tea tree oil suppositories
Tea tree oil has natural antimicrobial properties, and research indicates that while it effectively kills a variety of BV-causing bacteria, it seems to preserve “good” Lactobacillus bacteria.
Meaning, compared to antibiotics, it appears to be more selective and less damaging to the overall vaginal microbiome.
But don’t use straight tea tree oil—instead, consider short-term use of a tea tree oil suppository specifically meant to be inserted into the vagina.
“My favorite BV remedy is tea tree oil suppositories used nightly for six nights,” says Trubow. “I like them because they work well, are cheap, are naturally derived, and are well-tolerated. Tea tree oil is a natural antibacterial agent, and I find it to be gentler to the vagina overall.”
Because some people can be sensitive or even allergic to tea tree oil, experts recommend testing a small amount of the oil (diluted in a carrier oil such as avocado, olive, or coconut oil) on your skin and waiting a day or two to see if you notice a reaction.
A 2014 study, in which participants with BV took either a garlic supplement7 or the commonly prescribed oral antibiotic metronidazole for seven days, found that the treatments were similarly effective—yet there were fewer side effects in the garlic group.
Participants in this study took two 500-mg garlic tablets twice a day to alleviate their symptoms, but as always, consult with your doctor before trying this natural BV treatment.
While Trubow hasn’t used garlic supplements with her patients, she believes it could be promising, since garlic can be a powerful antibacterial agent.
Wear breathable clothing
Whether you’re dealing with BV or a yeast infection, it’s typically a good idea to stick with loose fitting clothing and cotton underwear until you feel better.
After all, the warm, moist environment created by tight yoga pants isn’t exactly a recipe for soothing already-irritated vaginal tissue.
Temporarily abstain from sex
Whatever treatment protocol you’re following, it can be wise to simultaneously avoid sex, or at least use condoms, until your treatment is complete, says Trubow.
The introduction of bacteria during sex, could disrupt the ecological environment of the vagina and delay recovery.
Avoid vaginal irritants
Some other basic strategies that may help speed healing or quel vaginal irritation associated with BV include using mild unscented soaps (or no soap at all—splashing the genitals with warm water is often enough and won’t mess with your vaginal pH, says Gersh), avoiding tampons or menstrual cups in favor of unscented pads, wiping from front to back when you go to the bathroom, and never douching.
One to skip: Hydrogen peroxide
While one small study from 2003 found that irrigating the vagina with hydrogen peroxide9 was effective for eliminating BV symptoms and restoring normal vaginal bacterial flora, both Gersh and Trubow caution against this natural remedy. “It has the potential to be overly caustic and kill everything, even the good bacteria,” says Trubow.
While BV is an incredibly common condition triggered by an imbalance in vaginal bacteria, finding the right treatment is tricky.
Functional and integrative physicians are increasingly embracing natural treatments and you should feel encouraged to explore all of your options.
However, sometimes antibiotics truly are necessary, and you should always consult with your doctor about the right approach for you, given your personal medical history and other factors.
They may be able to recommend a combination of natural treatments, or home remedies and antibiotics, that is more beneficial than any one strategy alone.
Editor's Note: This article was originally published on March 3, 2014. A previous version of this article indicated that bacterial vaginosis affects roughly 22 million people per year. We have since clarified this statement to indicate that bacterial vaginosis affects more than 21 million per year.
Stephanie Eckelkamp is a writer and editor who has been working for leading health publications for the past 10 years. She received her B.S. in journalism from Syracuse University with a minor in nutrition. In addition to contributing to mindbodygreen, she has written for Women's Health, Prevention, and Health. She is also a certified holistic health coach through the Institute for Integrative Nutrition. She has a passion for natural, toxin-free living, particularly when it comes to managing issues like anxiety and chronic Lyme disease (read about how she personally overcame Lyme disease here).