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The best approach to managing recurrent bacterial vaginosis

Written by Lesley O'Connor |


Bacterial vaginosis (BV), otherwise known as BV, is the most common vaginal infection to affect women worldwide.

While common, BV can affect self-esteem, relationships, and quality of life on a day-to-day basis. Long-term health implications of BV are related to infertility, ectopic pregnancy, chronic pelvic pain, preterm labour, and miscarriage.

There is a high rate of remission, with approximately 80% of women experiencing symptoms three months after effective treatment. Clearly, the current approach to treatment isn’t getting to the root causes of BV. Most women with recurrent BV have tried the ‘low hanging fruit’ of cutting out scented period products, not using soap, wiping front to back, and only wearing cotton underwear.

The idea that BV is just a vaginal infection needs to change. We need to take a holistic view of the body's wider ecosystem when examining the driving factors of BV. Having recurring BV indicates that there is a larger problem at play such as nutrition, blood-sugar metabolism, and stress. This is why seeing a naturopath or clinical nutritionist is important for the long-term management of recurring BV.


Common contributing factors of recurrent bacterial vaginosis include:

  • Gut and vaginal dysbiosis
  • Lower fibre diets
  • High Glycemic Load (GL) diets and carbohydrate consumption
  • Poorly controlled blood sugars
  • Alcohol consumption
  • Stress
  • Vaginal douching
  • Cigarette smoking
  • The use of an intrauterine device (IUD)
  • Oral contraceptive pill

One of the key causes of BV is an alteration to the vaginal microbiota, with depletion of the beneficial bacteria Lactobacillus. There are several different species of lactobacilli that normally reside in the vagina to help prevent the growth of other pathogenic types of bacteria, such as Gardnerella vaginalis. When G. vaginalis takes hold, it creates a biofilm that then allows other opportunistic bacteria to grow within the vagina.

This results in the classic signs and symptoms of:

  • Thin grey-white discharge
  • Fishy odor
  • Itching or irritation
  • pH > 4.5

Natural remedies

Interestingly, a link has been made between fibre consumption and the incidence of BV. Those with diets richer in fibre were less likely to develop BV. This could be due to the fact that fibre can influence Lactobacillus species in the gut microbiota and this association may also be true for the vaginal microbiota. This can be a key area to address when trying to prevent the reoccurrence of BV.

A connection has also been made between low micronutrient status and the development of BV. These include vitamins A, C, E, and D, β-carotene as well as low dietary intakes of folate and calcium (Thoma 2020). One of the best sources of micronutrients and fibre is vegetables!

Carbohydrate quality also plays a role in the prevalence, progression, and persistence of BV. The consumption of higher glycemic load foods, which are simple carbohydrates, was linked to an increased incidence of BV. When we are continually experiencing changes in our blood glucose levels, our antioxidant defences are exhausted, creating inflammation, and impairing our immunity. These are some of the key mechanisms which contribute to the development of BV.

For those with recurrent BV, it’s ideal to follow the principles of reducing dietary sweets and simple carbohydrates, while increasing the consumption of vegetables, fruits, and whole grains. Aiming for five servings of vegetables, and two servings of fruit per day is ideal. Generally, current fibre intakes are below the recommended amounts. We need between 25g-30g of fibre daily which we can easily source from fruits, vegetables, whole grains, and legumes.

Things to avoid

There has never been a better time to start implementing stress management techniques. Why? Research has found a link between stress and BV. Chronic stress leads to activation of the hypothalamic-pituitary-adrenal (HPA) axis eventually leading to elevated levels of cortisol. Chronically elevated cortisol influences our blood-sugar metabolism and our immune system, resulting in a loss of the protective vaginal Lactobacillus species that help protect again BV.

Everyone has their own preferences when it comes to stress management. It's about finding what works for you. Aim for imperfect action. If you miss a day or two, then pick it back up on the third day, rather than falling off the bandwagon altogether.

Here are some common stress management techniques:

  • Deep breathing
  • Breath works
  • Journaling
  • Meditation
  • Exercise
  • Crocheting or knitting
  • Light stretches
  • Yoga
  • Music therapy
  • Counselling
  • Colouring or painting

Try a few of the techniques above and see what is most effective for you. Have a few that you can practice regularly and draw on easily when you are heading into a busy or stressful period.

Stress management, along with consuming adequate fibre, micronutrient-rich vegetables, and whole grains helps Lactobacillus spp. to proliferate and supports our immunity, antioxidant status, and blood sugar metabolism to help stop the reoccurrence of BV.

Taking a holistic view of bacterial vaginosis is the best approach to preventing recurrent BV. Multiple studies link our nutrition and stress to our vaginal health. A food-first approach plays a positive and influential role in not only recurrent BV but our long-term health as well.

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Amabebe, E., & Anumba, D. (2018). Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health. Frontiers in endocrinology, 9, 568.

Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis-A brief synopsis of the literature. European journal of obstetrics, gynecology, and reproductive biology, 245, 143–148.

Shivakoti, R., Tuddenham, S., Caulfield, L. E., Murphy, C., Robinson, C., Ravel, J., Ghanem, K. G., & Brotman, R. M. (2020). Dietary macronutrient intake and molecular-bacterial vaginosis: Role of fiber. Clinical nutrition (Edinburgh, Scotland), 39(10), 3066–3071.

Tomás, M., Palmeira-de-Oliveira, A., Simões, S., Martinez-de-Oliveira, J., & Palmeira-de-Oliveira, R. (2020). Bacterial vaginosis: Standard treatments and alternative strategies. International journal of pharmaceutics, 587, 119659.

Thoma, M. E., Klebanoff, M. A., Rovner, A. J., Nansel, T. R., Neggers, Y., Andrews, W. W., & Schwebke, J. R. (2011). Bacterial vaginosis is associated with variation in dietary indices. The Journal of nutrition, 141(9), 1698–1704.

Parsapure, R., Rahimiforushani, A., Majlessi, F., Montazeri, A., Sadeghi, R., & Garmarudi, G. (2016). Impact of Health-Promoting Educational Intervention on Lifestyle (Nutrition Behaviors, Physical Activity and Mental Health) Related to Vaginal Health Among Reproductive-Aged Women With Vaginitis. Iranian Red Crescent medical journal, 18(10), e37698.

Vodstrcil, L. A., Muzny, C. A., Plummer, E. L., Sobel, J. D., & Bradshaw, C. S. (2021). Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment. BMC medicine, 19(1), 194.

Lesley O'Connor

Lesley O’Connor is a Naturopath (BHSc) who helps support women with their fertility, energy and vitality, and metabolic health, through herbal, nutrition, and lifestyle medicine. Lesley values a 'food as medicine' approach to health, while also assessing environmental factors for a holistic view of women’s health.

Lesley offers a client-centred approach where women feel validated about their health concerns and encourages women to work with their bodies for optimal health and the best health outcomes. Educate and empower is top of the list in Lesley’s clinical practice, where she provides women with the tools to improve their health that are so sorely lacking in our current health care system.

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