I should have written about this a long time ago. It's a very common, grossly misunderstood women's health issue. So common in fact, that maternity providers ask every single pregnant woman at each and every visit if they have any funny smelling discharge, particularly after #sex. The biggest clue of bacterial vaginosis (besides clue cells on microscopic exam) is a fishy odor. Many women though, believe this is their normal and they carry shame for it.
Here's the thing too, many, many healthcare practitioners are giving really bad advice about this issue. Here's what you need to know and what you need to share with your sisters and your friends, even your mothers and daughters: #fishy vaginal odor equates to bacterial vaginosis and if you have it, you aren't dirty or gross and it isn't a sexually transmitted disease. As a clinician, although there are specific diagnostic tests, I don't even need them because this is such an easy women's health issue to identify and treat. If you aren't getting the results you want, find yourself a more informed clinician or maybe, let me empower you with some education.
No one knows my mother. I haven't even talked to her in twenty years so I share this with the knowledge that not one of you will identify this woman, although admittedly, I suspect many of you could share an identical story. We had one bathroom in our home growing up. My mother was single and raised my sister and I largely on her own as my father didn't think we were deserving of child support. One time we were shopping at Walgreens and my mother put a single box up on the counter. As the nosey little child I always was, I asked her what it was and she told me to hush. I noticed the look the saleslady gave her which only peeked my curiosity even more. I thought, "I am mature. I can know these sorts of things," so I persisted and my mother grew increasingly irritated with me.
Later at home she explained the douche in the box she'd purchased was a private matter that I would learn more about as I grew up. While she never did extend this knowledge to me, that hose and rubber bag had always been a familiar fixture hanging in our shower. Many years later, when I was in nursing school, we were working through a variety of women's health topics and this particular topic - the fishy odor - was presented and I knew immediately, that's the smell of our childhood bathroom after my mother would use the restroom, and oh my gosh, that's why she was so regularly douching!
Like many women, my mother thought that odor was just her at the end of the day. She was trying to wash it away, clean herself, freshen up, believing she was dirty and unclean. Of course, my very direct, unashamed, naive self was rather excited to visit my mom and inform her of this super exciting information I'd just learned.
"Mom, that smell in the bathroom - that isn't you! That isn't your natural self; it's the result of douching. Maybe one time you took antibiotics and that threw off your flora, maybe some of your relationships or very possibly the loads of stress you endured caused an imbalance in your vulnerable ecosystem, but whatever the cause, stopping douching and rebalancing your flora will clear it up entirely!"
I always felt a lot of shame from my mother. She was a very critical spirit, so it gave me great pleasure to be able to tell her this was something she could free herself from, but if your mom is anything like mine - more worried about what the neighbors think that what is actually going on behind closed doors - than you know that my even mentioning this to her was a huge offense. She was quite pissed to be honest. Again, the shame she always carried.
I don't know if she ever took my advice, but I do know that everytime I use a public restroom and I smell that same fishy smell ruminating from another stall, it takes every bit of restraint I have to not catch that poor lady at the sink and drop her my business card. Truth be told, while bacterial vaginosis is not a sexually transmitted infection, it absolutely can be sexually transmitted in a sense that some men's cooties just don't blend well with our own microbiota, so much so that midwives have a popular saying among our circles, "Don't stay with no man who messes up your pH." Huge red flag, cuz your ecosystems should be complementary.
Don't Douche: Rebalance
The mainstay of conventional medicine for treating bacterial vaginosis (otherwise called BV) is, of course, antibiotics, specifically metronidazole or clindamycin. The reason is that just about anything can disrupt your normal flora, or rather any change in routine. Stress does impact our gut flora so this can migrate its way forward and throw off the balance of good and not-so-good flora. Certainly any new activity in the vagina itself, which may be a new partner, a new toy, a not so fresh toy, lubrication, or even a change in sexual routine can throw off the balance. Some women experience an imbalance after each menstrual cycle (how unfortunate but among other things, #chasteberry or vitex can be helpful) and other women can suffer BV after a change in their diet, particularly if they typically eat pretty clean and then splurge and eat a bit of baked goods. Alcohol and poorly controlled blood sugars are additional causes. Yeast and bacterial vaginosis are like kissing cousins.
Antibiotics though is a very temporary fix. Many women suffer BV again because there really wasn't restoration. More so there was a wiping out of the more bad bacteria, which were a bit more odorous, but good was also eliminated and without any attempts to restore, the bad bacteria are free to replenish and claim territory once again. Antibiotics also pose risk, such as reducing the effectiveness of birth control and who is ever told of this risk!?!
This is only a bandaid then and continuing to provide this regimen without adequate education or worse, with the wrong information, is one of the many travesties of women's health. Bacterial vaginosis isn't an isolated event like getting an infection in a cut on your finger. Its an imbalance in your vaginal microbiome, likely your gut's ecosystem as well. It can cause worsening infections higher in your pelvis, increase your risk of endometriosis and abnormal Pap smears, and even cause #infertility and ectopic pregnancies. The literature is somewhat contradictory regarding the risk of bacterial vaginosis in pregnancy. It may increase the risk of miscarriage and preterm birth, and is associated with increased risk for postpartum #endometritis. When BV is present during pregnancy, I found Group B Strep much more often among my own clientele. In fact, an increased amount of discharge in general seemed to be linked so we began treating more aggressively with probiotics and found this did improve.
Evaluating your lifestyles choices is important for improving your overall health which will ultimately improve your vaginal and gut ecosystem, reducing your risk for bacterial vaginosis. Balancing your blood sugar is especially important as the not-so-good-for-you bacterias thrive on sugar, particularly those from processed foods and refined grains. Natural sugars can also add up, as does alcohol. Admittedly, women have shared with me that while dating, they could tell when a new partner was an alcoholic early in the relationship because it would throw off their pH.
Restoring your gut flora balance is potentially the biggest contributor to eliminating bacterial vaginosis, particularly recurrent infections. Clients who are active members of Eden have access to the 4R Protocol in our Detoxification & Wellness program, which is excellent for helping restore gut health. If you have obtained a MRT test, the LEAP therapy can be done yet again if you have found you're a bit off balance especially if experiencing constipation or diarrhea.
Take a high-quality probiotic daily, specifically one that contains Lactobacillus reuteri and Lactobacillus rhamnosus, two great for the vaginal ecosystem but also rotate through the high-quality probiotics, purchasing a new blend with each bottle. The goal is more diversity rather than just high levels of specific #probiotics. You can even open these capsules and insert the probiotic into your vagina, or do both. I typically recommend doing this after using the restroom, just prior to going to bed, and then using a spoon or syringe after you have laid down in bed. Clients have also used yogurt vaginally, although avoid the fruit varieties, and this can be cooling for those who also have yeast or inflammation. However, as more and more work to avoid milk, many have strayed away from this option although we have had a great deal of success with these approaches in my practice. Eating yogurt, sauerkraut, and other lacto-fermented vegetables, kimchi, and miso are also options.
Assure you are getting 30mg of zinc daily, 400IU of vitamin E daily, and up to 10K units of vitamin A daily so support vaginal healing from inflammation.
He Messes Up My pH, but I Really Like Him
When new couples begin sharing their lives together and become intimate, they often notice all sorts of new bodily responses as their individual bacterial ecosystems begin to merge with one another. Even upper respiratory infections are more common. Certainly bacterial vaginosis is more common when new partners are introduced, and wearing a condom has shown to reduce this opportunistic infection, but as new bacteria is introduced and the woman's body works to attack these offenders, in time, we can see this start to settle for many couples. Our ecosystem can adapt so to speak.
The lubrication on some lubricants can cause BV in itself, so consider the role of lubricants and toys and such as you are working through offenders, but if you do really like your guy and your pH is initially a bit off kilter, try some of these natural approaches and give it time. Do assure you have a proper diagnosis and are not overlooking gonorrhea or chlamydia which can have similar symptoms, but if just an imbalance, time and our wonderful ability to adopt can correct this with a smidge of patience.
Same sex partners aren't left out of this joyful adventure. Oral sex is a big trigger for many because the pH of the mouth is quite different from that of the vagina. Research has even suggested that rates of bacterial vaginosis is even higher among women who have sex exclusively with women. Even among heterosexual couples though, if oral sex is a big part of your foreplay, especially if he entertains a bit more alcohol in his routine (or has a white tongue), you may find it challenging to keep your flora well balanced.
Clean Up Your Period Products
If BV is a persistent issue for you after your #menses, this may be hormonal, but this may also be related to your products. If you wear pads, try changing your pad more frequently or trying cloth pads. Switch your tampons to an organic variety or maybe try a reusable menstrual cup. Conventional menstrual products are vulnerable to toxins, such as fragrances and dyes, and this can cause inflammation and disrupt your flora. Even using cloth pads at night and giving your vagina more breathing space during these twelve hours can help reduce the incidence of BV if you particularly enjoy tampons during the day.
Yogurt in the vagina is effective and I've recommended this for more than a decade. Garlic can also be used, a full clove (be careful not to nick it as this may be irritating if inflamed) in the vagina overnight, but my clients have also used tampons rolled in a variety of natural ingredients. Consider rolling an organic tampon in coconut oil and then inserting it into the vagina, or tea tree oil. Lavender, calendula and thyme essential oil are also great options, as well as comfrey root powder and goldenseal root powder. You can even purchase tampons already prepped with goldenseal or berberine. If trying these options, tuck a pantyliner in your underwear as these will melt and possibly seep out during the night.
If you are crafty, combine many of the ingredients above to the base of one cup of cocoa butter and a half cup of coconut oil, and then refrigerate them. Molds are available for purchase online, although I've made them in foil, rolling them into the size of my little finger.
No matter your approach, remember your vaginal health is the result of your overall health, particularly your gastrointestinal health. Eat clean and balanced. Minimize your stress.