Bacterial Vaginosis (BV) is a condition primarily caused by an imbalance in vaginal acidity, which leads to an overgrowth of problematic bacteria. This results in vaginal odor, discharge, and irritation—however, it does not usually cause itching or pelvic pain. BV is not an infection per se, but is more of an overgrowth of bacteria that normally exist in the vagina in small concentrations. BV is very common and it affects at least a third of all adult women at some time. 

The most common complaints are:

  • Vaginal odor, usually “fishy” in nature
  • Vaginal discharge that is general white/gray
  • Vaginal irritation

The vaginal environment normally has bacteria called Lactobacillus that produce acid. An intervention that disrupts these healthy bacteria can lead to problems and BV. The most common culprits are douches, body washes, bubble bath, and soaps with fragrance or strong antibacterial components and possibly even detergents. The vaginal environment is like a “self-cleaning oven” and is designed to cope with normal substances like menstrual blood and semen; it does not need specific treatment or cleaning to remove them.

Diagnosing BV is fairly straightforward. It requires swabbing the vagina and evaluating the sample under a microscope, done by your healthcare provider or a lab.

The goal of treatment is to reinstate the normal vaginal environment. It usually begins with antibiotics (Metronidazole/Flagyl, Clindamycin/Cleocin,  Tinidazole, or Secnidazole) in oral or vaginal forms. 

Other supplements and natural treatments can also be very helpful in treating BV, particularly with recurrent symptoms. 

  • Acidic treatments, like Boric acid capsules or suppositories, should be inserted vaginally. They are often prepared at a specialty pharmacy.
  • RePhresh®, an over-the-counter treatment, helps restore vaginal acidity (or pH).
  • Probiotics, particularly those containing L. acidophilus, have also shown promise in helping regulate vaginal environment and have many other benefits.

The most important component of treatment for BV, particularly if it is persistent or recurrent, is to develop a relationship with a provider that is comfortable with listening to your concerns and with the diagnosis and treatment of BV. Sometimes, the course of treatment can be frustrating, but there are many effective ways to treat BV and get you back to feeling great!

Dr. Susan Lacy is a Gynecologist practicing in Memphis for over 20 years. She attended Johns Hopkins Medical School and completed OB-GYN Residency at the University of Tennessee Memphis. Dr. Lacy created Modern Gynecology & Reproductive Health in 2019 in response to a need for more accessible gynecologic healthcare, transgender care, fertility services, and general wellness. She is excited to bring an innovative approach to reproductive care in Midtown Memphis. For more information, visit or call 901.316.9818.