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.” While researchers don’t know the 2exact2 cause of BV2 or why some women get it and not others, several factors can increase your risk. “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. So how do you know if you actually have BV? Though around 84% of women1 may have no noticeable BV symptoms, those who do may notice the following: “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. “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: “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. Experts speculate that supplementing with these beneficial strains helps produce antimicrobial compounds4 and inhibit pathogens from adhering to the vaginal wall.* This means incorporating probiotic foods such as kefir, yogurt, kimchi, and raw sauerkraut into your diet, along with a diverse array of fiber-rich plant foods. 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. “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. 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. Research is mixed8 on just how effective these strategies are for preventing BV or speeding your recovery, but they can at least make you feel a bit more comfortable. After all, the warm, moist environment created by tight yoga pants isn’t exactly a recipe for soothing already-irritated vaginal tissue. The introduction of bacteria during sex, could disrupt the ecological environment of the vagina and delay recovery. 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.
