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Bacterial Vaginosis - Symptoms, Causes and Risk Factors

The information provided herein does not constitute an expert or medical advice, nor intended to replace such advice.

Women Health

Bacterial vaginosis, or BV, is the most common vaginal condition in women between the ages of 15 and 44. Although sex is a risk factor, BV actually is not a sexually transmitted disease. What are the causes of vaginosis? What are some bacterial vaginosis signs you should watch out for? How can you know whether you might be at risk for getting bacterial vaginosis?

What is bacterial vaginosis?

Bacterial vaginosis is an imbalance in the bacteria in the vagina. 

The vagina normally contains a variety of different microorganisms, including bacteria and fungi. In a healthy vagina, different species remain in balance with each other. The main bacteria normally found in the vagina are a type called lactobacilli. These bacteria help to control the growth of other bacteria, primarily through maintaining a slightly acidic environment inside the vagina. This helps to protect you from infections. There are also many other types of bacteria normally present in the vagina, but the lactobacilli keep them in check.

In people with BV, the balance of bacteria is altered. There are fewer lactobacilli, and more of other types of bacteria, particularly those in a category known as anaerobes. This imbalance leads to bothersome symptoms, and may also cause complications.

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What are the symptoms of bacterial vaginosis?

The symptoms of bacterial vaginosis may include:

  • Vaginal discharge. Bacterial vaginosis discharge is usually gray or white, and thin in consistency.

  • Vaginal odor. The smell of BV is often described as being “fishy.” It may be more obvious after sex.

  • Itching in and around the vagina.

  • Pain or a burning sensation in the vagina, which may be more noticeable during sex or when you urinate.

Some of these symptoms are similar to those of common sexually transmitted diseases (STDs), including gonorrheachlamydia, and trichomoniasis. They may also be confused for candidiasis (a yeast infection). Although the color, consistency, and odor of the discharge are generally somewhat different in BV than in other conditions, it’s not always easy to tell the difference. 

Testing is helpful to determine whether you have BV or another condition with similar symptoms. A vaginal swab is usually used, but some tests use a urine sample. You can visit your doctor and ask to be tested, or you can order a home test kit and collect your sample on your own at home. This option is more convenient for many people, and maintains your privacy.

It’s important to diagnose and treat BV, not only to increase your comfort, but also to prevent complications. BV increases the risk of getting an STD, and it can sometimes lead to pelvic inflammatory disease (PID), which can scar the reproductive tract and lead to infertility. Pregnant women who have BV are also at an increased risk for pregnancy complications, like preterm birth.

How do you get bacterial vaginosis?

Sometimes, people think that BV is a sexually transmitted disease (STD). However, this isn’t exactly accurate. That’s because BV is not transmitted by a particular microorganism, as STDs are. The symptoms of BV may be similar in some ways to vaginal bacterial infection symptoms (such as the symptoms of gonorrhea or chlamydia), but BV isn’t technically an STD. It’s caused by an imbalance of the normal bacteria in your vagina, rather than by an infection with a particular microorganism.

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Researchers are still working to understand what causes BV. However, sex does seem to be a risk factor. In fact, BV rarely affects people who have never had sex. In other words, it’s not an STD, but it is associated with having sex.

This is believed to be because sex changes the environment inside the vagina. Sex can introduce new bacteria from your partner’s body into your own. It may also alter various aspects of the vagina, such as the pH (how acidic the vagina is). These changes can influence how well different bacteria are able to grow, which can change the balance of bacteria that can grow.

Although BV is not itself an STD, it can increase the risk of STDs. This is because BV irritates the inside of the vagina, which makes it easier for other infections to get established. 

Bacterial Vaginosis Risk Factors

Researchers are still working to understand what causes BV. However, there are certain risk factors that make a person more likely to develop BV. These include:

  • Douching

  • Not using condoms during penetrative sex

  • Having a new sexual partner

  • Having multiple sexual partners

Douching alters the environment inside the vagina, which can cause an imbalance of bacteria in the vagina. Although women often choose to douche in order to keep the vagina clean and healthy, it actually has the opposite effect. It’s better to avoid douching to keep your vagina healthy.

Limiting your number of sexual partners, and using a condom every time you have sex, also decreases your risk of BV, as well as helping to prevent STDs.


Bacterial Vaginosis – CDC Basic Fact Sheet. Centers for Disease Control and Prevention. https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm. Accessed 17 May 2023.

Bacterial Vaginosis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK459216/. Accessed 17 May 2023.

Chacra LA, Fenollar F, et al. ​​Bacterial Vaginosis: What Do We Currently Know? Front Cell Infect Microbiol. 2021; 11: 672429. doi: 10.3389/fcimb.2021.672429

Dr. Patricia Shelton

Dr. Patricia Shelton

May 24, 2023

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