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The vaginal condition you’ve never heard of – that’s more common than thrush

It’s far more common than thrush, with one third of women experiencing it. So what is Bacterial Vaginosis and why should you care? Consultant gynaecologist Dr Shazia Malik explains

Vaginal infections, thrush, rashes – we don’t usually like to speak about these embarrassing intimate symptoms. Any mention of discharge or odour and it’s a ‘no thanks, next convo please’.

But it’s important that we do discuss anything unusual ‘down there’ because many women automatically assume thrush to be the cause of their intimate issues, but as it turns out – there’s something else that’s more likely to be behind it.

Bacterial Vaginosis (BV) is actually twice as common as thrush, with one third of UK women having it at some point in their lives. In fact, a whopping 60 per cent of women mistake their BV symptoms for thrush which leads to incorrect treatments and further frustration when the symptoms continue to reoccur.

Dr Malik’s clinic alone, at least 50 per cent of women who think they have thrush actually have BV

‘There is still a lot of embarrassment surrounding women’s intimate health, which often means women will just put up with their symptoms, even if they suspect something isn’t quite right,’ says Dr Shazia Malik, consultant obstetrician and gynaecologist at The Portland Hospital in London.

‘Talking openly about conditions like BV is the first step to addressing this issue and helping women seek help to look after their vaginal health,’ Malik asserts.

Plus, speaking about the symptoms you have will mean you are more likely to get the correct diagnosis. Be clear, detailed and honest when describing your symptoms to your GP, it’s nothing to be embarrassed about and doctors will have heard and seen it all before’


So, what is Bacterial Vaginosis or BV?

Unlike thrush, BV is not a yeast infection. It occurs when there is a change in the natural pH balance in the vagina and if good bacteria are in short supply, the unhealthy bacteria will take over. This will lead to a bacterial imbalance in your vagina.

‘The vagina is a self-cleaning organ and the balance of bacteria is a crucial part of this defence mechanism as they help to maintain a slightly acidic pH and keep a healthy lining,’ Dr Malik explains.

If good bacteria are running low however, other bacteria can grow and trigger BV. ‘Anything that upsets this balance and increases the number of other bacteria can increase the likelihood of vaginal infections,’ adds Dr Malik.

BV is often believed to be a sexually transmitted infection but this is not actually the case.

So, what’s really going on is this: the vaginal mucosa is designed to maintain a healthy balance of bacteria (called lactobacilli) and a slightly acidic pH which keeps it healthy and clean. The bacteria act as a natural disinfectant and keep unhealthy bacteria at very low levels. If the pH increases (becomes more alkaline), the number of lactobacilli decrease, or there is an overgrowth of other bacteria, then your chances of getting BV increase.

BV is often believed to be a sexually transmitted infection (STI) but this is not actually the case. However, women with untreated or recurrent BV are more likely to contract STI’s, says Dr Malik. ‘It’s important to treat it as soon as possible to stop recurrence and be sure to get checked for STIs if you do have sex without a condom’.

Men don’t have to worry though, even if they have had sex with a woman who has BV.  ‘Only people with a vagina can get BV, that’s why BV is more likely to occur in women in same sex relationships, especially if they share sex toys,’ Dr Malik warns.

However, even with heterosexual intercourse, a change of partner or multiple partners can predispose BV especially if you do not use a condom, as semen is alkaline. Oral sex can also predispose BV in some women.

Bacterial Vaginosis – signs and symptoms

  • Fishy odour, this is the most defining symptom of BV
  • Grey coloured discharge
  • Watery discharge
  • Discharge worsens after intercourse or during a period

‘The discharge caused by BV tends to be grey in colour and is often watery and more profuse than normal. BV also tends to have a fishy odour, especially after sex or during a period,’ explains Dr Malik.

Thrush – signs and symptoms

  • Odourless, thrush doesn’t have a smell
  • Yellow or white discharge
  • Thick discharge
  • Sore and itchy vulva/vagina
  • Burning during intercourse
  • Burning when passing urine

‘Thrush is much more likely to cause burning during intercourse or sore and itchy red skin around the vulva and vaginal opening, which is unlikely with BV,’ Dr Malik specifies.

So, the main tell-tale differences between BV and thrush are:

In Dr Malik’s clinic alone, at least 50 per cent of women who think they have thrush actually have BV. Luckily, there are a few differences to look out for when trying to distinguish between the two.

  • BV will have more of a fishy odour, thrush is odourless.
  • BV will have a grey discharge, thrush is yellow or white in colour.
  • BV is likely to be thin and watery, thrush is much thicker and associated with soreness and itching.

If you’re still unsure about your symptoms you can check out Balance Activ online Symptom Checker, which has helped nearly one million women workout out what their symptoms could be.

Common causes of BV

vaginal condition you've never heard of - coil - in text
A common cause of BV can be insertion of a coil.

Some people believe that genetics could be the cause of BV, but Dr Malik says that genetics are unlikely to have a major effect.

Women can be more prone to BV at different stages of life, for example after an illness, if their periods become prolonged and heavy or after the menopause, Dr Malik explains. ‘This can affect the pH and balance of bacteria, and hormonal changes can affect the vaginal skin’s thickness and defence mechanisms’.

Of course, there isn’t much you can do to stop BV if life stages are the cause. But, one thing you can stop is smoking as this is a possible cause for BV. Smoking can affect vaginal health and studies have shown that smokers usually have a lower proportion of vaginal lactobacillus (a good bacteria) compared to non-smokers.

Some contraception too can also cause BV. ‘There are some women who seem to get BV more commonly after insertion of a coil,’ Dr Malik suggests, ‘If other causes have been excluded then it might be worth changing your method of contraception’.

There are also many everyday factors that can upset the natural vaginal balance and therefore cause BV, such as your period or having sex, ‘Women who are sexually active are more likely to contract BV, as semen is naturally alkaline,’ Dr Malik adds.

In all women BV is more likely to occur or worsen if:
  • You use scented or medicated soap, bubble bath or shower gel to wash around the vulva/vagina.
  • You do vaginal douching or use vaginal deodorants.
  • You use antiseptic liquids in the bath.
  • You wash your underwear with strong detergents.

What are the risks of BV?

If you get discharge during pregnancy it is important to get it checked. ‘If you get BV during pregnancy then it can slightly increase the risk of premature birth, a small baby or miscarriage,’ Dr Malik explains. ‘If a diagnosis of BV is made it can be treated safely during pregnancy’.

As mentioned before, if you get recurrent BV there will be a higher risk of getting STIs which can further lead to PID (Pelvic Inflammatory Disease), so it is advisable to use condoms and get a full STI check.


BV can sometimes clear up by itself. However, if it doesn’t then don’t panic as symptoms of BV can be easily relieved.

Don’t ignore your symptoms, ‘BV should be treated otherwise it’s likely to reoccur, creating a never sending cycle of symptoms and potential embarrassment,’ advises Dr Malik. This can affect a woman’s confidence, daily life and relationships.

vaginal condition youve never heard of - BV - pharmacy - in text
There are many products that treat BV that can be picked up in a pharmacy, and antibiotics can be prescribed.

There are many products that can treat BV that can be picked up in the pharmacy, saving you the bother of a trip to the GP, and of course antibiotics can also be prescribed.

Natural solutions include increasing the number of healthy lactobacilli and removing the overgrowth of unhealthy bacteria. This can be done using vaginal products such as Balance Activ BV Gel, £10.20 and their Vaginal Pessary £10.20. 

‘These products provide a natural solution to BV and are clinically proven to effectively treat symptoms of BV by restoring normal pH and vaginal flora. It can also be used to help prevent recurring symptoms of BV,’ says Dr Malik.

‘If this doesn’t work, visit your GP who will prescribe a course of antibiotics, your doctor will advise whether tablets or gel is the best choice for you, plus any side effects or precautions’.

Dr Malik continues, ‘Although not proven I also advise my patients to take a course of oral probiotics for a few months to try to increase the numbers of healthy lactobacilli in the gut and vagina’.

This article has been sponsored by Balance Activ

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