Ever had one of those days as a vagina owner where you wake up and something feels off? Maybe you’re slightly itchy down there, maybe your skin is irritated, or maybe it burns a bit when you urinate. Maybe you even notice a weird discharge. It happens to most of us. In fact, up to 75% of women will experience some form of vaginitis, or vaginal inflammation, at some point of their lives. Vaginitis can have many different causes, and some forms are more serious than others.
Let’s take a look at the two big ones: bacterial vaginosis and yeast infections.
Do I Have BV or a Yeast Infection?
Bacterial vaginosis (BV) and vaginal yeast infections are the most common forms of vaginitis affecting women on a regular basis. The symptoms can be similar, so it’s often hard to tell the difference, but it is important to know which one you have. Why? Because the two infections are caused by different things, and have different treatments.
That’s right: Medicine that works for BV won’t clear a yeast infection, and medicine that works for a yeast infection won’t touch BV. Many women who try to self-diagnose wind up treating the wrong thing and allowing the real infection to get worse. If you have any kind of vaginitis, your best bet is to go to your doctor and let them help you pinpoint what you really have and how to treat it.
How Common Are BV and Yeast Infections?
Both vaginal yeast infections and bacterial vaginosis are incredibly common. In fact, BV is the most common vaginal infection affecting women of reproductive age in the United States, and it can hit women of any age, even they’re not sexually active.
Meanwhile, up to 75% of women will have a vaginal yeast infection at least once in their life, with at least 45% of women experiencing more than one.
What Are Common Causes of These Infections?
To understand how you get BV and yeast infections, it’s important to understand the vaginal microbiome. The vagina naturally has a fairly acidic internal environment in which good bacteria called lactobacilli can thrive. These lactobacilli have an important job — to create enough lactic acid to maintain that acidic pH of 3.5 to 4.5.
Your lactobacilli and the low-pH environment they create are what prevent infections from getting a foothold. Unfortunately, maintaining that environment is a delicate balancing act, and a lot of different things can throw off the vaginal ecosystem, raising the pH level and disrupting the normal levels of lactobacilli, thus leaving you open to vaginitis.
Bacterial Vaginosis (BV)
One of the most common causes of BV is douching, which is rinsing the vagina using water and a cleaning agent like vinegar. Douching can easily disrupt the healthy vagina by killing the lactobacilli, which raises the risk for BV.
However, douching is not the only cause of BV. Anything that changes the pH of the vagina can cause an imbalance in vaginal flora and leave the door open to harmful bacteria. Some of these things include common hormonal changes, like menstruation, pregnancy, breastfeeding, and menopause. Sex can also contribute; BV is not considered a sexually transmitted infection, but semen’s pH is much higher than the vagina’s, so unprotected sex can raise your overall vaginal pH — and can potentially introduce new bacteria at the same time.
Yeast infections also take advantage of disruptions in your vaginal ecosystem. The difference is that while BV is caused by an overgrowth of bacteria, yeast infections are caused by an overgrowth of yeast. Vaginal yeast infections also commonly strike during normal hormonal changes, and in particular during pregnancy. In addition, they can be caused by certain medical conditions and often follow antibiotic treatment, even when you’re taking antibiotics for something entirely unrelated.
What Are the Risks If Left Untreated?
While BV and yeast infections might not seem serious at the outset, it’s important to treat them as soon as you start noticing symptoms. Bacterial vaginosis can cause preterm labor or miscarriages if left untreated in pregnant women.
For non-pregnant women, BV can cause an increased risk of contracting other STIs, since it leaves the vagina vulnerable to other types of bacteria. BV that goes untreated for long periods of time can even leave you vulnerable to things like pelvic inflammatory disease, which can make it harder to get pregnant later on.
Untreated yeast infections are not quite as concerning to healthcare practitioners for an average, healthy woman who is not pregnant. While they are irritating and uncomfortable, they won’t cause permanent damage. However, if you are trying to get pregnant and you have a yeast infection, it’s important to treat it, since yeast infections can prevent pregnancy.
What Is the Difference Between Yeast Infection and BV?
The fundamental difference is in what causes the infection. Bacterial vaginosis comes from an overgrowth of bacteria in the vagina. Bacterial vaginosis often has no symptoms, but if it does, then the typical symptoms are vaginal itchiness, a grayish, discharge and a fishy odor.
A vaginal yeast infection, on the other hand, is a fungal infection caused by an overgrowth of yeast in the vagina. Vaginal yeast infections often follow other infections, especially ones that require you to take antibiotics. Although BV and yeast infections can look similar, they do have some different symptoms.
Here are a few pointers to help you tell the difference between BV and a yeast infection:
If you have BV, you might notice an odor reminiscent of bad fish. Yeast infections, on the other hand, don’t usually have much of a smell, and if they do it’s ... well, yeasty. When you are judging odor, remember that even a healthy vagina has a natural scent to it. The question is not whether you smell like anything, but whether you smell different than usual.
BV can produce a discharge that is thin, gray, and foamy. The discharge from a yeast infection is instead likely to be white or cream colored, and it will be thicker, with the consistency of cottage cheese. As with odor, the key is to look for discharge that’s unusual for you.
Both BV and yeast infections can itch, and both can give you a burning feeling when you urinate. Discomfort from BV is usually mild, whereas yeast infections can make your vagina sore and painful, especially during sex. A yeast infection can also result in redness or a rash.
Importance of Proper Diagnosis to Ensure Proper Treatment
If you’ve had BV or a vaginal yeast infection before, you might think you can just treat it yourself and not worry about checking in with your doctor. However, because BV and yeast infections sometimes show similar symptoms, it’s easy to start treating the wrong thing and have to backtrack when the infection doesn’t go away, gets worse, or comes back soon after treatment. OB-GYN Ruth Arumala says, “It’s important to have a good relationship with your OB, so that you can always ensure proper diagnosis and treatment.” Moreover, while a yeast infection, properly diagnosed, can be treated over-the-counter, BV cannot.
Another reason why it’s so important to get proper diagnosis is that while vaginitis is not sexually transmitted, some STIs can show similar symptoms, like itching and burning. If those are your symptoms, it’s not just a matter of telling whether you have BV or a yeast infection — it's determining if you have an STI instead. Again, proper diagnosis is essential to get the treatment that you need.
Over-the-Counter Options for Yeast Infection Treatment
Since yeast infections are fungal infections, they can normally be treated in a few days with an effective, targeted anti-fungal medication. Companies like Monistat create various creams and suppositories that can get rid of your yeast infection within a week or less.
Your doctor may also prescribe a single pill to get rid of your yeast infection. Common prescriptions for yeast infections include antifungals like diflucan or fluconazole.
When you’re treating a yeast infection, whether you use your doctor’s prescription or an OTC treatment like Monistat, it’s important to follow the directions and take the medication in its entirety, even if your symptoms go away earlier. When your symptoms first go away, there may still be some yeast left. If you stop treatment, it can come back stronger than ever. It’s also important to avoid sex and not insert anything into the vagina while you are healing.
How to Treat BV
If you have symptoms and you suspect that you have BV, it’s important to contact your doctor. They will do a pelvic exam and take some vaginal secretions to put under a microscope and look for bacteria.
If you do come back positive for BV, your doctor will likely prescribe medications such as metronidazole, clindamycin, or tinidazole. While these medications should get rid of the infection, some women find that BV recurs. If this happens, it’s important to go back to the doctor.
Since BV is a bacterial imbalance and the bad bacteria depend on out-of-balance pH, if you experience recurring BV it might be a sign that you need to work on maintaining an optimal pH balance in the vagina. Rebalancing the pH helps promote good vaginal bacteria like lactobacilli. Along with eating a healthy diet full of probiotic-rich foods, like fermented foods and yogurt, consider a vaginal probiotic, such as Good Clean Love’s BiopHresh Vaginal Probiotic Suppository (coming Summer 2020), which includes several different strains of beneficial lactobacilli designed to provide your vaginal ecosystem with the healthy bacteria needed to maintain a good pH level.
For addressing symptoms related to BV, we recommend Good Clean Love’s other Bio-Matched products, Restore Moisturizing Vaginal Gel and Balance Moisturizing Personal Wash. Both products are designed to support healthy vaginal conditions and are important tools in your pH-balancing arsenal.
Can You Have BV and a Yeast Infection at the Same Time?
Yes, it is possible to have both BV and a yeast infection at the same time. This is another reason why it’s so important to get a proper diagnosis from a doctor when you notice symptoms. If you’ve had a yeast infection before, you might recognize the signs and get an over-the-counter treatment — but, your yeast infection might conceal a separate case of BV, which your yeast medicine won’t do anything for. If you go to your doctor instead, they’ll be able to detect both infections, and give you the right medicines.
It is also possible for one infection to lead to another. BV is usually treated with antibiotics, and antibiotics can contribute to yeast infections. So it’s not surprising that Dr. Arumala often sees yeast infections following treatment for bacterial vaginosis. “The vagina has to be filled with something, so in the time after treatment for bacterial vaginosis, some women are prone to getting yeast infections.”
Tips for Avoiding BV and Yeast Infections
While you can’t totally control whether or not you get vaginitis (after all, things happen), there are some things you can do to lower your chances.
Douching gets rid of all of the bacteria in your vagina, both good and bad. This leaves your vagina more susceptible to foreign agents, which can throw off your vaginal pH and create an environment that is less hospitable to the good bacteria that keep your vagina healthy. In fact, your vagina (that’s the internal portion of your lady parts) is entirely self-cleaning, and you shouldn’t put any kind of soap or wash in there at all. On the other hand, the vulva (that’s the external part) can be washed with a mild, unscented feminine wash, such as Good Clean Love’s Balance Personal Moisturizing Wash.
Practice Good Vaginal Hygiene
Good hygiene is as much about what you don’t do to your vagina as what you do. In particular, avoid scented vaginal products, such as scented pads, tampons, and soaps. The fragrances in these products can cause irritation to the sensitive vaginal environment and upset your pH, allowing bad bacteria to thrive. In addition, since bacteria and yeast thrive in moist environments, keeping things dry down there is helpful in preventing vaginitis. Wear breathable fabrics, like cotton panties, and change sweaty or wet panties or bikini bottoms promptly.
Probiotics are beneficial to your body in all kinds of ways, including supporting an environment of strong lactobacilli in the vagina. We recommend including probiotic-rich foods such as kimchi and yogurt in your diet, as well as taking a quality vaginal probiotic, like Good Clean Love’s BiopHresh Vaginal Probiotic Suppository (coming Summer 2020). A probiotic specifically designed for women will ensure that lactobacilli strains that are specific to the vagina, such as lactobacillus crispatus, are being replenished regularly.
When Is It Time to See Your Medical Professional?
It’s important to contact your doctor at the first sign of unusual symptoms. Some things to look out for include any strange discharge (white, cottage-cheesy discharge for yeast infections and grayish discharge for BV), any strange odors (yeasty for a yeast infection and fishy for BV), and any vaginal redness, itching, irritation, or burning. Since BV isn’t always symptomatic, it’s a good idea to have a positive, supportive relationship with your doctor of choice to ensure you’re getting the regular vaginal care you need.
If you are treated for vaginitis and the symptoms don’t go away or they return soon after treatment, contact your doctor right away.
Vaginitis Happens to the Best of Us
In the end, even if we take all preventative measures, vaginitis happens to the best of us. What you need to know about the two most common forms is that bacterial vaginosis (BV) is caused by an overgrowth of vaginal bacteria, whereas vaginal yeast infections are caused by yeast.
Both infections can have some similar symptoms, such as vaginal itching, burning, or irritation, but are also marked with differences — such as the fishy odor and grayish discharge of BV versus the yeasty odor and cottage-cheesy discharge of yeast infections. Sometimes BV even shows no symptoms at all.
If you do start noticing any of these symptoms, it’s important to contact your doctor so that you can ensure proper diagnosis and treatment. Both of these infections may be a headache to deal with, but the good news is they’re both very common and easily treatable.