Women’s impressions of BV episodes, recurrences, and care

Women with bacterial vaginosis (BV) are both frustrated and dissatisfied with treatments for the condition and its likelihood of recurring. They also expressed dissatisfaction with the inconsistency of advice and information, misdiagnosis, and insensitive and dismissive attitudes of clinicians in regard to BV, according to an Australian study published in the journal PLOS One. In addition, many women have turned to self-help remedies, including vaginal douching, to manage the condition.

Despite the fact that BV is the most common vaginal problem of women of reproductive age-affecting 10% to 30% of heterosexual women and 20% to 50% of women who have sex with women (WSW)-little is known about the causes of BV. The condition is not classified as a sexually transmitted infection, and it is not clear whether it is sexually transmitted. Current antibiotic treatment regimens employing oral metronidazole or topical clindamycin cream are effective in the short term, but have many adverse effects and do not prevent repeat episodes. The recurrence rate for BV 12 months after treatment is over 50%. It is also unknown whether recurrences are actually new episodes of infection or persistent infection.

Study Design

Women ages 18 to 45 years who had experienced two or more diagnosed episodes of BV over the past 5 years were invited to participate in the study. All were required to be fluent in English. A broad sample of women from different backgrounds and sexual orientations was sought: heterosexual and WSW, single women and those in relationships, women from different areas of Australia, and women who had experienced few and many BV recurrences. Some of the women had previously participated in a previous BV study; others were recruited from the Melbourne Sexual Health Clinic (MSHC), specialist sexual health clinics, and primary care practices with high numbers of reproductive-age female patients. Participants were interviewed over the phone, at the MSHC, or in their own home. The questions included 15 demographic, sexual behavior, diagnosis, and treatment questions, followed by BV-specific questions.

Of the 35 women who were interviewed, the researchers found that most had no knowledge of BV before they were diagnosed with it. Many thought they had a vaginal yeast infection or an STI. When they visited a clinician, they were frustrated by the lack of knowledge about BV and its triggers, dismissive and insensitive management, misdiagnosis, and ineffective and bothersome treatment choices. Many suffered from nausea, stomach cramps, diarrhea, yeast infections, and an oral taste in their mouth as a result of antibiotic treatment. The women reported that many clinicians did not understand the impact of recurrent BV on patients, including their level of embarrassment, shame, and concern about vaginal odor and discharge. They cited sexual health practitioners as being more caring than primary care providers. 

Many Women Turn to Self-help Remedies

Due to their frustration with current treatments and clinicians, many women had turned to self-help remedies to treat the symptoms of BV, such as probiotics, douching, and over-the-counter products.

Most of the home remedies were not helpful, and some, such as douching, have been shown to exacerbate BV symptoms.

Women also adopted lifestyle changes in an attempt to prevent recurrences. These included improving their diet, avoiding alcohol, increasing exercise, wearing only cotton underwear, avoiding tight clothing, and improving their general hygiene. Some, particularly WSWs, also improved their level of sexual hygiene, such as no longer sharing sex toys. “For most women,” the researchers reported, “long term lifestyle modifications had little effect on recurrences, resulting in a strong sense of frustration and for some women a sense that they would always have BV.”

Improving Clinical Management

The results of this study paint a picture of ineffective treatment and point the way to more empathetic management of this common vaginal condition, which is highly disturbing and frustrating for women who suffer from BV. “Women need to be informed about the scientific uncertainty around BV to assist them in understanding why treatments may not be highly effective and to hopefully reduce intensive self-help approaches which may be exacerbating recurrences,” said the researchers.