Can They Forestall Vaginal Infections?

BV doesn’t always cause symptoms, per the Office on Women’s Health. But when it does, you might notice:

• White, milky, or gray discharge
• Strong, fishy odor
• Burning when you pee
• Itching or irritation around your vagina

So, can taking probiotics help prevent BV from happening again, or even just reduce symptoms? “The only FDA-approved regiments for BV are antibiotics, which are available in oral or topical form,” Kameelah Phillips, M.D., a New York-based OB/GYN and Organon health partner tells Well+Good. But as far as probiotics go, Dr. Phillips recommends skipping the unapproved treatment. Learn more about BV below, and why probiotics might not be the best choice.

How does a vaginal imbalance occur in the first place?

Like your gut, your vagina has its own microbiome with tons of bacteria—mostly good strains like Lactobacillus—that work to keep your vagina healthy. But sometimes these good bugs get overrun by unfriendly ones like Gardnerella. The proliferation of these bad bacteria can disrupt your vagina’s normal pH (which is usually pretty acidic) and lead to BV, according to the National Women’s Health Network.

Where do the infection-causing bacteria come from? Often, they get introduced into your vag from sex (particularly unprotected sex or sex with multiple partners) or from douching, Dr. Phillips says. But again, BV can ultimately affect anyone with a vagina.

Can probiotics help…even a little bit?

If you’re experiencing a vaginal imbalance or developing symptoms of BV, you might wonder if probiotics (“good” bacteria) can help get rid of the bad bacteria. But the answer isn’t as simple as we think. In short: probiotics have some possibility to help. But for now, there’s not enough evidence to give a firm YES or offer specific treatment guidelines with the use of probiotics. Here’s what the science says so far.

Oral probiotics like Lactobacillus rhamnose might play a role in supporting antibiotic treatment for BV, according to an analysis published in the journal Reproductive Health. However, this means that probiotics may help as a supplement to antibiotics, not in replacement of the medications. Additionally, a randomized controlled trial, published in the New England Journal of Medicine, found that taking Lactobacillus vaginally after treatment can reduce the risk of BV coming back (which happens a lot). But more research is needed, according to the authors of the study.

So for now, you shouldn’t turn to probiotics to manage your BV—at least not before seeing your healthcare provider, getting an accurate diagnosis, and having an informed discussion about approved treatment options (aka antibiotics). “I have seen many patients attempt to self-treat at home. This often delays women from coming in for a diagnosis, and then end up at my office when symptoms persist,” Dr. Phillips says.

Other prevention and treatment options for BV

If you have BV that’s causing symptoms, your healthcare provider will likely recommend treating the infection with antibiotics like Cleocin (clindamycin) or Metrosa (metronidazole), both of which can be prescribed orally, topically, or vaginally. About 90 percent of the time, these meds will clear a BV infection within a month, per the National Library of Medicine.

In some cases, your healthcare provider might prescribe a second round of antibiotics if the first course isn’t effective, or if your BV comes back. But even then, recurrent BV can sometimes be a stubborn problem. “It can be frustrating and embarrassing for patients. Aside from the emotional impact, untreated infections may lead to serious complications,” Dr. Phillips says.

At that point, it’s worth having a convo with your provider to come up with a strategy to reduce your infection risk as much as possible, says Dr. Phillips. Together, you might decide that probiotic supplements should be part of the plan.

But you’ll likely need to address lifestyle-based risk factors too, she adds. To reduce your BV, the Office on Women’s Health recommends the following tips:

• Avoid douching: It messes with your vagina’s natural bacterial balance.
• Practice safe sex: Use condoms or dental dams, limit your number of partners, and clean sex toys each time you use them.
• Be careful when you wipe: Always go from front to back, so bacteria from your anus doesn’t get near your vagina.
• Wear cotton undies: Cotton wicks away excess moisture, which reduces the risk of bacterial growth.

When to see a healthcare provider

If you’re noticing symptoms of BV, it’s important to schedule a call or visit with your provider as soon as possible. “To get an accurate diagnosis for BV or other vaginal health concerns, you need to be seen by a healthcare provider, so I encourage people to reach out to their doctor if they notice any unusual-for-them vaginal changes,” Dr. Phillips says. Once you figure out what’s going on, you can work with your provider to develop a plan that’s best suited for your body’s needs.