Bacterial Vaginosis (BV) is one of the most common vaginal conditions affecting people of reproductive age, yet it remains widely misunderstood. Below, we break down what BV is, how it impacts fertility, and why restoring vaginal balance matters for reproductive health.

What is Bacterial Vaginosis?

Bacterial Vaginosis, or BV, is the most common genital tract disorder in reproductive-aged women. It occurs when the vaginal microbiome shifts from a healthy, lactobacillus-dominated environment to one overrun by unhealthy bacteria.

The most recognisable symptom of BV is a strong fishy odour, often accompanied by grey discharge, burning during urination, itching, or pain during sex.

What Causes BV?

BV is caused by an imbalance in vaginal bacteria. Women with BV have lower levels of amylase, an enzyme that breaks down carbohydrates into glycogen—the main food source for healthy lactobacilli. Without this glycogen, beneficial bacteria can’t thrive.

They also have reduced antimicrobial peptides (AMPs), which normally protect against invading bacteria. This disruption creates a cycle that can make BV difficult to clear.

How Common Is BV?

Globally, one in four people with a vagina of reproductive age will experience BV. Prevalence varies between countries and communities, but it’s clear that BV affects millions of women worldwide.

How Does BV Affect Fertility?

BV can impact fertility in several ways:

• Increases inflammation, creating a hostile environment for sperm and egg.

• Causes damage to sperm and vaginal cells.

• Interferes with healthy cervical mucus production.

• Can lead to scar tissue that blocks fallopian tubes, preventing sperm and egg from meeting.

The Role of Vaginal pH

In a healthy vagina, lactic acid-producing bacteria maintain an acidic pH around 4.5. This acidity keeps harmful bacteria under control and supports normal exfoliation of vaginal cells, releasing glycogen for beneficial bacteria to feed on.

When BV develops, this acidic environment is lost. The resulting higher pH allows unhealthy bacteria to multiply and form a biofilm that protects them from being cleared, perpetuating the imbalance.

If you’re curious about how to maintain optimal pH, read our related guide:
Why Your Vaginal pH Matters

BV and Pregnancy Risks

BV has been linked to a two-fold increase in early pregnancy loss following IVF. In pregnancy, untreated BV may increase the risk of miscarriage, preterm birth, low birth weight, and postpartum infections.

Long-Term Effects of Recurrent BV

If left untreated, recurrent BV can:

• Cause scarring of the fallopian tubes, leading to fertilisation failure.

• Keep the vaginal immune system in a persistent state of inflammation.

• Increase interleukin levels, chemical markers of inflammation.

• Weaken infection-fighting white blood cells, increasing risk of HPV and HIV infection.

Diagnosing Bacterial Vaginosis

Doctors use the Amsel criteria for diagnosis. If three or four of the following are present, BV treatment can be offered:

• Thin white or grey discharge

• Elevated vaginal pH (above 4.5)

• Fishy odour, especially after adding potassium hydroxide to vaginal fluid (the “whiff test”)

• Presence of “clue cells” on microscopy

Testing is usually performed via vaginal swab and pH measurement, either by a clinician or with a self-collected sample.

Treatment Approaches

For women trying to conceive, both the patient and their partner should be treated to reduce recurrence. After antibiotic therapy, recolonisation with lactobacillus probiotics can help restore a healthy vaginal microbiome.

Preventing BV Recurrence

Lifestyle and hygiene practices can support vaginal balance:

• Use vagina-friendly lubricants such as Equilibrium, designed by gynaecologists to respect the natural vaginal microbiome.

• Avoid washes, soaps, and douching products, which disrupt natural flora.

• Maintain gentle, non-stripping hygiene routines that respect the skin’s natural pH.

Partner Treatment and Sexual Health

Treating sexual partners has been shown to reduce recurrence rates, especially in monogamous relationships. Partner treatment involves oral and topical antibiotics for both partners at the same time.

BV is now recognised to have overlap with sexually transmitted infections, so partner management is important for ongoing vaginal health.

Common Misconceptions About BV

Myth 1: BV isn’t sexually transmitted
BV can indeed be passed between sexual partners.

Myth 2: Douching helps prevent or treat BV
Douching removes beneficial bacteria and increases the risk of infection. The vagina is self-cleaning, it is best to avoid internal cleansing.

Myth 3: BV and yeast infections are the same
While symptoms can overlap, they differ in discharge and treatment. BV discharge is thin, grey, and fishy-smelling, while yeast infections cause thick, white discharge with minimal odour. BV requires antibiotic treatment, not antifungal creams.

If you’re unsure, see your healthcare provider for a swab test. Self-diagnosis and incorrect treatment can worsen vaginal imbalance.

When to Seek Specialist Help

Women with recurrent BV, especially those trying to conceive, should seek fertility advice. Without partner treatment, recurrence rates can reach 60–80%.

Simultaneous treatment of both partners reduces reinfection and improves outcomes for conception and vaginal health.

In Summary

Bacterial Vaginosis is common, treatable, and closely linked with reproductive health. Understanding how to restore and maintain a balanced vaginal microbiome is key to preventing recurrence and protecting fertility.

For ongoing support, always consult a qualified healthcare provider, and choose products designed to protect your intimate microbiome, like Ellechemy’s Equilibrium, our pH-balanced, gynaecologist-designed lubricant and daily moisturiser.