Did you know that 75% of women will experience thrush at some point in their lives, and around one-third will encounter BV? If you're dealing with these issues, you're definitely not alone.

Are thrush and BV actually “infections”?

Bacterial Vaginosis (BV) and thrush (Candida yeast) are two of the most common issues faced by women. Around 75% of women will have thrush at some point in their lives, and approximately 10% of women have BV at any given time (NICE CKS).

These conditions are generally treated as infections with antibiotics or antifungal medicines.

The UK National Health Service (NHS) defines an infection as: “The invasion of the body by a harmful organism or infectious agent such as a virus, parasite, bacterium, or fungus.”

But what if the cause of the problem is already there?

The bacteria and yeasts that cause BV and thrush are natural parts of a woman’s vaginal microbiome. They are present in most women all the time and generally don’t cause problems. When conditions in the vagina change, these microbes can overgrow, leading to thrush and BV. It's more accurate to call these conditions an imbalance, where bad bacteria or yeast overgrow and cause symptoms.

What causes the bad bacteria and yeast to ‘take over’?

The vagina is kept healthy by a balanced ecosystem called the vaginal microbiome. This collection of microbes mostly works to keep the vagina clean, healthy, and problem-free. Ideally, the majority of these microbes are good bacteria called Lactobacillus, specifically:

• Lactobacillus crispatus
• Lactobacillus jensenii
• Lactobacillus gasseri

These good bacteria thrive in the lining of the vagina (vaginal mucosa) and produce natural antimicrobial compounds that prevent the bad bacteria and yeast that cause thrush and BV from growing out of control. The most common antimicrobial is lactic acid, which maintains the vaginal acidity at a pH level of 3.8-4.5. This acidity stops the bad microbes from multiplying and causing symptoms. If there is an imbalance reducing Lactobacillus populations, BV or thrush can dominate. You can test your vaginal pH with a simple at-home pH test like the one from VJJ Health.

What causes an imbalance in the vaginal microbiome?

The vaginal microbiome is quite sensitive. Several common factors can affect the good bacteria:

• Periods: Menstruation involves a drop in progesterone and oestrogen, and the uterus sheds its lining as blood. The reduced oestrogen and less acidic blood can alter the balance of Lactobacilli, leading to thrush or BV around your period.
• Unprotected sex: Spermatic fluid is very alkaline and can affect the vagina's acidity (pH), encouraging the growth of microbes that cause BV. Recurrent BV is common with increased sex. Using a non-spermicidal condom can help maintain vaginal pH.
• Using soaps and washes: Most soaps and washes affect the vagina's acidity and kill good bacteria. The vagina is self-cleaning and shouldn’t be washed with soap. Use water or a gentle moisturising emollient like Cetraben for the vulva, but never for the vagina.
• Tight, sweaty underwear: Tight sportswear, artificial underwear, and wet swimsuits can create a hot environment perfect for thrush to multiply. Change out of tight-fitting clothes quickly and wear natural, breathable fabrics like cotton or Tencel.
• Menopause: Lower oestrogen levels cause changes in the vagina, such as thinning of the vaginal mucosa where good bacteria live. Without HRT or vaginal oestrogen, the vaginal pH rises, increasing the risk of Urinary Tract Infections (UTIs).

BV is more than just a smelly discharge

BV causes an unpleasant smelling discharge, often described as ‘fishy,’ but it can also contribute to infertility and early pregnancy loss (miscarriage). BV can be asymptomatic, meaning there are no visible signs. A simple pH test can detect an asymptomatic infection.

What can I do to balance my intimate health?

The first line of treatment for BV is antibiotics, which kill both the bad and good bacteria, often leading to thrush after treatment.

There is considerable clinical evidence showing that supporting your vaginal microbiome with the right strains of vaginal Lactobacilli can treat thrush and BV and reduce the likelihood of recurrence. Perfect V, a specific oral women’s vaginal probiotic from VJJ Health, contains the three most common healthy Lactobacilli and has been clinically validated to reach the vagina, improve pH, and be effective against thrush and BV. In menopause, taking the Lactobacilli in Perfect V can maintain a healthy pH and relieve some symptoms of vaginal atrophy.