Bacterial vaginosis (BV) and sex: common misconceptions

Key Points:

• Bacterial vaginosis (BV) is not a sexually transmitted infection. However, it is more common in people who are sexually active and who have multiple sex partners.
• BV is caused by an overgrowth of some kinds of bacteria in the vagina. You can’t “catch” BV because the bacteria are already present in most vaginal microbiomes.
• You can reduce the risk of developing BV by practicing safe sex and following good hygiene practices, like not douching and avoiding harsh soaps in the genital area.

There’s a lot of confusion about bacterial vaginosis (BV) and sex. On the one hand, BV is not a sexually transmitted infection. The bacteria that cause BV are naturally present in a healthy vagina, and it’s possible to get BV even if you don’t have sex.

On the other hand, BV is much more common in people who are sexually active and in people with multiple sex partners. It’s also possible to spread the bacteria between sex partners, especially among women who have sex with other women.

There are ways to reduce the risk of getting BV and to help protect yourself during sex. Latex condoms and dental dams can help, as can using good hygiene practices.

What is bacterial vaginosis (BV)?

Bacterial vaginosis is an imbalance of “good” and “bad” bacteria in the vagina. It can happen whenever something disrupts the normal balance of bacteria in the vagina.

A healthy vagina usually has a lot of Lactobacillus bacteria. If there aren’t enough Lactobacillus, other types of bacteria may grow and cause symptoms like vaginal discharge or a foul, fishy odor.

How does bacterial vaginosis (BV) spread?

You can’t catch bacterial vaginosis like you might catch a cold or strep throat. If you spend time near someone with BV, you won’t catch it.

Here are some of the ways that BV is not spread:

• Sharing bed linens
• Swimming pools or hot tubs
• Touching the same surface as someone with BV
• Being near someone else with BV

The truth is that researchers aren’t entirely sure what causes the wrong kinds of bacteria to grow and spread in the vagina. However, there are clear links between some types of activities and BV.

Bacterial vaginosis is more likely in people who:

• Have a new sex partner or multiple sex partners
• Douche or use potentially irritating vaginal products
• Have unprotected sex
• Smoke
• Were assigned female at birth (AFAB) and have sex with other AFAB people (including women who have sex with women)

What to know about bacterial vaginosis (BV) and sex

Bacterial vaginosis is not a sexually transmitted infection. That’s because BV can occur in people who are not sexually active (although this is not as common). Also, BV is caused by an overgrowth of bacteria typically found in the vagina – not a new bacteria or another organism introduced during sex.

However, it is possible to spread the bacteria that causes BV to a sex partner during intercourse. And the more sex partners you have, the more likely BV will occur.

One study found that about 18% of women who were not sexually active developed BV. In comparison, BV was found in 22% of women with one lifetime partner, 43% of women with 2-3 lifetime partners and 58% with four or more lifetime partners.

The risk is also higher in AFAB people who have sex with other AFAB people (including women who have sex with women). This study reported that the rate of BV rose to 45% in this group compared to 29% in the group who stated they had never had sex with a female partner.

Latex condoms and dental dams can help prevent BV. This could work in different ways. First, it can prevent the spread of harmful bacteria from one partner to another. Second, semen is alkaline and can raise the pH of the vagina and make it easier for harmful bacteria to grow.

Bacterial vaginosis and birth control

Some research shows that BV is more common in people who use an intrauterine device (IUD), especially the copper IUD.

It’s possible that copper IUDs increase bleeding, which may alter the pH of the vagina and create an environment that is more friendly to “bad” bacteria. This theory is supported by other studies that show a link between hormonal birth control and reduced rates of BV. Hormonal birth control often reduces vaginal bleeding.

Bacterial vaginosis and men

Men can carry the bacteria involved in bacterial vaginosis, but BV does not cause any problems in men. Generally, men and people with penises do not need to get treated if their partner has BV.

If men have a partner with recurrent BV, there is some evidence that treating the male sex partner can help reduce the chances that BV will come back.

Treatment options for bacterial vaginosis

The good news is that bacterial vaginosis is treatable with antibiotics. The bad news is that it often comes back.

You can reduce the risk of getting BV (or having it come back) by combining antibiotics with safe sex practices and good hygiene. This includes using condoms, limiting the number of sex partners and avoiding harsh soaps or other potentially irritating vaginal products.

If you struggle with BV that comes back, talk to your medical provider about other options. Recurrent BV can be treated with long-term antibiotics, possibly in combination with a probiotic supplement or another form of birth control.

Need help understanding your options for BV treatment? Dr. B can connect with a board-certified medical provider who can provide low-cost and no-cost consultations. Get started today.

Sources:

Abou Chacra, L., Fenollar, F., & Diop, K. (2022). Bacterial Vaginosis: What Do We Currently Know?. Frontiers in cellular and infection microbiology, 11, 672429. https://doi.org/10.3389/fcimb.2021.672429

Centers for Disease Control and Prevention. (2021, July 22). Bacterial vaginosis - STI treatment guidelines. Centers for Disease Control and Prevention. Retrieved February 14, 2023.

Goje, O. (2021, April 31). Bacterial vaginosis (BV) - gynecology and obstetrics. Merck Manuals Professional Edition. Retrieved February 6, 2023.

Joseph, R. J., Ser, H. L., Kuai, Y. H., Tan, L. T., Arasoo, V. J. T., Letchumanan, V., Wang, L., Pusparajah, P., Goh, B. H., Ab Mutalib, N. S., Chan, K. G., & Lee, L. H. (2021). Finding a Balance in the Vaginal Microbiome: How Do We Treat and Prevent the Occurrence of Bacterial Vaginosis?. Antibiotics (Basel, Switzerland), 10(6), 719. https://doi.org/10.3390/antibiotics10060719

Hutchinson, Katherine B.; Kip, Kevin E.; Ness, Roberta B. Condom Use and its Association With Bacterial Vaginosis and Bacterial Vaginosis-Associated Vaginal Microflora. Epidemiology 18(6):p 702-708, November 2007. DOI: 10.1097/EDE.0b013e3181567eaa

Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007 Nov;34(11):864-9

Madden, T., Grentzer, J. M., Secura, G. M., Allsworth, J. E., & Peipert, J. F. (2012). Risk of bacterial vaginosis in users of the intrauterine device: a longitudinal study. Sexually transmitted diseases, 39(3), 217–222. https://doi.org/10.1097/OLQ.0b013e31823e68fe

Peebles, K., Kiweewa, F. M., Palanee-Phillips, T., Chappell, C., Singh, D., Bunge, K. E., Naidoo, L., Makanani, B., Jeenarain, N., Reynolds, D., Hillier, S. L., Brown, E. R., Baeten, J. M., Balkus, J. E., & MTN-020/ASPIRE study team (2021). Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(3), 513–520. https://doi.org/10.1093/cid/ciaa703

Vodstrcil, L. A., Muzny, C. A., Plummer, E. L., Sobel, J. D., & Bradshaw, C. S. (2021). Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment. BMC medicine, 19(1), 194. https://doi.org/10.1186/s12916-021-02077-3