BV prevention is a priority for many women because bacterial vaginosis is the most common vaginal condition affecting people with a vagina during their reproductive years — and it recurs frequently. Bacterial vaginosis (BV) occurs when the normal lactobacillus-dominant vaginal microbiome is disrupted and replaced by a diverse overgrowth of anaerobic bacteria. While antibiotic treatment is effective for acute episodes, rates of recurrence within 12 months are high.
Understanding what disrupts the vaginal microbiome and what evidence-based BV prevention strategies exist can help reduce both incidence and recurrence. 1
What Is Bacterial Vaginosis?
Bacterial vaginosis is not a sexually transmitted infection in the traditional sense, though sexual activity is a risk factor. It is a polymicrobial disruption of the vaginal microbiome, characterized by a decrease in protective Lactobacillus species (which produce lactic acid to maintain a low vaginal pH) and an overgrowth of bacteria such as Gardnerella vaginalis, Prevotella species, and Mobiluncus species.
Symptoms include a thin, gray-white or yellowish vaginal discharge, a characteristic fishy odor (especially after sex), and sometimes mild vaginal irritation. Many women with BV are asymptomatic. Untreated BV is associated with increased risk of sexually transmitted infections, pelvic inflammatory disease, and pregnancy complications. 2
Key BV Prevention Strategies
Avoid Douching
Douching is one of the most strongly associated risk factors for BV. Vaginal douching disrupts the protective acidic vaginal environment and washes away beneficial Lactobacillus bacteria, making conditions more favorable for BV-associated organisms. The CDC, ACOG, and most gynecological health organizations recommend against vaginal douching entirely. 1
Use Condoms Consistently
Consistent condom use reduces the risk of BV. 5), favoring the growth of BV-associated bacteria. Studies show that women who use condoms consistently have lower rates of BV recurrence. 3
Limit Number of Sexual Partners
Having multiple or new sexual partners is associated with a higher risk of BV, likely due to introduction of new bacterial strains that shift the vaginal microbiome. Partners' own genital microbiomes can influence vaginal flora. Stable partnerships with consistent safe sex practices are associated with a lower BV risk profile.
Probiotic Use
Lactobacillus-containing probiotics — particularly those with L. rhamnosus GR-1 and L. reuteri RC-14 strains — have been studied as adjuncts to antibiotic therapy to reduce BV recurrence. Some clinical trials and meta-analyses suggest that oral and vaginal probiotic preparations may modestly improve the rate of sustained cure and reduce recurrence when used alongside or after antibiotic treatment. 4
Avoid Scented Products Near the Vagina
Scented soaps, washes, sprays, and wipes used around or inside the vagina can alter the vaginal pH and disrupt the microbiome. Fragrances and harsh surfactants are common irritants that may predispose to BV. Unscented, pH-balanced external cleansers — used on the vulva only — are the safest choice. Fragrance-free, non-dyed menstrual products are also preferable for women with recurrent BV.
Boric Acid Suppositories
Intravaginal boric acid (600mg suppositories) is used as an adjunct to antibiotic therapy or as a preventive maintenance strategy for recurrent BV in some clinical settings. Boric acid lowers vaginal pH, creating a less hospitable environment for BV-associated organisms. Some studies support its use after antibiotic treatment to reduce recurrence rates. It is not an approved FDA treatment for BV, should not be used during pregnancy, and should not be taken orally.
Dietary and Lifestyle Considerations
Emerging research suggests that diet may influence the vaginal microbiome, though direct evidence for dietary BV prevention is limited. Some studies suggest that diets higher in folate and certain micronutrients may support healthier vaginal flora. Smoking has been associated with increased BV risk, possibly due to effects on local immunity and microbiome composition. Avoiding smoking is a general recommendation that may have vaginal microbiome benefits among other health advantages.
Stress management may also play a role through effects on cortisol and immune function, though this relationship is less directly studied. Probiotics and how to choose the right strains is particularly relevant as lactobacillus-based probiotics show the most promise for vaginal microbiome support.
Managing Recurrent BV
For women with recurrent BV (three or more episodes per year), standard short-course antibiotic therapy is often insufficient. Maintenance therapy with metronidazole gel twice weekly for 4–6 months after an initial course has been shown in clinical trials to reduce recurrence rates. Some clinicians also use boric acid maintenance protocols in combination with antibiotics.
Partner treatment has been studied but evidence is inconclusive for heterosexual couples; it may have more benefit for same-sex female partners who share bacterial strains. Discussion of a maintenance strategy with a gynecologist is recommended for women with frequent recurrences. 3
When to See a Doctor
See a healthcare provider if you experience: vaginal discharge that is unusual in color, consistency, or odor; symptoms that do not resolve or recur frequently; discharge accompanied by pelvic pain, fever, or painful urination (which may suggest a more serious infection such as pelvic inflammatory disease); or if you are pregnant and notice any vaginal symptoms. BV during pregnancy requires treatment as it has been associated with preterm birth.
Self-diagnosis using symptom checkers is unreliable because other conditions — including yeast infections and sexually transmitted infections — can produce similar symptoms and require different treatments. Vaginal discharge colors and what each one means can help women better describe their symptoms to a provider.
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Frequently asked questions
Can BV go away on its own without treatment?
BV can sometimes resolve without treatment, but untreated BV carries risks including increased susceptibility to STIs and, during pregnancy, complications such as preterm birth. Most healthcare providers recommend antibiotic treatment for symptomatic BV. Recurrent BV requires a management strategy beyond single-course antibiotics.
Does probiotics help prevent BV?
Some evidence suggests that oral or vaginal Lactobacillus probiotics — particularly strains L. rhamnosus GR-1 and L. reuteri RC-14 — may help reduce BV recurrence when used alongside antibiotic therapy. They are generally safe but should not be used as the sole treatment for active BV.
Can stress cause BV?
Stress may influence the vaginal microbiome through hormonal and immune mechanisms, and some research has found associations between psychological stress and BV risk. However, stress alone is unlikely to cause BV without other contributing factors. Managing stress is a reasonable part of overall health but is not a standalone BV prevention measure.
Can you get BV without being sexually active?
Yes. While sexual activity is a significant risk factor for BV, it can occur in women who are not sexually active. The vaginal microbiome can be disrupted by factors including antibiotic use, hormonal changes, and hygiene products even in the absence of sexual activity.
How do I know if I have BV or a yeast infection?
BV typically causes a thin, watery gray-white discharge with a fishy odor and raised vaginal pH. Yeast infections usually cause thick, white, cottage-cheese-like discharge with itching and a normal vaginal pH. Accurate differentiation requires laboratory testing — clinical diagnosis based on symptoms alone is frequently incorrect.