The Latest Covid-19 Recommendations for New Moms and Babies

An OB-GYN answers questions and explains best practices. Read more

Bacterial Vaginosis: What to Do When Your Vagina Smells Bad

How to fix odor “down there”.

Let’s face it. Humans sometimes stink. Our genitals, butts, and armpits do not always smell like roses. Women expect postworkout smelly armpits, but no one is happy when the pungent odor comes from the vagina.

So, what causes the “not so fresh” feeling?

Sweat, food intake, medications, and hormonal changes all alter vaginal scent, but the most common cause of an unpleasant vaginal odor is an overgrowth of normal vaginal bacteria called bacterial vaginosis.

Bacterial vaginosis is easy to treat with antibiotics, but the crucial step is to confirm the diagnosis with a medical provider. Self-diagnosing often leads to errors. The malodorous situation “down there” will not improve if we are not treating the right thing.

While most women will get bacterial vaginosis at some point in their life, everyone wants to know why BV happens and how to get rid of it.

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is not an infection in the traditional sense, but rather a condition caused by an overgrowth of anaerobic bacteria living in the vagina.

Vaginal bacteria are supposed to be present. Bacteria live on our skin, mouths, and gastrointestinal tracts all the time. These healthy bacteria help keep our body systems running smoothly. The vagina always contains small amounts of healthy, protective bacteria.

Vaginal bacteria and yeast live in perfect harmony, maintaining the vaginal ecosystem. Bacteria and yeast work to keep the vaginal chemistry pH balanced in the healthy range between 3.5–5.5.

Periodically, something disruptive happens to break the chemical balance allowing bacteria to flourish. When bacteria outgrows the counterbalancing yeast, women develop bacterial vaginosis.

When vaginal bacteria overpower and suppress yeast, women will notice a gray or yellow, fishy smelling discharge.

Who is at risk for bacterial vaginosis?

BV is the most common vaginal condition, and any woman can get it. BV is more common in sexually active women, but it is not a sexually transmitted infection.

BV is most common in ages 15 to 44, but it can happen at any age and in women who do not have sex.

The risk of bacterial vaginosis increases with:

What are the symptoms of BV?

BV symptoms vary from person to person. While some may have no symptoms, others will notice a fishy vaginal odor, vulvar irritation, or discomfort with urination. Some experience a watery or foamy white, yellow, or gray vaginal discharge.

These symptoms are often confused with STIs and vaginal yeast infections. Seeing your doctor or practitioner is the only way to determine if you have a BV and not a more severe problem.

The signs and symptoms of a BV are similar to other more serious infections. Trichomoniasis is a common STI that also causes itching and vaginal odor.

If left untreated, STIs and BV raise your risk of getting other STIs, including HIV. Untreated gonorrhea and chlamydia can lead to problems getting pregnant. BV can also lead to problems during pregnancy, such as preterm labor and premature delivery.

How is bacterial vaginosis diagnosed?

A doctor will do a pelvic exam to look for the characteristic discharge. The doctor may also use a cotton swab to take a sample of the discharge from the vagina.

A test can be done to see if the pH is elevated. The providers may add a chemical called KOH to perform a Whiff test. (Yes, this involves smelling the discharge). Finally, the provider may look at the sample under a microscope to evaluate for a particular finding called clue cells.

Nucleic acid amplification microbial testing is a widely available rapid test technology to help distinguish between yeast, bacterial vaginosis, and trichomoniasis.

How is bacterial vaginosis treated?

BV is treated with prescription antibiotics. Metronidazole pills or vaginal gel are the most common. Clindamycin is a common acceptable alternative.

Sex partners do not need to be treated.

Patients suffering from recurrent bacterial vaginosis may qualify for more robust treatment protocols.

Many times, BV will resolve on its own. Vaginas are very effective at self-correcting. Untreated BV increases the risk of getting HIV, genital herpes, gonorrhea, chlamydia, and pelvic inflammatory disease. Women with HIV who get BV are also more likely to pass HIV to a male sexual partner.

Is it safe to treat pregnant women who have BV?

The medicine used to treat BV is safe for pregnant women at any stage of pregnancy. All pregnant women with symptoms of BV should be tested and treated. Some evidence indicates a link between BV and preterm birth.

How can I lower my risk of BV?

Researchers do not know exactly what causes BV, but we know ways to help the vagina maintain a normal pH and reduce the risk of BV. Steps include:

  • Keeping your vaginal bacteria balanced. Use warm water to clean the outside of your vagina. Always wipe front to back from your vagina to your anus. Keep the area cool by wearing cotton or cotton-lined underpants.
  • Fix irregular bleeding. Blood in the vagina raises the pH. A gynecologist can help find a solution to abnormal uterine bleeding and spotting. Fixing the blood exposure often eliminates recurrent bacterial vaginosis.
  • Avoid douching. Douching wipes out the balance of good and harmful bacteria in your vagina.
  • Not having sex. Abstaining from sex is not a popular option for some, and you can get BV without having sex. But BV is more common in women who have sex.
  • Pull out. Semen raises the vaginal pH. Women with recurrent BV may want to have their male partner withdraw the penis prior to ejaculating inside the vagina.
  • Limiting your number of sex partners. Research indicates an increased BV risk with multiple partners.

Uterine Fibroid Embolization; A Treatment You May Not Know About

Women need to know all their options to treat fibroids. Read more


Understanding the mystery of the mammary glands.

We all have breasts. Structurally, breasts are simply modified sweat glands. But functionally, the mammary glands produce milk, life- saving nutrition for newborn babies allowing the human race to evolve and flourish.

The mammary glands are wondrous and complex structures. Let’s take a tour of the breast anatomy.

What are the mammary glands?

Used with permission from Medika Life

Mammary glands are located in the breast overlying the pectoralis major muscles. Both males and females have them, but they are functional only in women.

Externally, each breast has a raised nipple surrounded by a circular pigmented area called the areola. The nipples are sensitive to touch because of a dense array of nerve fibers and smooth muscle that contracts and causes them to become erect in response to stimulation.

Internally, the adult female breast contains 15 to 20 lobes of glandular tissue that radiate around the nipple. The lobes are separated by firm connective tissue and fatty adipose tissue.

The connective tissue helps support the breast. Bands of connective tissue, called suspensory (Cooper’s) ligaments, extend through the breast from the skin to the underlying muscles. The amount and distribution of the adipose tissue determine the size and shape of the breast. To keep it simple, fatty tissue determines breast size and connective tissue holds them up.

A complex plumbing system

Have you ever wondered how milk gets to the nipple? Each lobe consists of lobules that contain the milk-producing glandular units. A tube called a lactiferous duct collects milk from the lobules and carries it to the nipple.

Milk is stored in a reservoir called the ampulla (lactiferous sinus) just before arrival at the nipple. After the sinus, the duct splits and narrows allowing multiple ducts to bring milk to the surface of the nipple.

Mammary gland function is regulated by hormones

Four hormones have an integral role in breast development. Estrogen levels increase during puberty and stimulate the production of glandular breast tissue. Estrogen increases adipose tissue causing the breast to increase in size. Progesterone plays a role as well by stimulating the development of the duct system.

During pregnancy, these hormones further enhance the development of the mammary glands. Prolactin from the anterior pituitary gland stimulates the milk production inside of the glandular tissue, and oxytocin triggers the ejection of milk from the glands.

Used with permission from Medika Life

Breast surface anatomy

The breast is located on the anterior thoracic wall. It extends horizontally from the lateral border of the sternum to the mid-axillary line. Vertically, it spans between the 2nd and 6thintercostal cartilages. It lies superficially to the pectoralis major and serratus anterior muscles.

The breast is composed of two regions. The circular body is the prominent area of the breast. The axillary tail is a smaller area running along the inferior lateral edge of the pectoralis major towards the axillary fossa.

At the center of the breast is the nipple. It is made mostly of smooth muscle fibers. The pigmented area of skin surrounding the nipple is called the areolae. There are numerous sebaceous glands within the areolae . These glands enlarge during pregnancy, secreting an oily protective lubricant for the nipple.

The breast’s blood supply

The middle of the breast receives blood from the internal mammary artery, a branch of the subclavian artery.

The lateral part of the breast receives blood from four vessels:

  • Lateral thoracic and thoracoacromial branches — originate from the axillary artery.
  • Lateral mammary branches — originate from the posterior intercostal arteries (derived from the aorta). They supply the lateral aspect of the breast in the 2nd 3rd and 4th intercostal spaces.
  • Mammary branch — originates from the anterior intercostal artery.

The breast lymphatic system

Used with permission from Medika Life

The lymphatic drainage of the breast is incredibly important. Breast cancer spreads through the lymph when it spreads (metastisizes).

There are three groups of lymph nodes that receive lymph from breast tissue — the axillary nodes (75%), parasternal nodes (20%), and posterior intercostal nodes (5%).

Thank you to BeingWell for publishing this article on Medium

Originally posted on Medika Life

Blog Author: Dr. Richard Wagner

Main Blog Photo By: Jan Kopřiva on Unsplash

Now Is the Time to Try a Menstrual Cup

Coronavirus pandemic leads to a shortage of sanitary napkins and tampons

Have you been to the grocery store lately? Have you seen the panic-induced lines at Costco and Walmart due to the Coronavirus? Read more

Better Care is Needed for Postpartum Depression

A doctor learns to ask the right questions to help patients get the help they deserve.

Read more