Bacterial Vaginosis: What Black Women Need to Know

According to the Centers for Disease Control and Prevention, bacterial vaginosis (BV) is the most common vaginal condition in women of reproductive age in the United States, affecting approximately 21 million women. BV has also been shown to disproportionately affect Black women.

BlackDoctor.org sat down with Board-Certified Obstetrician/Gynecologist Kameelah Phillips, MD to discuss what BV is, how it differs from other vaginal infections, and its specific impact on Black women as well as the treatment options available to women living with this condition.

What is bacterial vaginosis and how does it differ from other vaginal infections?

Bacterial vaginosis is one of the most common infections of the reproductive age women. It is an overgrowth of bacteria in the vagina. Different things can offset the sort of delicate microbiome of the vagina. When that happens a certain group of bacteria get to overgrow and that’s bacterial vaginosis. In my practice, women come complaining of an increase in their vaginal discharge – that it might be a little more runny. The hallmark really is a complaint of a fishy odor or vulvar discharge and I find that often people get bacterial vaginosis confused with yeast infections.

Can you describe the difference between BV and yeast infections, and how to distinguish between them?

Bacterial vaginosis tends to be a more copious watery discharge. Yeast infections tend to be a little thicker. We describe [it] as cottage cheese-like discharge. That’s the way we distinguish them. Some people just have a vulvar irritation because there’s just so much moisture there whereas, on the other hand, with yeast it’s red, swells a little bit [and] it can feel swollen. With BV, [you] typically don’t get complaints about each or discomfort in that sense but the yeast infections can cause a ton of itch and urinary tract infection. BV, in particular, can be really embarrassing for people and because it’s so common (one in three women can get it) it can cause discomfort – it can cause embarrassment. Come to the doctor so we can help discuss treatment options for you.

What advice do you have for women dealing with the embarrassment of BV?

I think one thing is to normalize bodies and what happens with bodies and reduce the stigma in terms of bodies that may have imbalance or odor and that kind of thing because it’s such a common infection. We should talk about it with each other – with our healthcare providers especially and I think that that starts to destigmatize some of what’s going on with our bodies. It helps us feel more comfortable addressing it with our healthcare providers it also helps us talk about the options for management and treatment. With upwards of 58 percent of women having a recurrence of bacterial vaginosis, talking about it and understanding what to do to helps minimize BV as something that we should all know and be familiar with and feel comfortable talking to our doctors about.

How does BV specifically affect Black women?

We do see a disproportionate amount of BV in the Black and Hispanic community and it’s a little unclear as to why. But what we do know is that the microbiome in our population and Hispanic women can be a little different and I’m not saying that’s bad or good, but it’s just different and everyone’s microbiome for the vaginal environment is different and so that’s one reason we actually need more research so we can learn how to manage that. Culturally, I do see women who still practice douching or different internal vaginal cleaning and I do really try and discourage that because we know that douching, along with smoking and having new or multiple sex partners are risk factors for bacterial vaginosis.

Are there any preventive measures or lifestyle changes that women can make to reduce the risk of BV?

I don’t frame it as preventing BV because it can create a sense of blame. Instead, we focus on risk factors and awareness. For example, avoiding douching, which disrupts the vaginal microbiome, is important. Smoking is another risk factor, as smokers have higher rates of BV. Regarding sexual activity, whether or not it includes condoms, having multiple partners can be a risk factor. I don’t intend to shame anyone but rather to provide information for consideration. BV can still occur despite these precautions, so seeking timely treatment is crucial.

RELATED: Bacterial Vaginosis: What Causes It (And How To Deal With It)

What are the next steps for women who suspect they have BV, and what are the treatment options available?

We do this: itching? Yes. Copious discharge? Yes. Fishy odor? Yes. We often follow this algorithm, especially since it can be recurrent in the reproductive age domain. Sometimes, we use swabs, but primarily, it’s a clinical diagnosis based on examination. Healthcare providers can diagnose BV using the patient’s history as well. Patients should talk to their healthcare provider to see if they’re a candidate for treatment.

The antibiotic used is called Clindamycin, which has been a staple in medicine for a long time. We know it’s effective against bacterial vaginosis, making it a tried and true medication. The other part is Xaciato, which is a single-dose vaginal gel. Its noteworthy property is that Clindamycin is formulated in a thermosetting gel, allowing the medication to