Sunday, March 13, 2011

What about Bacterial Vaginosis?

Open any sexuality education curriculum and you will see a guideline for teaching about the usual suspects such as: HPV, Gonorrhea, Chlamydia, Syphilis, or HIV, but how about Bacterial Vaginosis? Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age.  BV is associated with an imbalance in the bacteria that are normally found in a woman’s vagina. Currently, it is unclear what role sexual activity plays in the development of BV, but what we do know is that BV is prevalent.  According to the Center for Disease Control (CDC), there were 21.2 million reported cases of BV between 1999-2004 (Koumans et al., 2007).

This is how the other conditions mentioned above measure up according to the CDC Sexually Transmitted Disease Surveillance 2009:

HPV: about 20 million cases currently, 6 million new cases each year
Gonorrhea: 301, 174 cases in 2009
Chlamydia: 1,244,180 cases in 2009
Syphilis: 13,997 cases in 2009
HIV: about  1,000,000 current cases,  56,000 new cases each year

For the most part, untreated bacterial vaginosis doesn’t cause future serious complications in the manner of HIV, syphilis, or HPV. This could be why little emphasis is put on teaching about the infection. However, the condition certainly causes a lot of shame amongst young women and for that reason, educators should take note.

The most common symptom of bacterial vaginosis is a foul, fish-like odor from the vagina. Think about the implications that could have on an impressionable young woman who has little information about her body or access to that information. This young woman may not even be sexually active. She could have gotten the infection from using a new soap around her vagina, wearing too tight non-cotton underwear, or she could have a genetic pre-disposition to getting BV.  

On the other hand, maybe she is sexually active. Maybe this young woman thinks that the infection is a result of not washing her vagina well enough, so she douches, uses perfumes and further irritates the matter, but doesn’t realize that (for the most part) her infection can only be treated by a prescription antibiotic. So this young woman continues to have sex, and maybe her similarly uneducated partners take note of her foul scent and talk to their friends about it in school and they talk to another person and before you know it, this young woman has a reputation for being ‘dirty’, ‘smelly’, and/ or ‘diseased’.

How could an educator change this potential situation?
Add BV to your repertoire. Throw it in with the other sexually transmitted infections and related conditions that you typically teach about. Put an end to the myth that women’s vaginas smell bad and educate young people about irregular odors. While doing so, be sure to mention that not all infections are related to sexual activity. If you do that, it will just perpetuate the myth that a smelly vagina is synonymous with those who have multiple partners. 

In conclusion, my suggestion is to get to know BV and tell all your friends and students about it too.

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 healthExternal Web Site Icon. 
Sex Transm Dis. 2007 Nov;34(11):864-9

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2009. Atlanta: U.S. Department of Health and Human Services; 2010 CDC. HIV Prevalence Estimates—United States, 2006. MMWR 2009;57(39):1073-76.


  1. Teaching about vaginal infections is always something that I struggle with placing.

    Keeping cognizant of the society in which we're currently living, I always want to talk about those, but I don't want to put them in the same category as STIs. STIs can be pretty stigmatized, and although in classes where I have more time, I like to work with de-stigmatization ... most classes I don't have time to cover that.

    And if I include BV and yeast infections in the STI lesson, how much of STI related Stigma gets transferred onto those infections (even with the disclaimer that they aren't always sexually related)? I also wonder if the stigma is going to be there anyway because the infections are related to the vagina ... which then is a whole other conversation.

    I do think that they're important infections to teach about, however. This has definitely gotten me thinking about where the best place to put this lesson would be, and then how to approach speaking about the infections.

    Thanks Gigi!

  2. I think this is such a great topic. While I knew what BV was, I wasn't really forced to examine it until last semester in our bio class. I now couldn't agree more with the fact that it should be included.

    I think it would be great to talk about BV when you start talking about body parts in a segment. For instance, if you introduce the vagina, it might be nice to challange myths about it, one that it is fishy-smelling. Perhaps you could then introduce BV without grouping it with STI's. You could also just talk about it if you go into depth about pH balance of the vagina, how to take care of your vagina, or common occurances with genitals. It might also be nice to cover it in a "body issues" class with girls as young girls may be just as embarrased about their vaginas as their body fat.

  3. Hi Gigi!

    This is such an important topic to bring to our attention! Working in the bar business, I tend to hear a wide array of conversations and jokes about sex, etc. One evening, a group of friends were hanging out (they were ages 25-40), and the topic of vaginas came up. While one of the heterosexual young women was talking about vaginas with her friend who identifies as a lesbian, she argued that vaginas just smell and look gross. It was very disappointing to hear a woman so ashamed of her genitals most likely due to the stigma of “smelly, icky vaginas,” but I was a bit reassured when one of the heterosexual males in the group explained how he absolutely loves vaginas and performing oral sex. I without a doubt believe that vaginal infections should be covered in sexual education, but it is vital that these infections are separated from the STI course time because they are lumped into one group FAR too often. Meg, I really like your idea of introducing vaginal infections while discussing body parts and myths involving our genitals. What a great idea!

    The absence of Bacterial Vaginosis in sexual education curricula triggers memories from biology class. When we were required to do a powerpoint presentation on either an STI or a method of contraception, I was assigned mycoplasma and ureaplasma. While everyone around me had topics like gonorrhea and condoms, I felt lost. I never heard of mycoplasma or ureaplasma in my life! It turns out that mycoplasmas are the smallest free-living bacteria and are unlike any other bacteria because they have no cell wall. Mycoplasma hominis is common in almost all humans- it resides in the urinary and genital tracts and occasionally may result in infection. Mycoplasma hominis (debatably considered an STI) frequently colonizes the genital tract of sexually active men and women as well as post-abortal/post-partum women. Symptoms include painful urination and discharge (usually foul-smelling or of unusual color)- this discharge is the extra mucous and infected fluids that are being excreted. Pain during intercourse may be experienced; an inflamed ureter may press upon the vaginal wall, and when the vagina is engorged with blood due to arousal, the two tissues press against one another= PAINFUL INTERCOURSE! Men typically have no pain or symptoms.

    Mycoplasma genitalium is fairly recently discovered and the 3rd most common STD diagnosed among young people! It is linked to bacterial vaginosis, cervicitis, PID, and endometriosis. Further more, it can be transmitted by direct contact between hosts (genital-genital or oral-genital contact) or from mother to offspring (either at birth or in utero).

    After that quick little lesson for those who are unfamiliar with mycoplasmas, I wonder, why are vitally important infections that affect so many of us not being discussed more often?!?

  4. So many women are embarrassed about their vagina, and have misconceptions about what it should and should not smell or look like. Adding this topic to a sex-ed class is a great idea, especially for girls. but its also important to stress the importance of getting medical care for what someone may think is BV.

    In bio class last spring i actually had to do my presentation on BV, yeast infections and trichomoniasis. at first, i was very confused, because all three have very similar symptoms and are often difficult to distinguish without proper medical testing. trichomoniasis is an STI no one really hears about, and a woman may have trich and think it is BV or a yeast infection and just get an OTC medication to treat a yeast infection. the only way to really distinguish between the three is taking a culture and looking under a microscope, where the doctor (or lab tech) can see if its an STI (based on the way they move under the microscope), or if it is yeast or bacteria.

    I'm not saying that BV, yeast infections and trich should be taught about in minute detail, but maybe emphasize that if you have any changes in the way your vagina smells, the way the discharge looks or if it it itchy, you should go to a doctor to get proper medical attention, instead of treating thr wrong thing.

  5. So, I would just like to say that because of your post, I included mention of BV and Yeast Infections in a curriculum that I might not have otherwise!

    Thanks for the inspiration.

  6. Wow! Being that I haven't taken biology yet, this was an eye opening post. I agree that we, as sexual educators do not fully address all of the genital issues that can come naturally only to become more complicated once a student becomes sexually active.
    I also think that it is important that we make as much information as possible, available to the student as we can provide. Thank you for this interesting information.
    Long live the healthy vagina!

  7. It is so great to have reminders of all the information we learned in Biology (or what we didn't) because I am not an anatomy person and I totally need to update my knowledge-base with BV and other vaginal infections. Not only am I going to update personally but I have to add this to the curriculum I am working with at Widener. We have trich in our presentations but most of the time, students never come up with it on their own and when we first starting educating about it, I didn't even know what it was. The same goes for BV. The numbers are what always get me, I had no idea it was so prevalent!

    Since women are one of my populations I frequently work with, I probably should have a lot more knowledge about these kinds of things. Especially for postpartum women because that's who I'm working with now so I will totally be brushing up on these things ASAP. Thank you for the re-energizing!

  8. Great topic!

    The first thing that came to my mind when thinking about why this isn’t taught more is...vaginas are yucky! For a lot of people, especially young people, there’s this idea that female genitalia is gross or dirty (and many of my fellow commenters have touched on this). To really talk about BV, the learners would first need to know what a healthy vagina looks and smells like. This gets into topics like odor, discharge, and hygiene. As Meg pointed out, this would fit quite well in a lesson about sexual anatomy. There is so much work to be done in educating the world about female anatomy. A couple weeks ago I was in a workshop with a woman (in her mid-50s) who didn’t know what vaginal discharge was. It was her first time ever hearing the words! I was astounded and it reminded me of how uninformed so many people are about female anatomy.

    I love that you bring up douching because this is a topic I frequently encounter when teaching. Fortunately, it’s a great teachable moment about the wonders of the self-cleaning vagina. However, one thing that’s tricky about this is that there is no easy answer for what a vagina should smell like (if anyone has a good answer, please let me know!). There’s lots of scents that a vagina should NOT have: flowers, sea breezes, autumn rain, etc. But for young people who are still going through adolescence and getting to know their bodies, it can be difficult to decipher the natural odor of a vulva versus an infection. Nonetheless, it’s such important information for young people to have. Thanks, Gigi!

  9. This is so important, as the other posters have commented. The fact that this isn't taught on a regular basis just reenforces the need for COMPREHENSIVE sex education. We are only given so much time so we focus on the "most common" or "most important". What if the only thing related to her reproductive system a woman ever has a problem with is BV? To that woman, the “most important” thing is learning about BV. I know it is easy to get caught up in the fight about abstinence vs. safe sex, but I think this issues like this really can expand the support for comprehensive sex education.

    To address the issue of smell, I think it is the kind of thing that women should be encouraged to examine on a regular basis- every Sunday spread your legs and smell, or something like that. Similar to a breast exam, you can't know if something is wrong if you don't know what is normal for you. It is also important to note that smell can change with diet. Those might be a good places to start.

    ~Rachel Girard

  10. If only there was more time for sex ed! BV is definitely an important topic that I would want to address with groups, especially because I see so much confusion on a regular basis in which people confuse BV, chlamydia, and gonorrhea as all one infection. I agree with Meg, talking about BV completely separately from STDs would be a great opportunity to discuss facts and myths about the vagina. BV feels to me like a more natural fit in a discussion about how to keep your body healthy – as you mention BV can be caused by some underwear, soap irritation, or other non-sexual situations.

    I really like Rachel’s point: “We are only given so much time so we focus on the ‘most common’ or ‘most important.’” Too true! But maybe we can use this as a way to compromise with or sway some people who are opposed to sex education by pointing out the many ways what we teach applies to people even if they choose not to have sex right now. Recently I was talking with a friend who said she wished that she received basic hygiene information at a young age – like telling girls they should wipe themselves front to back v. back to front to avoid spreading bacteria to the vagina. If we can find a way to work these kinds of conversations about healthy bodies/vaginas into our lessons we may be able to start changing the bad rap surrounding vaginas!

  11. This is very useful info about bacterial vaginosis, and I find out there are various natural remedies for BV we can use at home.

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