Itching, soreness, burning, unusual discharge—these are all common, uncomfy signs that something’s up with your vagina. But even when you know something is off, sometimes it’s still hard to pinpoint exactly WTF is going on down there. Is it a yeast infection? Or bacterial vaginosis? And whatever it is, why is it happening, and how can you make it stop ASAP?
We may have all experienced one—or both—of these conditions at some point in our lives. But don’t worry—it’s normal to have a pH imbalance from time to time in your life. At first, bacterial vaginosis (BV) and yeast infections may appear to be very similar due to their comparable symptoms, but the causes and treatment are totally different. So, how exactly can we discern between the two?
Mary Jane Minkin, MD, and OB GYN at Yale University says that BV “is caused by a relative overgrowth of some bacteria that don't like oxygen a lot (so-called anaerobes) and a decrease in the good guy bacteria of the vagina, the lactobacilli.” Meanwhile, yeast is “often associated with a change in the normal vaginal flora—particularly if you take an antibiotic which kills the good guy lactobacilli and lets the yeast take over.”
BV is a bacterial infection, whereas yeast is fungal due to an overgrowth of Candida fungus. Candida lives inside of the body—in the mouth, throat, gut, and vagina—and on the skin. Researchers say that approximately 20% of folks have Candida without showing any symptoms in the vagina. BV is considered a “vaginosis” which is an infection of the vagina, whereas yeast is considered “vaginitis,” which is an inflammation of the vagina.
BV is the most common type of vaginal condition, and yeast infections come in second. This led me to wonder—how many times have I confused these two conditions without seeking proper treatment?
Causes of BV and yeast infections
BV occurs when there is too much bacteria in the vagina, either from a pH balance change or an overgrowth of Gardnerella vaginalis bacteria. A pH balance change can be caused by hormonal changes, pregnancy, excessive douching, or penis-in-vagina intercourse.
Researchers are still stumped about the cause of BV, and why some patients get it more frequently than others. Most studies state that sexually active folks may be disrupting their bacteria balance during intercourse, but researchers still don’t know how intercourse can contribute to BV. We do know that if one partner has it, the other has it too, and they pass the condition back and forth to one another. Since having BV can increase your chances of getting an STI, it’s best to treat it right away.
As for yeast infections, changing medications can impact your pH levels. Taking antibiotics can kill bacteria in the body, but they may also kill the aforementioned “good” kind of bacteria. This bacteria keeps the vagina slightly acidic by keeping yeast to a minimum, but when it’s reduced, yeast grows excessively in the vagina. Birth control pills, pregnancy, and hormonal changes can all influence this increase.
The reason these two conditions are so commonly confused is because they have several similarities in symptoms, like vaginal itching, burning sensations, and overall discomfort. The one major difference, however, is in discharge color and odor.
Symptoms of a yeast infection
Both conditions cause unusual vaginal discharge. A yeast discharge is thick like cottage cheese, doesn’t have a scent, and is typically white in color. There may be redness or swelling around the opening of the vagina, too. Burning, pain, and soreness can all be present if you have a yeast infection. A burning sensation during sex is especially worth looking into.
If you’re pregnant, have diabetes or a weakened immune system, or are taking antibiotics or birth control, you may be more likely to get a yeast infection. 1.4 million patients struggle with yeast infections annually in the U.S.
Symptoms of BV
Research shows that most people who have BV don’t show any symptoms. But if you do have symptoms, they’ll typically include a yellow or gray discharge that has a strong, unpleasant odor—people often describe it as chemical or “fishy.” After sex, this smell may get stronger, and after urination, there may be burning or vaginal itching.
Minkin says that BV can set you up for “acquiring some STIs like gonorrhea and chlamydia, and if someone gets pregnant with BV, they run a higher risk of preterm labor.”
Treatment for a yeast infection
Over-the-counter (OTC) medication is typically best for treating yeast infections. Dr. Minkin says, “There are plenty of over-the-counter yeast vaginitis products to insert into the vagina, so if you have a cottage-cheese-like discharge and are itchy, [you should] treat it.”
Although antibiotics can contribute to yeast infections, doctors may prescribe the oral antifungal pill fluconazole. If you have chronic yeast infections, consider taking a probiotic that contains lactobacillus.
Treatment for BV
Prescription medication and antibiotics are used to treat BV. However, BV can return 3 to 12 months after treatment.
BV can lead to some serious health complications, from increasing your chances of acquiring an STI, to pregnancy complications, to pelvic inflammatory disease (PID).
You can pass both of these conditions on to your partner(s), so it’s best to contact a doctor right away if you have any similar symptoms.
Prevention for both conditions
Try to balance your vagina’s natural microbial environment. You can do this by wiping from front to back when using the bathroom, wearing loose clothing and cotton underwear, changing out of wet clothes, not spending a lot of time in the bathtub, avoiding strongly scented fragrances and douching, and taking probiotics.
Dr. Minkin says that “one good rule for prevention of just about any infectious vaginal condition [is to] never have unprotected sex unless you’re in a mutually monogamous relationship and you and your partner have been STI-tested.”
If you feel like you have any discharge or foul odor, visit your doctor right away to get a pelvic exam. Medication and treatment can get your vagina back to the sexy, happy self it’s meant to be.
Photo by Ashley Armitage for Refinery29.