Dr. Rose, M.D. (researcher)

Evan Jerkunica (writer)

Probiotics Can Help With Bacterial Vaginosis

There is high quality scientific research showing that probiotics can prevent and eliminate BV.E When probiotics are taken together with antibiotics treating BV, BV recurrence rates dramatically decrease. Probiotic supplementation can also prevent overgrowth of Candida albicans (yeast infection) often seen after antibiotics.F

Why Did Scientists Think Probiotics Might Help BV?

Bacterial Vaginosis (BV) is an overgrowth of bad bacteria inside the vagina. So, scientists wanted to check if good bacteria (probiotics) could fight these invading bacteria, and possibly prevent BV, cure BV, or at least decrease the symptoms of this inflammatory condition.

What Bacteria Causes BV?

The bacteria that causes BV is called Gardnerella vaginalis, and it is not supposed to be in the vagina. When G vaginalis invades, it can crowd out the native vaginal probiotic bacteria that maintain a healthy, non-inflamed, normal odor vagina.

BV Develops When G vaginalis Kicks Out Lactobacillus

The vagina’s healthy bacteria are overwhelmingly from the Lactobacillus family. They live together in a cooperative way, keeping out bad bacteria and yeasts.

But G. vaginalis can multiply rapidly, outgrow healthy vaginal bacteria, and form a slime layer that allows pathogenic bacteria to thrive. When G vaginalis overgrows, total bacteria counts in the vagina increase up to 1000 times, while the number of healthy Lactobacilli decreases.A

Things That Increase Risk of BV

Here are a few things that directly, or indirectly disrupt the vaginal probiotics that protect against BV:
  • douching (which disrupts the natural lactobacillus probiotics in the vagina)B
  • being reproductive age (post-menopausal women don’t typically get BV)C
  • being sexually active (more partners increases risk, women having sex with other women also increases BV risk)D

Antibiotic BV Treatment Often Leads to Recurring BV

The typical treatment for BV is antibiotics, and there are a variety of reliable antibiotic combinations that eliminate BV.

The problem is that the BV often comes back! Post-antibiotic recurrence of BV is almost expected. So far, doctors haven’t found a combination of antibiotics that always prevents BV from returning. This reinfection after antibiotic BV treatment has led scientists and many women to try probiotics to BV for good…and to have a lower chance of BV regrowth.

Probiotics are considered safe and should probably be taken both during antibiotic treatment, and after antibiotics, since they help maintain or regrow normal healthy bacteria after they’ve been wiped out by the antibiotics.

In addition, they help strengthen a person’s immune system, and potentially have dozens of other health benefits.

Which Probiotics Help with BV and How Are They Taken?

Lactobacilli are the heroes in treatment and prevention of BV. In research studies, this family of probiotics is taken orally or put directly into the vagina with a vaginal suppository.

In a randomized prospective clinical trial (the best kind), capsules containing Lactobacillus rhamnosus and Lactobacillus reuteri worked better for BV than intravaginal metronidazole (an antibiotic).G

BV recurrence was prevented by daily treatment with an intravaginal capsule containing L. rhamnosus, L. acidophilus, and Streptococcus thermophilus. This study lasted 11 months.H

So in summary, the probiotic strains that help with bacterial vaginosis have been shown to be:

Vaginal Fluid Transplants for BV

Late in 2019, we’ve been hearing about pilot studies on vaginal fluid transplants. This sounds like a logical treatment for people who don’t respond to antibiotic or probiotic supplementation for treating their bacterial vaginosis. It sounds very similar to the fecal transplants (FMT) for people who have digestive issues and other issues related to sub-optimal probiotics in their intestines.

Just as we screen blood transfusions for HIV, vaginal fluid transplants will need screening for std’s, viral infections and other pathogens will need to be perfected before this treatment becomes widespread. But once those issues are overcome, this is likely a very promising treatment. FMT has failed those screenings, so that treatment is banned currently in the USA for health risks.

Which Commercial Probiotics Should You Take For BV?

We are still doing our research on the best probiotics for BV. Once we know, we’ll publish it here. But since Dr. Rose and I don’t have vaginas, we don’t have direct experience with these products. We want to do more research before we start vouching for products put into your vagina.

Where should I go if I have questions?

You should definitely contact your primary care provider, or OBGYN. More information on sources for Lactobacilli can be found in this site at and . The links below may be helpful as well.

Full Reference List

  1. Donders GG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Expert opinion on pharmacotherapy. 2014 Apr 1;15(5):645-57.
  2. Ness RB, Hillier SL, Richter HE, Soper DE, Stamm C, McGregor J, Bass DC, Sweet RL, Rice P. Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Obstetrics & Gynecology. 2002 Oct 1;100(4):765-72.
  3. Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. American journal of obstetrics and gynecology. 2013 Dec 1;209(6):505-23.
  4. Amaya‐Guio J, Viveros‐Carreño DA, Sierra‐Barrios EM, Martinez‐Velasquez MY, Grillo‐Ardila CF. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD011701. DOI: 10.1002/14651858.CD011701.pub2.
  5. Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non‐pregnant women. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006055. DOI: 10.1002/14651858.CD006055.pub2.
  6. Senok AC, Verstraelen H, Temmerman M, Botta GA. Probiotics for the treatment of bacterial vaginosis. Cochrane Database of Systematic Reviews. 2009(4).
  7. Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes and Infection. 2006 Oct 1;8(12-13):2772-6.
  8. Ya W, Reifer C, Miller LE. Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. American journal of obstetrics and gynecology. 2010 Aug 1;203(2):120-e1.

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