How to Use Probiotics for Bacterial Vaginosis (BV)

Good Bacteria Help Restore Balance in the Vagina

Medically reviewed by Monique Rainford, MD

Probiotics for bacterial vaginosis (BV) can help restore the balance of vaginal flora. BV is a common vaginal infection that affects more than 21 million women ages 14 to 49 years. It occurs when the unhealthy bacteria outweigh the healthy bacteria in the normal vaginal flora (microorganisms).

A strong “fishy” smelling vaginal discharge is the most common symptom of BV. Vaginal discharge also increases, and it is thin and (sometimes foamy) gray, greenish, yellow, or white.

Probiotics are “good," or beneficial, bacteria that naturally live in the body. They keep excess “bad,” or harmful, bacteria away and help maintain vaginal flora balance and health.

This article reviews why vaginal imbalances occur and how probiotics help maintain balance. It also discusses the best probiotics for bacterial vaginosis, dosage, and alternative treatment options.

Why Do Vaginal Imbalances Occur?

A healthy vagina has a vaginal flora consisting of bacteria, yeast, and fungi. The good bacteria and vaginal discharge keep the vagina clean and infection-free.

Typically, the vagina's pH level (acidity) helps the good bacteria to survive. Vaginal imbalances occur when there is an overgrowth of harmful or unhealthy bacteria in the vagina.

Medications, diet, hormones, sexual activity, douching, and lifestyle factors can disrupt the balance. This creates an environment in which harmful bacteria can grow and cause bacterial vaginosis.

Sexual intercourse with a male partner is an example of how sexual activity can disrupt the pH level in the vagina. A pH of 3.8 to 5.0 is ideal for normal flora to thrive.

A man's semen has a pH level between 7.1 and 8. Having vaginal intercourse increases the risk of BV because the pH in sperm increases the pH in the vagina, making it easier for bacteria to grow.

At Home Feminine Screening Tests

Vaginal pH tests, or feminine screening kits, are available for at-home testing and are easy to use. You collect a vaginal discharge sample with either litmus paper or a vaginal swab. Once collected, you can compare your results with an easy-to-read pH color chart.

You can also buy at-home tests to check the balance of the vaginal flora. The collection is similar to pH tests. However, they are packaged and sent to a lab, so results aren't immediate.

Having pH levels above 4.5 may indicate BV. In this case, contact your healthcare provider to get proper treatment.

Related: Supplements for Vaginal Health

How Do Probiotics Help Maintain Balance?

Probiotics are good bacteria that are present in your:

• Intestines

• Skin

• Lungs

• Mouth

• Urinary tract

• Vagina

Probiotics can help support your immune system, decrease inflammation, and digest food. Some studies show that probiotics help to restore the normal vaginal flora so that the bad bacteria don’t outgrow the good bacteria.

Probiotics may also be helpful for certain people who get recurrent BV. If you are not getting enough probiotics in your diet, your healthcare provider may suggest supplements.

Foods That Contain Probiotics

Probiotics naturally occur in fermented foods, such as:

• Yogurt

• Pickles

• Kombucha (fermented tea)

• Kimchi (fermented cabbage)

• Kefir (fermented dairy drink)

• Buttermilk

• Sourdough bread

• Fermented sauerkraut

• Miso soup

What Probiotics Are Best for Treating BV?

The best probiotics for treating BV are Lactobacilli-based probiotics such as Lacticasebacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus fermentum, and Lactobacillus reuteri.

Lactobacilli play a key role in maintaining vaginal health. They produce lactic acid, which creates the acidic environment needed in the vagina. Certain types of lactobacilli are used in foods or in supplements, such as probiotics.

The following are probiotics that are lactobacilli-based:

• Lacticasebacillus rhamnosus (also referred to as Lactobacillus rhamnosus or L. rhamnosus) GR-1 (or LGR-1)

• Lactobacillus acidophilus (oral or intravaginally)

• Lactobacillus fermentum RC-14

• Lactobacillus reuteri RC-14

Probiotics for BV are most effective when taken by mouth. Vaginal administration is usually less effective.

Probiotics Dosage

Probiotic supplements come in capsules, powders, wafers, liquids, and more. They also come in suppositories that you insert into the vagina.

Probiotics have different strengths, ranging from one to 50 billion colony-forming units (CFUs). While there is no set dosage, the recommendation is for adults to start with probiotics with at least 1 billion CFUs.

Talk with your healthcare provider to find out what dose and timing would work for you. The following are some common probiotic regimens that your healthcare provider may recommend:

• Two capsules daily for six weeks

• Two capsules for seven days, nothing for the next seven days, then two capsules for another seven days
  

• Once weekly, for several months, if taken intravaginally

• Two capsules daily (continuously) for recurring BV

If you are taking antibiotics, your healthcare provider may also recommend taking probiotics two hours after the antibiotic.

How Long Do Probiotics Take to Work?

The length of time it takes for probiotics to work for BV varies on the person and severity of BV. Whether the probiotics are taken along with antibiotics also makes a difference.

Probiotics can start working within five days, but BV can take a couple of months to completely resolve, especially for those with recurring infections.

Using Probiotics to Prevent BV

You can use probiotics to help prevent BV. Probiotics can help keep the natural flora in the vagina balanced. This creates an environment where good bacteria thrive, which keeps bad bacteria from overgrowing.

After your initial BV has been cured, taking probiotics may reduce your chances of BV returning by almost half. This effect may last for one month or more.

Side Effects of Probiotics for BV

Probiotics are considered safe for otherwise healthy people. Possible side effects include:

• Upset stomach

• Bloating

• Gas

• Constipation

• Increased thirst

While the research is limited, some have shown possible harmful effects, such as infections for those with compromised immune systems or severe illnesses.

People with food allergies should check ingredients carefully, as some probiotic supplements may contain allergens such as milk, yeast, egg, soy, or gluten.

Other BV Treatment Options

BV is typically treated with one of the following antibiotics:

• Flagyl (metronidazole)

• Clindacin, Cleocin, Clindesse (clindamycin)

• Tindamax, Fasigyn, Simplotan (tinidazole)

Your healthcare provider may also consider:

• Boric acid

• Vaginal vitamin C

• Xifaxan (rifaximin)

• Sucrose gel

Your provider may prescribe these medications as pills taken by mouth or as a vaginal cream or gel. Sometimes healthcare providers prescribe both oral and vaginal medicines for you to take at the same time. This is especially true for recurring infections (those that come back repeatedly).

Research has shown that when taken with antibiotics, probiotics are even more effective than either treatment alone.

Summary

Bacterial vaginosis occurs when there is an imbalance in the normal flora of the vagina. Medications, diet, hormones, sexual activity, and more can cause an imbalance where the bad bacteria outgrow the good bacteria.

Probiotics are good bacteria that can help restore balance in the vaginal flora. Lactobacilli-based probiotics are best for treating BV. There is no set dosage for probiotics, but the recommendation is that adults start with probiotic supplements with at least one billion colony-forming units (CFUs).

Bacterial vaginosis is also treated with oral or vaginal antibiotics. Probiotics are often recommended in addition to these antibiotics to help fight recurring BV.

Read the original article on Verywell Health.