Bacterial vaginosis
Also known as: bacterial vaginosis, BV, vaginal dysbiosis, Gardnerella-associated vaginosis, anaerobic vaginal dysbiosis, recurrent bacterial vaginosis, abnormal vaginal discharge
Bacterial vaginosis is a common vaginal condition caused by disruption of the usual vaginal microbiome, with a reduction in protective Lactobacillus species and an increase in diverse anaerobic bacteria. It is not adequately described as infection by one organism, and finding Gardnerella vaginalis alone does not confirm the diagnosis. Many people have no symptoms. When symptoms occur, the most characteristic presentation is a thin, uniform white or grey vaginal discharge with a noticeable fish-like odour, which may become more apparent after sex or during menstruation. Marked itching, vulval inflammation, pelvic pain, fever, ulcers or significant pain during urination are not typical and should prompt assessment for candidiasis, trichomoniasis, cervicitis, urinary infection, dermatitis, retained foreign material or another condition. BV is associated with sexual activity but is not classified straightforwardly as a conventional sexually transmitted infection. New or multiple partners, vaginal douching and changes affecting the vaginal environment may increase risk, while BV can also occur without sexual activity. Diagnosis may use clinical examination, vaginal pH, microscopy, Amsel criteria or validated laboratory testing. Symptomatic BV is generally treated with an appropriate antibiotic such as metronidazole or clindamycin according to current clinical guidance. Recurrence is common and does not necessarily indicate treatment failure, poor hygiene or infidelity. BV during pregnancy is associated with adverse pregnancy outcomes, so symptomatic pregnant patients should receive prompt maternity or medical assessment. Acupuncture and Chinese herbal medicine have not been established as substitutes for antibiotic treatment and cannot reliably restore the vaginal microbiome or prevent pregnancy complications. No substance, herb, needle, steam, smoke or cleansing solution should be inserted into the vagina as part of TCM treatment. Adjunctive care should focus on comfort, informed sexual-health assessment, recurrence support and avoidance of harmful intravaginal practices. [1][2][3][4][5][6]
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Lifestyle & Diet
- •Complete the full course of prescribed antibiotic treatment.
- •Return for review if symptoms persist or recur.
- •Avoid vaginal douching because it disrupts the vaginal environment and may increase recurrence risk.
- •Do not use fragranced washes, deodorants, antiseptics or wipes inside the vagina.
- •Wash the external vulval area gently with water or a mild fragrance-free product when needed.
- •Do not attempt to remove normal vaginal bacteria through cleansing.
- •Avoid vaginal steaming.
- •Do not insert yoghurt, garlic, vinegar, essential oils or homemade remedies into the vagina.
- •Use condoms or barriers according to sexual-health advice and personal circumstances.
- •Arrange STI testing when there is a new partner, multiple partners, possible exposure or symptoms suggesting another infection.
- •Discuss recurrent BV with a sexual-health or gynaecology clinician.
- •Do not assume recurrence proves that a partner was unfaithful.
- •Follow current clinician advice about partner assessment or treatment because recommendations may differ according to circumstances and evolving evidence.
- •Seek pregnancy testing when pregnancy is possible and menstruation is late or abnormal.
- •Pregnant patients should contact their doctor or maternity team about symptomatic BV.
- •Avoid alcohol when advised during metronidazole treatment and follow the medicine-specific instructions provided by the prescriber or pharmacist.
- •Report severe diarrhoea, rash, numbness, swelling or other concerning medicine reactions.
- •Use non-stigmatising language because BV is common and is not caused by being unclean.
- •Wear comfortable, breathable underwear if this improves comfort, while recognising clothing does not cure BV.
- •Change tampons and menstrual products as directed and ensure none are retained.
- •Use adequate lubricant during sex when dryness or friction is present.
- •Seek medical advice for bleeding, pelvic pain, fever, ulcers or severe itching.
- •Do not rely on over-the-counter thrush treatment when symptoms have not been diagnosed.
- •Discuss probiotic products with a clinician; product quality and evidence vary, and they should not replace prescribed treatment.
- •Maintain routine cervical screening and reproductive-health care.
Cautions & Contraindications
- •Do not claim that acupuncture or Chinese herbal medicine cures BV or permanently restores the vaginal microbiome.
- •Do not replace metronidazole, clindamycin or another recommended treatment with herbs or acupuncture.
- •Do not insert herbal medicines, powders, oils, pessaries or tinctures into the vagina unless they are regulated products specifically prescribed by an appropriate medical clinician.
- •Do not use vaginal steaming, moxibustion smoke or fumigation as treatment.
- •Do not douche with vinegar, antiseptic, hydrogen peroxide, bleach, salt water or herbal decoctions.
- •Do not advise the patient to clean inside the vagina.
- •Do not diagnose BV solely from odour.
- •Do not assume itching or thick discharge is BV.
- •Do not delay pregnancy testing, STI testing or pelvic examination.
- •Do not use lower-abdominal or strongly stimulating acupuncture without pregnancy screening.
- •Do not use strong Blood-moving herbs during pregnancy or around unexplained vaginal bleeding.
- •Dāng Guī, Chuān Xiōng, Táo Rén, Hóng Huā, Niú Xī, Sān Léng and É Zhú require pregnancy and bleeding-risk precautions.
- •Dà Huáng and other purgative herbs may cause cramping, diarrhoea, dehydration and electrolyte disturbance.
- •Fù Zǐ and related aconite herbs carry potentially fatal cardiac and neurological toxicity.
- •Gān Cǎo may cause hypertension, fluid retention and hypokalaemia and may interact with multiple medicines.
- •Mù Tōng and Fáng Jǐ must be botanically authenticated to exclude aristolochic-acid-containing substitutions.
- •Do not use products containing Aristolochia species or aristolochic acid.
- •Avoid unregulated products that may contain steroids, antimicrobials, heavy metals or undeclared pharmaceuticals.
- •Review oral herbs for pregnancy, breastfeeding, liver disease, kidney disease, allergies and medicine interactions.
- •Do not interpret worsening discharge, bleeding, fever, pelvic pain or treatment reactions as detoxification or healing.
Frequently Asked Questions
What is bacterial vaginosis?+
Bacterial vaginosis is an imbalance in the vaginal microbiome involving fewer protective Lactobacillus bacteria and increased anaerobic bacteria [3].
What are the usual symptoms of BV?+
Typical symptoms include thin white or grey discharge and a fish-like vaginal odour, although many people have no symptoms [3].
Is bacterial vaginosis an STI?+
BV is associated with sexual activity but is not classified simply as a conventional sexually transmitted infection. Testing for STIs may still be appropriate [3].
Does BV mean someone has poor hygiene?+
No. BV is not caused by being unclean, and washing inside the vagina can disrupt the microbiome further [3].
How is bacterial vaginosis treated?+
Symptomatic BV is generally treated with an appropriate antibiotic such as metronidazole or clindamycin according to clinical guidance [3].
Can BV return after treatment?+
Yes. Recurrence is common and may require diagnostic confirmation and a clinician-directed recurrence plan [3].
Is BV important during pregnancy?+
Yes. Symptomatic pregnant patients should seek medical or maternity care because BV is associated with adverse pregnancy outcomes [3].
Can acupuncture cure bacterial vaginosis?+
No. Acupuncture has not been shown to eliminate BV-associated bacteria or replace antibiotic treatment [7].
Can herbal products be inserted into the vagina?+
No unregulated herbal product, essential oil, steam or homemade remedy should be inserted into the vagina because it may cause irritation, burns or infection [7].
When does vaginal discharge require urgent assessment?+
Urgent assessment is needed when discharge occurs with severe pelvic pain, fever, pregnancy complications, collapse, heavy bleeding or serious systemic symptoms [3].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- Healthdirect Australia · 2026
Australian guidance on vaginal microbiome imbalance, symptoms, diagnosis, treatment and indications for medical care.
- World Health Organization · 2025
Current international overview of BV, epidemiology, symptoms, risk factors, complications and treatment.
- United States Centers for Disease Control and Prevention · 2021
Clinical diagnostic, treatment, pregnancy, recurrence and sexual-health guidance.
- United States Centers for Disease Control and Prevention · 2023
Patient information regarding symptoms, antibiotic treatment, recurrence and sexual-health considerations.
- NHS · 2025
Clinical information on common discharge characteristics, diagnosis, treatment and recurrence.
- Healthdirect Australia · 2026
Australian differential guidance for normal and abnormal vaginal discharge.
- World Health Organization · 2008
Standard acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2021
International reference for acupuncture competence, consent, procedures and safety.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.