Bacterial Vaginosis – Recognise, Treat, Prevent

The discharge is thinner than usual, more grey than white, and there is that smell – slightly fishy, often stronger after sex. Itching? Hardly any. If you are thinking of thrush now, you are often wrong: this exact picture usually points to bacterial vaginosis. It is one of the most common causes of changed discharge altogether, and it has nothing to do with poor hygiene. What you can do yourself is limited but effective: condoms, little soap and no fragrance where it does not belong.

First, and we mean this seriously: this article does not replace a visit to a doctor. Changed discharge has many possible causes, including sexually transmitted infections that can look similar. Whether it really is vaginosis is clarified by a gynaecologist with a simple swab. This is about putting the signs into context and understanding what helps in everyday life.

🔬 What is going on

A healthy vaginal flora is dominated by lactic acid bacteria, the lactobacilli. They keep the environment acidic, and in an acidic environment other germs have a hard time. With bacterial vaginosis the lactobacilli decline, the pH rises and other bacteria – Gardnerella is the best known – multiply strongly. So it is not an infection with a foreign pathogen, but a balance that has tipped.

The typical smell comes from metabolic products of these bacteria. That it gets stronger after sex has a simple reason: semen is slightly alkaline and makes the odour compounds more volatile. Many people affected have no symptoms at all and notice nothing.

🧭 Vaginosis or thrush?

The two are mixed up all the time, which is exactly why treating yourself on a hunch is not a good idea: an antifungal does nothing against bacteria. As a rough guide, not a diagnosis:

Feature	Bacterial vaginosis	Thrush
Discharge	thin, greyish-white	white, rather crumbly
Smell	fishy, stronger after sex	usually unremarkable
Itching and burning	rarely the main complaint	typical, often strong
Environment	pH raised	pH usually normal
Treatment	prescribed by a doctor	see a doctor, especially the first time

There is more on thrush and on when a break makes sense in our article Thrush & Sex. If it mainly burns when you pee, think of the urinary tract instead – see our article on cystitis after sex.

🩺 What happens at the doctor's

Diagnosis is straightforward: a swab, a pH test, a look under the microscope. Treatment is usually a prescription medicine, as tablets or for local use. Which one, for how long and whether your partner is included is for the doctor to decide. What matters is finishing the treatment, even if the smell has gone after a short time.

During pregnancy: changed discharge should always be checked promptly, not at the next routine appointment.

🛡️ What you can do yourself

There is no guarantee, and for some people vaginosis comes back without any obvious trigger. These habits do take pressure off the environment, though:

• Use condoms, especially with new partners. They keep semen away from the vaginal environment. The Durex Invisible is the brand's thinnest latex condom; if you cannot tolerate latex, go for the Skyn Elite made of polyisoprene. How a condom fits properly is shown in our condom guide.
• No vaginal douching. It washes away exactly the bacteria that keep the environment acidic.
• Little soap, no fragrance. On the outside, clear water or a mild pH-balanced wash is enough. Why intimate sprays only mask the smell is explained in our article on intimate sprays and deodorants.
• Neutral lubricant. If you need one, choose it without flavour, warming or cooling effect. According to the tube, the JoyDivision AQUAglide is kind to skin and mucous membranes, water-soluble, fat-free, condom-friendly and pH-optimised.
• Keep toys clean. Anything that switches between anal and vaginal use is cleaned in between or gets a fresh condom.

🧼 Toys during and after treatment

Used toys can carry bacteria back into a freshly treated environment. So: clean them thoroughly with lukewarm water and mild soap, then let them dry completely. On the go, the Intimate & Toy Cleaner is handy, but it does not replace the sink. With silicone, TPE and jelly an alcohol-free cleaner such as the Touché toy cleaner is worth it, because alcohol dries the surface out. Everything else is in our sex toy care guide.

❓ Frequently asked questions

🔁 Is bacterial vaginosis a sexually transmitted infection?

Not in the classic sense, because no foreign pathogen is passed on. Sex does play a part, though: new partners and sex without a condom make it more likely. That is why the topic still belongs under safer sex.

⏸️ Can we have sex during treatment?

Most doctors advise a break until the treatment is finished, or using condoms. Some products for local use can also damage latex – that is in the package leaflet, and you should read it yourself.

🌸 Does an intimate spray help against the smell?

It only masks it briefly and can irritate the mucous membrane further. The smell is a signal, not a cosmetic problem. Spraying it away only postpones the visit to the doctor.

📆 Why does it keep coming back?

Recurrences are not unusual with vaginosis, and the reasons are not always clear. If it comes back often, raise it explicitly. There are different treatment approaches for those cases than for the first time.

✅ Conclusion

Bacterial vaginosis is common, unpleasant and nothing to be ashamed of. The fishy smell and the thin grey discharge are the typical signs; only a swab at the doctor's brings certainty, though, and this article does not replace it. What you can do yourself: use condoms, skip douching and fragrance, choose a neutral lubricant and keep your toys clean and dry. The treatment takes care of the rest.

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