How to Use Probiotics to Treat Bacterial Vaginosis

Bacterial vaginosis (BV) is a common vaginal infection that affects more than 21 million women ages 14 to 49. 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, how probiotics help maintain balance, the best probiotics for bacterial vaginosis, dosage, and other 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, which at 3.8 to 4.5 are 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. 

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 help you 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. 

What Probiotics Are Best for Treating BV?

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 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 (CFU). 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 so they can suggest a dose and timing that works 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, they may also recommend taking probiotics two hours after the antibiotic. 

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). 

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 1 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. 

A Word From Verywell

It may feel uncomfortable to talk to your healthcare provider about vaginal symptoms. Remember that bacterial vaginosis is a common infection and is nothing to be embarrassed about. Early treatment can help reduce the risk of complications from untreated BV, so speak with your healthcare provider if any symptoms occur.