“What are you doing?”

“I think my vagina smells. I’m airing it out. Can you smell it? I think I can smell it.”

This is just one of the many ridiculous things you do when you are filled with the paranoia that comes with what seems to be everlasting bacterial vaginosis (BV).

You stand on city corners like Wonder Woman and ask your friend if she can catch a whiff of your lady parts while you wait to cross the road (she couldn’t, but I still swear I could).

You take drastic measures into your own hands as you search the interwebs for any clue as to how to get rid of this menacing thorn in your hoo-ha as you cry, wondering what you ever did to deserve smelly sex and milky underpants.

This is where my pain becomes your benefit. I’ve done all the deep dives into medical journals, foreign websites, hippie remedies, and outlandish theories to see what works in curbing what good ole WebMD calls a “mild problem that may go away on its own.”

(Any woman who has ever dealt with it would hardly call it a mild problem, especially when it continually reappears in your life.)

What is bacterial vaginosis?

First, let’s talk about what it’s not. It’s not a sexually transmitted infection, although it is often lumped together with such classifications when you’re looking for information on it.

It doesn’t make you dirty. And it should no longer be a hushed infection that many women deal with behind closed doors and in shame.

As my nurse practitioner at Planned Parenthood explained, it’s simply an imbalance in your vaginal bacteria. When your pH levels become too high the “good” bacteria—lactobacilli—can’t keep up with the body’s productions of naturally occurring “bad” bacteria that thrives and takes over in high pH environments.

That’s it. An imbalance. Nothing to be ashamed of. In fact, BV is the most common infection in women aged 15-44.

Symptoms and causes of bacterial vaginosis.

Some women have no symptoms at all. For those who do, symptoms usually include:

• A strong, fishlike odor, especially after sex.
• Thick or frothy discharge, usually white or grayish
• Itching, burning, or other pain

So what causes it? While it’s the most common vaginal ailment, the causes are largely unknown. While having a new (or multiple) sex partner(s) and douching are thought to increase your chances of bacterial vaginosis, these aren’t the only factors, and they don’t always cause it.

The Center for Disease Control warns of serious health risks if BV isn’t treated. These include:

• Increasing your chance of getting HIV if you have sex with someone who is infected with HIV
• If you are HIV positive, increasing your chance of passing HIV to your sex partner
• Making it more likely that you will deliver your baby too early if you have BV while pregnant
• Increasing your chance of getting other STDs, such as chlamydia and gonorrhea. These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

What affects vaginal pH?

Bacterial vaginosis comes down to an imbalance of your vagina’s pH levels. The normal range for your vagina’s pH is 3.8 to 4.5. Several things can cause it to be thrown off, making your body an invitation for BV:

• Your period: Blood has a pH of 7.4, so menstruation temporarily elevates your pH levels.
• Unprotected sex: semen has a pH of 7.1 to 8, so his sperm may be to blame.
• Conventional tampons: not only do they soak up and keep your period fluids in your body, but they often contain perfumes and other chemicals with pH levels higher than your body’s natural state.
• Soaps: again with the perfumes, chemicals, and dyes.
• Douching: douching upsets the natural balance going on in your body, therefore potentially creating an environment in which the bad bacteria can take over.
• Menopause or pregnancy: fluctuating hormones can increase your pH levels.

Normally, your body produces enough “good” bacteria to keep things in check. But when your body is struggling to produce lactobacilli or your pH is already elevated, it needs a little extra tender, loving help to avoid getting bacterial vaginosis.

Medical treatment for bacterial vaginosis.

The most common treatment—and one I have intimate, first-hand knowledge of thanks to years of recurrences—is metronidazole. Your doctor will perform a vaginal wet mount (basically just a swab of your vagina to see if you have an infection) and, if you do have BV, give you 7 days’ worth of metallic tasting, chalky pills to take every 12 hours, not to be mixed with alcohol. For many women, these pills do the trick and they can go on with their lives.

But then, there are the rest of us. According to the Mayo Clinic, even after treatment, BV is likely to recur within 3-12 months. Doctors can prescribe a more rigorous round of metronidazole in a gel form, administered directly into the vagina over the course of two weeks to six months, depending on the doctor’s recommendation.

For me, neither worked. And I dealt with BV coming back every 6–8 weeks for almost a decade. It was a vicious cycle of treatment that wiped out all bacteria, followed by an occasional yeast infection which was then treated, only to come back to the “bad” bacteria over-multiplying once again because my body was never given the chance to let the good bacteria flourish. And while it’s up to you and your doctor whether you take the antibiotics, I have come to realize that there are other things I can do to make sure that the bacterial vaginosis stays away once the antibiotics have done their job.

How to balance your pH.

I’ll warn you now, this is an extensive list, and everyone’s body is unique. What may work for one woman may not work for the next but a few of these things are bound to help.

• Apple cider vinegar: drink it, bathe in it, learn to love it. Drinking it helps transform the body from the inside. A weekly bath with a couple cups of apple cider vinegar helps your body balance its pH levels naturally.
• Probiotics: there are probiotics that are tailored specifically to vaginal health and these are the ones I recommend. Be sure to get them from a store that keeps their probiotics refrigerated, it keeps more of the strains within them alive, making them more effective. 
• Yogurt: plain and kefir yogurts naturally contain acidophilus, which helps your body rebalance.
• Breathable moments: wear cotton underwear, remove wet or sweaty panties as soon as possible, and consider going to bed sans-underwear.
• Boric acid suppositories: these are lethal if ingested…do not swallow! I heard about these in passing while volunteering at Planned Parenthood and they have changed my life. On the last day of your period, and for 2–3 days following, simply insert a boric acid suppository before bed. It helps the body lower your internal pH, giving the good bacteria a chance to thrive.
• Condoms: they aren’t always fun, but your health and pH balance is worth it.
• Natural or no soaps: use soaps that are as natural as possible on your body, and avoid the vaginal region altogether.
• Hydrogen peroxide: a good alternative if you feel you need to wash between your legs is a combination of hydrogen peroxide and water. The lactobacilli are a natural producer of hydrogen peroxide, so it helps to nix the bad bacteria while allowing the lactobacilli to remain. Do not douche with it. Simply rinse, or use on a washcloth to wash your outer labia.

At the end of the day, know that you aren’t alone and that there is a light at the end of the tunnel. Follow these tips and the next time you do your open-legged power stance on the side of a city street, it will be because you feel like Wonder Woman.

Please note you should consult your doctor if you think you might be experiencing symptoms of bacterial vaginosis.