Probiotics Learning Lab Impartially created by the experts at OptiBac

Bacterial vaginosis (BV) is the most common infection in women of childbearing age, affecting approximately 1 in 3 women, and yet surprisingly many women have never even heard of it. We decided to try and raise awareness, and look at how probiotics might come into play for those who are suffering.

female body
Bacterial vaginosis affects up to one in three women

So, what exactly is bacterial vaginosis?

Bacterial vaginosis, also referred to as anerobic vaginositis, non-specific vaginitis, vaginal bacteriosis or Gardnerella vaginitis, is characterised by an overgrowth of predominantly anaerobic, and pathogenic, organisms (such as Gardnerella vaginalis, the Prevotella species, Mycoplasma hominis, and the Mobiluncus species) in the vagina, leading to a reduction in healthy Lactobacilli populations. Reduced numbers of Lactobacilli can lead to an increase in vaginal pH from a healthy acidic level of below 4.5, to a less healthy pH that can be as high as 7.0.

In effect, BV is dysbiosis in the vagina and uro-genital tract. In the same way that the flora of the GI tract can lose its healthy balance, so too can the flora in this ‘intimate’ area.

Women are often unaware that they have BV, as in 50% of cases it does not produce symptoms. However, if left untreated it can still lead to other complications, such as reduced fertility and reduced birth-weights (when pregnancy does occur). If symptoms are present, these usually include a thin, white discharge and an unpleasant, ’fishy’ odour.

What causes the condition?

Doctors are not always sure what causes vaginitis, but certain lifestyle factors increase its likelihood. Women that have more than one sexual partner expose themselves to greater numbers of potential pathogens, and increase their chances of developing BV through exposure to these pathogens, though it is pertinent to note that BV is not a sexually transmitted infection. Also, women that douche frequently, or use soaps or shower gels in the intimate area, run the risk of alkalising the area too much, which allows pathogenic strains of bacteria to flourish.

Washing with soap can alter the pH of the vagina and affect the delicate flora

However for the large majority of sufferers there is no obvious, external ‘cause’ for the dysbiosis, and in these cases we need to consider the link between the gut flora and the vaginal flora.

Due to the close anatomical proximity of the vagina to the anus, it is easy for bacteria from the GI tract to ‘trans-locate’ (i.e. migrate) from one area to the other. Any pathogenic strains of bacteria that are present in the gut can therefore infect the vaginal tract and cause an imbalance of the delicate balance of flora there.

In order to reintroduce beneficial strains of bacteria into the vagina, it is not as easy as just using any probiotic strain. The strains need to be able to survive transit through the entire length of the digestive tract, and they also need to be able to successfully migrate to, and then colonise, the vagina. Strains of probiotic bacteria that colonise well in the digestive tract, do not necessarily show good adherence to the lining of the vaginal wall.

Could probiotics help those with BV?

There have been many different clinical trials over the years, looking at the efficacy of probiotics in the treatment of BV. It is understood that the Lactobacillus genus is the predominant genus of bacteria found in a healthy vagina, so most trials have centred around one or other Lactobacillus species.

Incidentally, Joanna has just written a piece about a new 'probiotic' that is supposedly going to make women's intimate areas smell like peach! We have explored the truth behind this claim, and found that the product has been misrepresented online - but the blog post might be an interesting read.

Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®

In another randomised, double-blind, placebo-controlled study3 125 women were divided into two groups. One group received a 7-day course of antibiotics, and the second group received both the antibiotics coupled with a probiotic formulation, containing the strains L. rhamnosus GR-1® and L. reuteri RC-14®.

The probiotic supplementation was continued for a further 3 weeks after the end of the antibiotic therapy. Treatment success rates increased from just 40% (as seen with antibiotic therapy alone) to 88% (on the combination therapy)!

These two strains, were originally isolated from a healthy vaginal tract; demonstrating that they are an integral part of the vaginal microbiota.

Not only do L. rhamnosus GR-1® and L. reuteri RC-14® reach the intimate area and adhere to the wall lining, they have also been shown to effectively colonise the area, as demonstrated by their presence in vaginal swabs taken up to 3 weeks after probiotic supplementation ceased.

Graph to show efficacy of probiotic strains in supporting those with BV

Update May 2017: Another great new clinical trial also shows promise for these strains in those with BV. Healthcare practitioners can follow this link to read more about the clinical trial.

Lactobacillus brevis CD2, Lactobacillus salivarius FV2, and Lactobacillus plantarum FV9

In a rather small but well-designed double-blind, randomised, controlled trial1 34 women with BV received either a vaginal probiotic tablet (containing at least 10 viable Lactobacilli; in particular L. brevis CD2, L. salivarius FV2, and L. plantarum FV9) or a placebo for 7 days.The 2-week relief rates were 61% (11 out of 18) in the active treatment group as compared with 19% (three out of 16) in the placebo group (p = 0.017).

BV can result in unpleasant symptoms such as itchiness and odour - could probiotics help?

Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001

A double-blind, placebo-controlled, randomised trial2 sponsored by Giellepi S.p.A, Italy, showed that probiotic strains L. acidophilus GLA-14 and L. rhamnosus HN001, in combination with bovine lactoferrin RCX and as an adjuvant therapy to antibiotics, can significantly improve symptoms of BV and also decrease the recurrence rate.

48 adult women presenting with symptoms of BV received either antibiotics and an oral probiotics mixture, plus lactoferrin, for seven days; or a placebo. Those taking antibiotics, probiotics and lactoferrin took a further capsule every day for ten consecutive days a month, over a period of six months.

Symptoms such as vaginal discharge and itchiness were markedly improved with the probiotic combination therapy, in comparison to the placebo, and recurrence rates were much lower, too.


I often see women in my clinic, complaining of unusual vaginal discharge and irritation. The symptoms are both uncomfortable and slightly embarrassing for them, and often they have suffered in silence for quite some time. If they have been to their GP, most likely they will have been prescribed a course of antibiotics. This may have brought temporary relief, however this is often short-lived as over time the antibiotics actually make the situation of dysbiosis worse.

Following a low sugar diet can be helpful, to reduce the likelihood of glucose being excreted in the urine (which can promote the overgrowth of pathogenic species of bacteria in the genito-urinary tract). However, probiotic supplementation alongside these dietary changes, is always the corner stone of any natural protocol to restore the health of the vaginal flora.

If you would like to read more about probiotics for female health, check our FAQ: Which probiotics are best for women?

Healthcare practitioners might be interested to read more about the Lactobacillus genus and its strains on the Probiotics Database, over in Probiotic Professionals.

1 Mastromarino et al, (2009) 'Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis'. Clin Microbiol Infect, 15(1): 67-74
2. 1. Russo R et al. “Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial.” Beneficial Microbes, Published online ahead of print on December 10, 2018.
3. Anukam et al, 2006. .'Augmentation of antimicrobial therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14'. Microbes Infect, 8(6): 1450-4


  • Thanks for this information. I have a vaginal bacteria infection now and the smell is on and off. I'm going to try this probiotic.

  • Probiotics Learning Lab

    Hi Lisa,

    Thanks for your comments.
    I hope that you find a benefit - do come back and share your personal experience!

    Best wishes,


  • I couldn't recommend probiotics enough! I was first put on to them by a health shop as I would get recurrent cystitis and BV. I have been using them for over a year now and have found that I have not had a case of cystitis or BV once, even in the cold winter months when it would be more prevalent.

    Highly recommend!

  • Probiotics Learning Lab

    Dear Sam,

    We are just delighted that you have found such a positive benefit from using live cultures to support your genito-urinary health.
    That's fantastic news - thank you so much for sharing your experience with us.

    Warm wishes,

    Nutritional Advisor

  • I felt like I had tried everything, including acidophilus probiotics, for my BV... a friend who takes probiotics recommended the Lactobacillus to me and, 3 months in, I am SO happy to have found it! The BV cleared up after a few weeks, but I'm still taking one a day in case it returns. What an incredible change, and such a relief.

  • Probiotics Learning Lab

    Dear Chloe,

    That's such great news!
    Thank you so much for sharing this with us.

    Best wishes,

    Nutritional Advisor

  • Hello,

    I used to suffer from chronic BV and have just had a reoccurrence for the first time in 8 months. I am back to using this product as I found it helpful in the past. I wonder if you have thoughts about using a pill internally to boost the good flora?

    Many thanks!

  • Hi,
    I am using a combination of different probiotics.
    I love them !
    I had a vaginal bacteria infection but now I feel much better!
    Are there also vaginal probiotics for local use?

  • Probiotics Learning Lab

    Hello Amy and Francesca,

    Thank you both for taking the time to share your thoughts and feedback with us.
    So pleased you've found positive benefits from using probiotics for intimate health.

    In terms of probiotics as pessaries: although we know of certain strains of probiotics that were briefly trialled as a topical product, we are unable to recommend that any supplements are used as pessaries. As women's probiotics are generally shown to colonise the intimate area very effectively when administered orally, topical application should not be necessary.

    In other parts of the world where the same strains are marketed, perhaps in the US, it may be that the regulations are different and therefore these probiotics can be recommended intra-vaginally in these countries. In the UK, however, we can only recommend that you take your probiotics orally.

    With kind regards,

    Nutritional Advisor

  • Hi
    I recently purchased some probiotics for women to treat my recurring bv and I was wondering, can I take probiotics along with a course of antibiotics?

  • Probiotics Learning Lab

    Dear Joanne,

    Thank you for your enquiry.

    Many probiotic supplements can be taken alongside antibiotic treatment; however, you would ideally need to them around 1-2 hours away from the antibiotic doses. I would advise taking it with food or a snack but preferably breakfast if possible. It is also prudent to check with the individual companies as to their products' effectiveness alongside a course of antibiotics.

    I hope this helps with your enquiry.

    Kind regards,
    Nutritional Advisor

  • Hi
    Would women's probiotics be a good option to try for a 10 (nearly 11) year old girl with recurring urine infections? I note there are specific probiotics for children available but I'm not sure how beneficial they would be for this particular problem. Any advice much appreciated.

  • Probiotics Learning Lab

    Hello Col,

    Thanks for your comments.
    I can advise you that probiotics are very safe substances, but you would have to check the specific product in question to see whether it is safe for children.

    Kind regards,

    Nutritional Advisor

  • Probiotics are truly a god send. I have suffered b.v for 9.5 yrs. It has affected my relationships, my self esteem and generally my mental and physical health. Please continue with the good work!
    Many Thanks

  • Probiotics Learning Lab

    Dear Claire,

    That's amazing!
    Thank you so much for sharing your personal experience - we're delighted that you've found such a positive benefit. What brilliant news.
    It's also really helpful for other ladies who might be suffering, to learn more about how others have got on using probiotics.
    Thanks again, and I hope that you continue to experience great results.

    Best wishes,

    Nutritional advisor

  • Hi
    I use probiotics everyday which has helped enormously with reducing bloating , but I also suffer from BV and would like to take women's products. Can I take both supplements or would that be too much lactobacillus ?

  • Probiotics Learning Lab

    Hi there Michelle,

    It's very difficult to 'overdose' on probiotics, which you can read more about in our FAQ:

    It is always prudent, however, to check the labels of specific products before taking them in combination.

    I hope that this answers your question.

    Best wishes,

    Nutritional Advisor

  • Wow. I finally started taking one enteric coated probiotics supplement daily after looking for a solution for reoccurring yeast infections after menstruation. It's been about 2 weeks now and I feel the cleanse in my body. My mood and energy levels have improved since as well. Great read.
    Thank you!

  • Hello. I have been burdened by BV on and off for the past year. I also suffer from IC so whenever I get BV i'm sent into a terrible flair. I was just wondering where I can buy probiotics? Since I've heard such good things about them

  • Probiotics Learning Lab

    Dear Elizabeth,

    Thank you for your comment. It does depend on the probiotics you are looking for, but a good start would be your local health food shop.

    With warm wishes,

    Kerry Beeson BSc. (Nut. Med.) Nutritional Therapist

  • I get BV all the time. My husband and I have been married for 10+ years (faithfully) and I have tried just about EVERYTHING to make my BV go away. I just started taking probiotics yesterday because my Dr recommended to (he didn't prescribe antibiotics). I'm waiting to see how long it takes for it to actually work (if it does. I have my doubts). Wish me luck!

  • Probiotics Learning Lab

    Hi there,

    Thank you for comment.

    Wishing you all the best with the probiotics and I hope you're able to overcome the BV!

    With best wishes,


  • Hi can you use these when trying to conceive? Thanks .

  • Probiotics Learning Lab

    Hi there Meghan,

    Thanks for your question! One of our probiotics experts will get in touch with you directly.

    Wishing you the best of health.

    Kind regards,


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