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Vaginosis – Distinguishing between BV, LV and CV

ReThinkOil Blog Vaginosis

Vaginosis – Distinguishing between BV, LV and CV

Vaginosis occurs when the balance of healthy vaginal flora is disrupted, leading to an overgrowth or depletion of certain bacterial species. While many assume all cases of vaginosis stem from bacterial infections, there are distinct sub-types, each with its own cause, symptoms, and treatment approach. Below is a detailed breakdown of the three primary forms of vaginosis: Bacterial Vaginosis (BV), Lactobacillosis, and Cytolytic Vaginosis.

 

1. Bacterial Vaginosis (BV)

Bacterial Vaginosis is the most common form of vaginosis and occurs when there is a shift from a healthy, Lactobacillus-dominated vaginal microbiome to one where anaerobic bacteria thrive. The primary bacteria involved include Gardnerella vaginalis, Atopobium vaginae, Mobiluncus species, and other anaerobes that outcompete beneficial Lactobacillus strains.

 

Causes & Risk Factors:

  • Douching, which disrupts the vaginal pH and flora
  • Use of antibiotics that eliminate protectiveLactobacillus species
  • Multiple sexual partners or frequent unprotected intercourse
  • Smoking and poor overall vaginal hygiene
  • Hormonal changes, including pregnancy or menopause
  • Use of intrauterine devices (IUDs)

 

Symptoms:

  • Thin, watery, white or gray vaginal discharge
  • Strong fishy odor, which is particularly noticeable after intercourse
  • Mild vaginal itching or burning, though many cases are asymptomatic
  • Slight vaginal irritation but typically no significant inflammation

 

Diagnosis:

A vaginal pH level greater than 4.5 is a key indicator, as the depletion of Lactobacillus allows the vaginal environment to become more alkaline. Under a microscope, "clue cells" (vaginal epithelial cells coated with bacteria) are often present, and the Whiff Test (adding potassium hydroxide to vaginal discharge) produces a strong fishy odor.

 

Treatment Options:

Probiotics can help restore a balanced vaginal microbiome and prevent recurrence. Combine with antibiotic or natural antimicrobial therapy, such as oregano.

  • Recommended Probiotic Strains:
    • Lactobacillus crispatus (e.g.,L. crispatus CTV-05) is highly effective in recolonizing the vagina.
    • Lactobacillus rhamnosus andLactobacillus reuteri also show positive effects in rebalancing the flora.
    • Multi-strain probiotics containing vaginal-specificLactobacillus species can improve symptoms and prevent recurrence.

 

2. Lactobacillosis (Hyperlactobacillosis)

Lactobacillosis occurs when there is an overgrowth of Lactobacillus species, leading to excessive vaginal acidity. While Lactobacillus is a beneficial component of vaginal flora, an imbalance can create an overly acidic environment, causing irritation and inflammation. The condition is often misdiagnosed as a yeast infection or BV due to overlapping symptoms.

 

Causes & Risk Factors:

  • Overuse of probiotic supplements containingLactobacillus
  • Excessive consumption of fermented foods such as yogurt, kimchi, and kombucha
  • Overcorrection of BV using probiotics, leading to an imbalance in the opposite direction
  • Underlying immune dysfunction that promotes selective bacterial overgrowth

 

Symptoms:

  • Increased vaginal discharge, which is thick, white, and sometimes clumpy
  • Vaginal burning, irritation, and discomfort
  • Sensation of dryness or tightness despite increased discharge
  • No strong odor, but a mild sour smell may be present
  • Symptoms often worsen after probiotic or fermented food intake

 

Diagnosis:

Unlike BV, the vaginal pH remains within a normal or slightly low range (3.8–4.2), but microscopic examination reveals an excessive number of Lactobacillus species without the presence of clue cells or other pathogens.

 

Treatment Options:

The goal is to reduce Lactobacillus overgrowth and restore a balanced vaginal environment. This can be achieved by:

  • Temporarily discontinuing probiotic supplements and fermented foods
  • Increasing dietary diversity to encourage a broader microbiome balance
  • In some cases, a short course of antibiotics or natural antimicrobials may be helpful

 

3. Cytolytic Vaginosis

Cytolytic Vaginosis is similar to Lactobacillosis in that it results from an overabundance of Lactobacillus bacteria. However, in this condition, Lactobacillus produces excessive lactic acid, leading to extreme vaginal acidity and cytolysis (breakdown of vaginal epithelial cells). The resulting symptoms mimic those of a yeast infection, causing it to be frequently misdiagnosed.

 

Causes & Risk Factors:

  • Overuse of probiotics, particularly those containingLactobacillus acidophilus
  • Frequent douching with acidic solutions (such as vinegar-based rinses)
  • Consumption of a highly acidic diet, including excessive citrus fruits and vinegar
  • Hormonal fluctuations, particularly in perimenopause and pregnancy

 

Symptoms:

  • Burning, itching, and irritation similar to a yeast infection
  • Thick, white, non-clumpy discharge
  • Vaginal soreness and discomfort
  • Pain or discomfort during intercourse
  • Sometimes, pain with urination (dysuria) due to epithelial irritation

 

Diagnosis:

Unlike BV, which has an alkaline pH, Cytolytic Vaginosis is characterized by an abnormally low vaginal pH (<3.8). A microscopic exam shows excessive Lactobacillus along with destroyed epithelial cells, a process known as cytolysis. No fungal elements (such as yeast) or clue cells are present.

 

Treatment Options:

Since the problem is caused by excessive acidity, treatment focuses on alkalinization rather than antibiotics or antifungals. Effective interventions include:

  • Baking soda sitz baths (1-2 tablespoons in a shallow bath)
  • Baking soda douching (1 teaspoon of baking soda dissolved in warm water, used twice a week)
  • Reducing acidic foods and fermented products in the diet
  • Avoiding probiotic supplementation until balance is restored
  • Temporarily discontinuing probiotic supplements and fermented foods
  • Increasing dietary diversity to encourage a broader microbiome balance

 

Key Takeaways:

  1. Bacterial Vaginosis is caused by a decrease inLactobacillus and an overgrowth of anaerobic bacteria, leading to a fishy odor and increased vaginal pH.
  2. Lactobacillosis results from excessiveLactobacillus growth, causing an overly acidic environment with irritation and increased discharge.
  3. Cytolytic Vaginosis is a severe form ofLactobacillus overgrowth, leading to extreme acidity, vaginal epithelial damage, and yeast-like symptoms.

 

Accurately diagnosing the type of vaginosis is crucial for effective treatment. Many cases of misdiagnosis lead to unnecessary use of antibiotics or antifungals, which can further disrupt vaginal flora. Identifying the root cause and restoring microbial balance is key to long-term vaginal health.

 

Oregano is a well-studied natural antimicrobial that can be utilized to rid the body of excess bacterial and fungal overgrowth.

Suggestions for using Oregano for BV symptoms:
ReThink's Pure Oregano Essential Oil
Symptom management - properly dilute 3-5 drops of oil into carrier oil of choice, take 3x daily for 4-5 days. 
Preventative - properly dilute 3-5 drops of oil into carrier oil of choice, take once daily or every other day.
ReThink's Oil of Oregano (1:4 dilution)- each 5 drops of oil of oregano = 1 drop oregano essential oil
Symptom management - Take 15-25 drops 3x daily for 4-5 days. 
Preventative - Take 15-25 drops once daily or every other day.

Those who are self-treating with natural antimicrobials (antibiotic, antibacterial and antifungals) should monitor symptoms closely during treatment and contact a medical professional if warranted.

Whether you choose to try natural methods or traditional prescription therapy, proper genital hygiene should be practiced.
PROPER GENITAL HYGIENE
1. Wiping from front to back.
2. Washing with warm water only.
3. Avoiding scented soaps and feminine hygiene products.
4. Avoiding douching, tampons, steroid creams (unless prescribed).
5. Wearing cotton underwear.
6. Avoiding constricting, tight fitting clothing.
7. Performing monthly vulvar self-examinations (WARNING GRAPHIC CONTENT!).
8. Sleeping without underwear.

COMPARISON CHART - CANDIDIASIS, BV, LV and CV

ReThinkOil Vaginosis Diagnostic Criteria Chart- Candidiasis Infection, Bacterial Vaginosis, Vaginal lactobacillosis, Cytolic Vaginosis

References: 1,2,3,4,5,6 
1) http://ispub.com/IJANP/6/1/12743#
2) https://www.sciencedirect.com/science/article/abs/pii/S000293781290736X
3) https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm
4) https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/symptoms-causes/syc-20352279
5) https://www.womenshealth.gov/a-z-topics/bacterial-vaginosis
6) https://www.jcgo.org/index.php/jcgo/article/view/294/121

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