‘Twas quite a journey.
The freezer after an outage. The garbage disposal after a salmon dinner. The hands of a fishmonger. These things that emit a vague fish order. Formerly on that list: My vagina.
For nearly a decade, every two to three months or so, while going about my day I’d notice the stench of week-old fish wafting up from between my legs. Each time I knew: that stubborn bacterial vaginosis had returned. Apparently, I’m not the only one who's gotten stuck on the BV hamster wheel: According to the CDC, bacterial vaginosis is the most common cause of vaginal symptoms among women, with an estimated 21.2 million women in the U.S. impacted.
I had the routine down: Aroma, antibiotics, repeat. The cycle continued, giving me serious vagina anxiety in the process, until a gynecologist friend (bless her) suggested that I learn more about my vaginal pH — I’ve now been BV-free for 12 whole months. Turns out a chemical process you learned about in seventh grade has everything to do with vaginal health.
For those unfamiliar, pH balance in the vagina ensures it’s healthy and functioning properly. On the pH scale which runs from battery acid acidic (0) to drain cleaner basic (14) on the pH scale, a healthy vagina falls closer to the battery acid end. “The pH of your vagina should measure somewhere between 3.8 and 4.5,” says Felice Gersh, MD, author of PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness. Meaning, a healthy honeypot is pretty darn acidic.
Why is the vagina is so acidic, exactly? One word: bacteria.
Dr. Gersh explains: There are millions and millions of bacteria living inside your vaginal canal which make up your vaginal microbiome. (Indeed, box bacteria sound gross, but these guys function as your vagina’s team of bodyguards, warding off bad bacteria.)
The most abundant type of good bacteria are known as Lactobacilli. Responsible for nearly 90% of the bacteria in the vagina, Lactobacilli produces two acidic substances, lactic acid and hydrogen peroxide, which help keep the vagina too acidic for infectious agents like e. Coli, Staph, and Candida (aka yeast) to survive, she explains.
How Vaginal pH Is Connected To Vaginal Health
Just because a healthy vagina falls within a specific pH range doesn’t mean all vaginas do.
Sometimes the quantity of Lactobacilli dips down, due to a variety of reasons that range from emotional stress to menopause. When that happens, the vagina isn’t acidic enough to kill off infectious-causing bacteria and yeast. “A high vaginal pH level puts you at risk for a bunch of different infections,” says Gersh. Most commonly: bacterial vaginosis, she says.
Annoyingly, once the makeup of the vaginal microbiome gets altered, and the pH changes, it’s difficult to re-establish a healthy pH level and microbiome, she says — that’s the reason so many people with bacterial vaginosis have recurrent infections.
The go-to bacterial vaginosis medication, for example, can effectively kill off the overgrowth of ‘bad’ bacteria causing the infection. But the meds don’t help repopulate the microbiome with protective Lactobacilli, she says, which leaves the vagina susceptible to another stint with BV, and other infections, too.
What Causes Vaginal pH Changes
The vaginal pH is impacted by everything from what we wear and wash with, to our emotions and medications, to sex life and birth control and barrier choices, and more, according to Dr. Gersh.
The biggest cause is hormonal imbalance. The Lactobacilli need to feed on glycogen to stay alive, healthy, and fighting. “In order for the vagina to produce the requisite glycogen, your body needs estrogen,” she explains. When your estrogen levels drop, so does the amount of food available for the Lactobacilli. The result? Some of these bodyguard bacteria die off, leaving the vagina more susceptible to infection. Le sigh.
Due to the hormonal flux, menopause, perimenopause, and postpartum are all associated with higher levels of vaginal issues, according to Dr. Gersh. “Some people who go on hormonal birth control will also notice they begin to get infections like BV more frequently because the contraceptive is changing the vaginal microbiome,” she says.
Another common cause of pH change is male ejaculation. The pH of semen is between 7.2 and 8.0 because sperm need a basic environment to survive and thrive. Most vagina-havers are able to handle being ejaculated into, but “the introduction of semen can cause problems for people prone to vaginal pH,” she says. Unprotected sex with a penis in general (with a new or existing partner) can throw off your pH balance, so it is often recommended to use the restroom before and after intercourse to flush out bateria that may have collected in your vagina.
How I Hacked My Vaginal pH To Stop Bacterial Vaginosis
For most of the time I’ve been plagued by recurrent BV, I’ve been in monogamous (trusting!) relationships with other vagina-havers. Meaning, birth control and semen were definitely not the culprit of my troubles.
When I told Dr. Gersh about my constant struggles with the fishy infection as well as my limited experience with birth control and semen, she suggested I take inventory of all the hygiene products I use. “Any products you use that could come into contact with your vagina that have irritants could be the cause,” she told me. I don’t douche, but apparently any product that was touching my vulva could lead to irritation further inside my body.
I’m a simple scent kinda girl who holds her nose when walking past Bath & Body Works in the mall. So I was shocked when eyeing the ingredient lists on the products in my laundry closet or shower shelf only to see hard-to-pronounce fragrance after hard-to-pronounce fragrance on everything from my body wash (Old Spice, thank you very much) and shaving cream to laundry detergent and dryer sheets. I donated them all to my friend with an iron snatch (she never gets BV), and replaced them with some fragrance-free (read: sensitive-coochie-approved) options.
She also suggested I incorporate an oral probiotic into my diet, change out of my sweaty workout leggings ASAP, and wear breathable panties to bed.
Since then, I haven’t had bacterial vaginosis once, the longest chunk of time I’ve gone without smelling rotting char waft from my vagina since I was in high school!
How You Can Biohack Your Own Vagina To Stop BV
If you, too, have fallen victim to regular vaginal odor (and the awkward itching that usually accompanies the infection) learning more about your own vaginal pH and the things you’re doing that may be affecting it might be useful.
But before you do that, Dr. Gersh recommends getting a full STI panel and talking to your doctor about your recurrent symptoms. “Itching and foul smell are symptoms of common STIs, too,” she says. Before self-diagnosing, it’s important to rule out other kinds of infections. Plus, while all STIs can be treated or cured, left untreated they can become serious.
A healthcare provider will also be able to come up with a game plan for switching contraceptives, if necessary. After all, you may not want BV, but if you’re taking birth control you probably don’t want a baby, either.