A healthy vagina essentially has no smell, or has a very "neutral" smell.
So, does that mean if you DO have a smell, you have a Sexually Transmitted Disease (STD?)
No... not necessarily.
Have you ever heard the joke about a woman's vagina smelling like fish? A fishy smell is actually a sign that a woman has an active bacterial overgrowth inside of her vagina. It's called BV, which stands for Bacterial Vaginosis. It is actually the most common cause of vaginal odor, effecting about 30% of all women sometime in their life. Most of the time, BV occurs between the ages of 20 and 50. But BV is NOT an actual STD.
In the 80's and 90's, BV was called Gardnerella Vaginosis - named after a particular bacteria inside the vagina that was found to be out of balance within the vagina. (I used to call it Godzilla Vaginosis!). We don't call it Gardnerella Vaginosis anymore because it is now known that Gardnerella is only one of the types of bacteria that have overgrown inside the vagina. There are actually multiple forms of bacteria that grow in excess that result in a full blown case of Bacterial Vaginosis, thus the name change.
Though sexually active women are more likely to get BV, it can occur less frequently even if you aren't sexually active. It is also more common right before your period or right after, both are times that the pH of the vagina rises. The natural pH of the vagina is 4.5, which is acidic. And anything that upsets this pH balance, such as blood flow, a change in partners, sex toys, and douching, can cause your pH to change, and thus place you at higher risk of BV. Even an IUD has been shown to increase the risk of developing BV.
Some cases of BV can go away on their own. Especially if it is right before your period or right after. But in most situations, it does require a specific type of antibiotic called Flagyl, or metronidazole (generic.) This medication comes in both oral and vaginal gel form.
Neither is supposedly better than the other, but frankly I treat with ORAL Flagyl if a patient gets BV more than once a year. If you can use the vaginal gel form of Flagyl, it is preferred because it treats the condition locally instead of systemically spreading the antibiotic throughout your body. And oral Flagyl has some nasty side effects such as nausea, metallic taste and increased emotional ups and downs. Fortunately these side effects resolve as soon as you are done with the treatment.
As for passing BV to your partner, there hasn't been complete proof that this is possible. However, clinically if I have a female patient who is prone to BV, I have on rare occasion also treated her partner, especially if he is not circumcised. Since the trend today is to do less and less circumcision, we may have more information regarding this in a decade or two. None the less, the jury is still out on that.
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