Kasidie Interview: Elizabeth A. Adie, MD

A candid conversation with this Obstetrician and Gynecologist about Bacterial Vaginosis: how is occurs, why, and how to treat it.

According to the Center for Disease Control, “Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after intercourse. Discharge, if present, is usually white or gray; it can be thin. Women with BV may also have burning during urination or itching around the outside of the vagina, or both.”

Charisma Lane sits down with Dr. Adie in her offices at Los Olivos Women’s Medical Group in Los Gatos, California. Dr. Adie practices all aspects of Obstetrics and Gynecology. Her special interests include high-risk pregnancies, laparoscopy, and other minimally invasive treatments of gynecological problems.

Charisma Lane: Tell me a little about what Bacterial Vaginosis is.

Dr. Adie: Bacterial Vaginosis is an overgrowth of normal bacteria- bacteria that is normally inside your vagina. It’s usually caused by a PH shift inside your vagina.

Charisma Lane: Okay, so when you say a PH shift, are there are contributing factors to that? Is it caused by something you eat? Is it based on your diet?

Dr. Adie: That gets into the category of ‘who knows?’ Certainly hormonal changes can affect it. Intercourse can affect it. There are probably some dietary things although nothing that we specifically know. Having your period or using a tampon could potentially affect it as well. That may, it’s hard to pull that out from a hormonal change, because by definition, having your period is a hormonal change. So those are typically the things- condoms can contribute. Just anything foreign that might be changing the vagina’s normal circumstances.

Charisma Lane: Got it. Are there particular statistics on woman who are more prone to getting Bacterial Vaginosis?

Dr. Adie: Well, actually the most interesting statistic is that about more than half- probably about 60% of woman who think they have a yeast infection actually have BV. Um, there are definitely woman who are prone to getting it and have recurrent BV, but again, for reasons that aren’t clear. We don’t understand why certain women seem to get it. And certain women seem to go through periods in their lives, where they have it repeatedly…

Charisma Lane: And then it goes away?

Dr. Adie: Just as out of the blue as it came into their life, it goes away and I don’t see them again for two years and yet I was seeing them before once a month.

Charisma Lane: Right… stress level maybe?

Dr. Adie: Who knows?

Charisma Lane: Interesting. So, you mentioned that woman usually think that they have a yeast infection. Are the symptoms similar?

Dr. Adie: The discharge is similar, yeah. There’s usually some form of itch or irritation. But BV is sometimes accompanied by a unpleasant and strong odor, often described as “fishy.”

Charisma Lane: So why do many women assume it’s a yeast infection?

Dr. Adie: I think woman are just more familiar with the symptoms of yeast infections…

Charisma Lane: Mmm… Hmm… and you can get the over the counter medications for a simple yeast infection.

Dr. Adie: Yeah. I don’t know if it is advertising or just that some how woman are more aware that yeast infections happen, and less aware that this other thing that happens. So they assume when they have a discharge and an itch they’ve got a yeast infection.

Charisma Lane: Got it. So what typically are the treatment options?

Dr. Adie: Unfortunately, there are no over the counter treatment for Bacterial Vaginosis.

Charisma Lane: So you need to see a doctor?

Dr. Adie: Yes. A doctor will give one of several different treatments. There’s Flagyl in either oral or vaginal cream form, and there’s also Clindamycin in vaginal form. Any of those treatments work pretty much equivalently.

Charisma Lane: Okay. And if you use the treatments, the BV typically goes away?

Dr. Adie: Yes. It’s an easy infection to fix.

Charisma Lane: How many patients on average do you see with BV? Does it happen a lot?

Dr. Adie: Yes. Well, again if you think about all the woman who think they have a yeast infection… and half of them actually have Bacterial Vaginosis… it happens a lot.

Charisma Lane: Normally when I have a yeast infection, I would go treat it with an over the counter medication.

Dr. Adie: Many women mistakenly try to treat it that way at first. Then they call a couple of days later and say, “I tried treating this, and it’s not going away!” I have days where I see 5 patients a day, and then other days, one. But pretty much every day there’s gonna be somebody in my office with BV.

Charisma Lane: So it’s that common?

Dr. Adie: Oh Yes.

Charisma Lane: Is it generally a surprise on their account? Or are people more educated now, perhaps going to WebMD and diagnosing themselves?

Dr. Adie: A lot of the women who have it have had it in the past. So they are not surprised. In fact, current patients, I can pretty much walk in to the room and say, “Does this feel like BV?” And they say, “Yeah.” I mean, they already know. The ones who have never had it before, they usually don’t have any idea what I’m asking them. They have no idea what they have.

Charisma Lane: So how long does Bacterial Vaginosis typically last?

Dr. Adie: Well…Wow! That’s a complicated question! It’s complicated because if you just tested all women, who had no symptoms, you would find evidence of BV. Those women might come back two weeks later and say, “Oh I am having symptoms now”. It may have just been too early.

Charisma Lane: Got it.

Dr. Adie: So, a lot of woman will look like they have Bacterial Vaginosis on a microbiological level, but they have no symptoms. And the flip side is a lot of the woman who thought they had a yeast infection and just thought, “Oh, I will just deal with it…” A few days go by and they start to feel better. It’s sort of their body’s own mechanism shutting the infection down. Some woman will get rid of it on their own. Some woman won’t get rid of it.

Charisma Lane: And if the women who don’t get rid of it on their own get treated, it takes 2-3 days?

Dr. Adie: Yes, a couple of days before they are feeling better.

Charisma Lane: Is there any prevention, or, things that you’ve learned over time- maybe advice that you’ve given?

Dr. Adie: Clean and dry! And for women who say they are using condoms and they get it every time they use a condom…

Charisma Lane: …don’t use the condom?

Dr. Adie: Well, then you are opening up a whole other ball of wax. There are women who can point to exactly the precipitating factor, and then there are also woman who say they get it pretty much every time they have a period. For those women, we usually give them a short course of treatment every period, which is more preventative than treatment.

Charisma Lane: So some women receive treatment regularly just as a preventative measure?

Dr. Adie: Yes.

Charisma Lane: Thank you so much for taking the time to enlighten us. Hopefully this interview will serve to help educate women about BV.

Dr. Adie: No problem.