Key takeaways:
Black women in the U.S. are more than twice as likely to develop bacterial vaginosis (BV) compared to white women.
Untreated bacterial vaginosis can contribute to poor reproductive health outcomes, such as a higher risk of sexually transmitted infection (STI) and preterm labor.
A tailored approach to BV diagnosis, treatment, and prevention can address the unique needs of Black women and improve health outcomes.
Women account for about half of the world’s population, yet they still experience inequality in healthcare. A better approach to their health issues is long overdue, as they have historically been treated and diagnosed based on studies of men.
As the medical field works to correct a long history of gender bias in medicine, inequalities among women must also be recognized. Systemic racism negatively impacts Black women and prevents them from receiving the medical help they need. Racial health disparities that go unchecked can result in negative health outcomes that have lifelong consequences.
One example is the disproportionate rates of bacterial vaginosis infections among Black women. Let’s discuss some factors that play a role and the potential repercussions below.
What is bacterial vaginosis?
Bacterial vaginosis (BV) is a common vaginal infection. Anyone with female-assigned reproductive parts can get bacterial vaginosis, and it’s most common between the ages of 15 to 44. Most people with BV don’t notice any symptoms.
For those who do have symptoms, they may experience the following:
A thin, white or grayish vaginal discharge
A fishy odor that can be unpleasant, especially after sex
Burning during urination
Itchiness in or around the vagina
To diagnose BV, your healthcare provider may test a small discharge sample and check the pH — level of acidity — in your vagina.
What causes BV?
The vagina is designed with its own unique environment (also known as vaginal flora) to keep things healthy down there. Normally, “good” bacteria keep the natural balance and prevent other types of bacteria, yeast, and viruses from living there.
It’s not exactly understood why, but sometimes “bad” vaginal bacteria can overgrow and cause problems. This disruption in the vaginal balance can lead to BV.
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What risk factors raise a person’s chances of developing BV?
Healthcare providers are still learning about BV, so it’s not known how to completely prevent it. But we do know there are certain activities that can raise your risk for getting BV. You can’t get BV from having sex, but your BV risk goes up with sexual activity.
Other BV risk factors can include:
Frequent douching
Having new or multiple sexual partners
Not using condoms or dental dams
Intrauterine devices (IUDs), especially with irregular bleeding
Pregnancy
How do you treat bacterial vaginosis (BV)?
BV treatment consists of antibiotics, such as clindamycin or metronidazole. You can take antibiotic tablets by mouth or insert a gel or cream into your vagina.
BV can clear up in a few days if treated with antibiotics. However, BV can also happen again. If you experience at least three BV episodes in a year, your healthcare provider may recommend taking a protective dose of antibiotics over 3 to 6 months.
Why are Black women disproportionately affected by BV?
About half of all Black women of reproductive age experience BV. That makes them more than twice as likely to have BV compared to white women. Let’s dive into some reasons why Black women are thought to experience higher BV rates.
Differences in the vaginal flora
The most important group of bacteria women need for a healthy vagina is called Lactobacillus. Lactobacillus is responsible for creating acid, which keeps the pH of the vagina low. This is important because it helps prevent unhealthy bacteria from growing.
Studies show the vaginal bacteria of white women are more likely to be dominated by Lactobacillus crispatus. On the other hand, Black women are more likely to have diverse vaginal flora or vaginal bacteria dominated by Lactobacillus iners.
Women with higher Lactobacillus crispatus levels generally have lower vaginal pH (more acidic) than women with Lactobacillus iners. This leaves Black women with fewer vaginal protective barriers and a higher infection risk.
Higher stress
When you have chronic stress, it can impact your health. Your stress hormone levels can get too high and lower the body’s ability to fight off infection. Constant exposure to social stress — such as racism — puts Black women at higher risk of a weakened immune system, which can lead to developing infections, such as BV.
Lower vitamin D
Low vitamin D levels are linked to a greater number of BV infections in pregnancy. Black women are more likely to have lower vitamin D levels, which may contribute to higher BV rates. Melanin found in darker-skinned people can lower the body’s ability to absorb sunlight, which is a key step in making vitamin D.
Can BV contribute to other health conditions?
BV was once thought to be harmless. Today, more information points to BV being something that could lead to reproductive health issues if left untreated.
Preterm labor
Pregnant people and their unborn babies are at risk from the bacteria that causes BV. If a pregnant person is exposed to a vaginal infection, the bacteria could infect the amniotic sac and fluid — the clear liquid that surrounds the baby during pregnancy.
An infected amniotic sac has a higher risk of breaking open and a greater chance of an early birth. Black women are twice as likely as white women to experience preterm labor (< 37 weeks) and three times more likely than white women to experience very preterm labor (< 32 weeks).
This highlights the need for more BV screening among Black pregnant people who experience BV symptoms.
Sexually transmitted infections
BV impairs good bacteria from protecting the rest of the vagina. This allows for sexually transmitted infections — such as HIV — to come in and penetrate the female genital tract.
New HIV diagnosis rates remain high among Black women compared to other races. In fact, Black people make up a little less than half (42%) of new HIV cases in the U.S.
People with BV are particularly susceptible to passing HIV to their partner or contracting the virus from a partner. Studies have shown a person’s chance of acquiring HIV goes up by 60% if they have untreated BV.
Pelvic inflammatory disease
For people who want to have children, untreated BV may also cause problems with fertility. When bacteria move from the vagina into the reproductive organs, this can lead to an infection called pelvic inflammatory disease (PID).
Almost 1 in 8 people with PID will experience difficulty getting pregnant. Black women are at a higher risk of developing PID compared to white women each year. Because of this, healthcare providers should raise awareness among Black women about traditional hygiene practices — such as douching — that could push unwanted bacteria further up the genital tract.
What should be done to help lower the BV disparity gap?
Barriers to healthcare, racial bias, unique risk factors, and socioeconomic status all merge to put Black women at higher risk of vaginal infections. A tailored approach to the diagnosis, treatment, and prevention of BV must be created to improve health outcomes for Black women.
Raise health literacy and awareness
Some people may prefer home remedies and will try to self-treat before seeing a healthcare provider. Although BV is a common infection, there are currently no over-the-counter (OTC) medications for this condition.
People can sometimes mistake BV for poor hygiene because of the odor or think it’s a yeast infection. However, incorrectly self-diagnosing — or treating BV through douching or using OTC yeast infection products — could actually make the situation worse.
Because Black women are at a higher risk of infection, it’s important to be aware of the symptoms, understand the risk factors, and know when to seek help from a medical professional.
Address risk factors
People who experience BV can feel a sense of shame that negatively impacts their quality of life. Surveys show some Black women may participate in hygienic practices, such as cleaning the vagina with scented soaps, because it’s passed down from older relatives. Others may know the risks of participating in rituals such as douching, but still regularly practice due to the unpleasant odor.
Sexual behavior and douching also don’t paint the full picture as to why Black women experience higher BV rates. Chronic stress, which is also linked to higher BV rates, should also be examined. As described above, Black women face constant social stress that can negatively impact their immune system and may result in unhealthy coping mechanisms, like smoking, that also raises BV risk.
In addition to addressing the root causes of stress, providing Black women under long-term emotional, psychological, or physical stress with healthy coping mechanisms could help improve health outcomes and reinforce healthy outlets for stress.
Lower barriers to care
Due to the high rates of and negative health outcomes from untreated BV, it’s especially important for Black women to get tested for BV and receive treatment.
However, Black women are more likely to work less flexible jobs, making it harder to take off time from work. Lack of childcare is another barrier for Black women when attempting to make an appointment to see a healthcare professional.
There should be more resources allocated to finding treatment options that don’t require an appointment (when appropriate). For example, developing OTC treatment options — outside of antibiotics — could potentially result in improved access to treatment and medication adherence.
But for those looking for a more convenient option in the interim, urgent care clinics might be a good alternative. Although BV testing and treatment may not be offered at all locations, some can provide this service — without an appointment. It’s best to call ahead to find a clinic near you that can help.
The bottom line
It’s important to have conversations around topics that are historically taboo or uncomfortable to discuss. Black women should feel empowered to address issues they experience while taking care of their vagina. The diagnosis, treatment, and prevention of BV should not be a one-size-fits-all plan due to the unique challenges and risk factors women from different backgrounds face.
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