Secret Garden
Bacterial vaginosis is a relatively common imbalance in the vaginal flora. The emotional strain on women suffering from it can be very high. Despair often sets in, especially when repeated visits to the doctor fail to provide a solution. But that doesn’t have to be the case. Because there are solutions outside the pharmaceutical industry.
Bacterial vaginosis occurs when the natural flora of the vagina becomes unbalanced due to various factors. Harmful microorganisms can then gain the upper hand and dominate the vaginal flora. The symptoms are discharge, odor and burning and can be very distressing. Repeated visits to the doctor seem to become a trip to Canossa and become increasingly stressful. At some point, frustration and helplessness set in. Depression and withdrawal into private life are the result.
A new perspective
A better basic understanding of the microbiological mechanisms and dynamics enables the vaginal flora to be returned to its natural balance and stabilized in the long term. This requires a new perspective on bacteria and a willingness to explore new avenues. Alternative healing methods can support this path, but not without a serious change of perspective.
How is bacterial vaginosis treated conventionally?
The usual treatment for bacterial vaginosis is based on metronidazole treatment, an antibiotic of the 5-nitroimidazole class.
This is not only effective against anaerobic bacteria, but also against protozoa such as Trichomonas vaginalis. It is correctly classified as an antibacterial chemotherapeutic agent.
By killing the bacterial flora, a microbial reset is carried out, so to speak, so that the beneficial bacteria, essentially the lactobacilli, can then reassert themselves. The fact that this approach is not particularly successful is shown by the high number of women who have relapses after treatment and are desperate. So if a method that has been used for decades demonstrably fails to bring the desired success, isn’t it time for a rethink?
The “bad boy” theory of vaginal dysbiosis
Vaginal dysbiosis – and in its extreme form bacterial vaginosis – is usually based on the simplified assumption that external circumstances have increased the pH value of the vaginal environment and harmful germs, usually Gardnerella, are growing and suppressing the beneficial flora. As a result, the germs must be killed so that the good germs can grow again when a new start is made. Nowadays, additional attempts are made to promote correct recolonization by using pH-lowering agents and probiotics.
The approach has always been the same for decades: name the culprits and kill them. Collateral damage is accepted.
What is the “secret garden”?
Modern microbiology shows that this approach is outdated and obsolete. Microbiological populations are not rigid systems, but dynamic and flexible – almost fluid. One microbial population influences another. Everything depends on each other. So it is not enough to kill the “bad guys”. A more complex and holistic approach is needed.
The vaginal flora – like other microbial biocenoses – can be compared to a garden in which the individual plants represent the various bacteria. The most important thing about this idea is that everything is already there. All the plants exist in this garden, but the external circumstances determine which ones can prevail. This basic idea is important because current research results show that most harmful germs coexist in a healthy vaginal flora – just in small numbers.
The most important cause of bacterial vaginosis, Gardnerella spp. is therefore part of the healthy flora, but in smaller quantities than in a destabilized community.
The three phases of bacterial vaginosis
Bacterial vaginosis develops in three phases: First, Gardnerella dominates, it initiates the biofilm, which is then supported by Candidatus Lachnocurva vaginae and Fannyhessea vaginae, which stabilize the biofilm matrix. This is followed by odor and inflammation enhancers such as Prevotella bivia, Megasphaera and Dialister microaerophilus, which further raise the pH value and are responsible for the “fishy” odor. Finally, Mobiluncus and Sneathia can cause inflammation by triggering cytokines and – in pregnant women – increase the risk of premature birth. The three phases are therefore: Biofilm initiation, matrix stabilization and metabolite formation.
However, this development is not a dead end from which only antibiotic treatment can lead.
The mindset – you can’t do without it
A very important factor here is the mindset. We now know that insecurity and fear can destabilize a flora. So if you are afraid of developing symptoms, you destabilize your immune system and increase the likelihood of them occurring. We now know that the brain and the various microbiomes in different parts of the body communicate directly with each other. These messages are sent in both directions. What we think therefore has a direct influence on the different areas. In addition to the gut-brain axis, there may also be a vagina-brain axis in which our thoughts determine the vaginal flora, just as the vaginal flora determines our thoughts and can lead to depression, for example.
However, the vagina-brain axis has not yet been scientifically confirmed.
This not only shows the danger of a negative or anxious mindset, but also opens up completely new treatment methods. We now know that energy follows attention. Just as negative or anxious thoughts can cause symptoms and even pain in the vaginal area, positive thoughts can also support the vaginal flora.
An experiment
This is not hocus-pocus, but modern medicine. The nocebo effect is just as real as the placebo effect. A little experiment very quickly illustrates the power of mental influence:
Concentrate on your little finger. Now think about the fact that your little finger has been different for a long time, that you are actually in pain and that it is rather immobile. Within a few minutes, often seconds, you will experience a strange feeling of strangeness in your little finger, which can develop into pain.
Now imagine how a negative mindset that is permanently afraid of infections or vaginal dysbiosis can affect the vaginal flora – if just one or two minutes is enough to make the little finger feel uneasy. Do the experiment with your finger. You will be surprised. In addition, you actually “know” that nothing is wrong with the little finger – quite different with the vaginal flora, where you may feel a general uncertainty.
Until recently, such approaches were strictly rejected by modern medicine. However, with increasing knowledge of the various communication highways between the brain and bacteria, there has been a turnaround.
Lifestyle changes are necessary
In addition to the mental attitude, which we mention first and foremost for good reason, a change in lifestyle can also have a direct positive effect on the vaginal flora. This is because it is not only the microbiome that is involved in communication, but also nerve connections that exist directly between the brain and vagina, bypassing the spinal cord. Animal and human experiments show that women with complete paraplegia can experience vaginal sensations and orgasms without the involvement of the spinal cord. The vagus nerve also plays a special role here.
The influence of hormones
Of course, hormones also play an important role. Oestrogen and progesterone influence the thickness of the mucous membrane, the glycogen content and the pH value of the vagina – all factors that change the microbial flora. In addition, stress hormones such as cortisol can have a devastating effect on Lactobacillus dominance and weaken the mucosal barrier. This shows why so many women do not experience lasting relief even after radical antibiotic therapy. Although the negative germs such as Gardnerella are initially pushed below the detection limit, if nothing is done to change the causes, they can regain the upper hand unhindered.
Practical tips for adapting your lifestyle
How should lifestyle be adapted to reduce the risk of vaginal dysbiosis or even bacterial vaginosis?
Be careful with intimate hygiene
Avoid vaginal douching.
Do not smoke
Smokers have a threefold higher risk of bacterial vaginosis and are more likely to have vaginal flora that is low in lactobacilli.
Use condoms
This initially prevents the microbiomes from clashing, and the microbiomes of the vagina and penis can then adapt to each other in a long-term partnership. Women who wear copper intrauterine devices are also more frequently affected by bacterial vaginosis because the balance of the flora is affected.
Eat a healthy diet
Studies show that a diet high in sugar and fat increases the risk, while a diet high in fiber can significantly reduce it.
Watch your vitamins and minerals
People with low levels of vitamins A, C, D and folate, calcium and beta-carotene have a higher risk of bacterial vaginosis. In this case, blood values should be checked regularly and substituted if necessary.
Consider probiotics
The vaginal administration of probiotics containing specific lactobacilli can have a particularly supportive effect.
Practice mindfulness meditation
Even if it may seem like a challenge for inexperienced people at first glance, mindfulness meditation is not that difficult. With a little practice and dedication, progress can be made very quickly. Just 30 minutes a day can make a real difference to your life. Give it a try.
10 alternative treatment methods
In addition to a change in lifestyle, alternative measures are recommended. It should be noted that these usually have to be combined with a change in lifestyle. Hardly any measure is effective on its own! It is therefore no use using vaginal probiotics if the stress level is extremely high and the diet is very high in fat and carbohydrates, for example. A holistic approach is necessary.
The following measures have been evaluated in studies. However, the dosages and specific application are not described in detail, as this would go beyond the scope of this article and we do not wish to present them in such a brief and uncommented form.
If you want to know more: The studies, lots more information and additional measures to combat bacterial vaginosis will be covered in our new online course from fall 2025. Sign up for our newsletter if you would like to be informed in good time as soon as our course goes online.
1. vaginal acidification (pH modulation)
Lactobacilli like it acidic. There are vaginal gels and lactic acid rinses, but the best results have been achieved with vitamin C vaginal tablets.
2. curcuminoids
In Ayurvedic medicine, turmeric has always been considered anti-inflammatory and antimicrobial. It also promotes the recolonization of vaginal Lactobacillus flora. In a study, turmeric was twice as effective as conventional antibiotic treatment.
3. berberine-containing medicinal plants
In traditional Chinese medicine, cork tree bark (Phellodendron amurense, Huang Bai) is used to treat urogenital infections. The main active ingredient is berberine – an alkaloid that is also found in barberry (Berberis vulgaris and others). Various studies have shown a significant improvement in the symptoms of bacterial vaginosis. Berberine has an antimicrobial effect against germs that have a negative influence on the vaginal flora and also inhibits inflammation. It can also modulate the immune system and acidify the environment.
4. tea tree oil
Tea tree oil is a proven home remedy for vaginal infections. As early as the late 1990s, initial laboratory findings indicated that bacteria associated with bacterial vaginosis are sensitive to tea tree oil, while protective lactobacilli remain comparatively resistant. However, there is a risk of mucosal irritation if used incorrectly. It must therefore be used highly diluted. The active ingredient in tea tree oil is terpenes, which kill pathogenic anaerobes and can also inhibit fungi without damaging the good flora.
5. spanish thyme
Thymbra capitata is a wild thyme species (also known as Spanish oregano) with a high concentration of phenolic active ingredients. In an experimental biofilm model, it reduced the bacteria without damaging the vaginal epithelial cells. It has an antibacterial and anti-inflammatory effect.
6. marigold
Calendula is a wound healer and antiseptic in folk medicine. In a double-blind study, a vaginal cream with calendula extract was tested against metronidazole gel. Just one week after treatment, all symptoms (burning, itching, dyspareunia) had disappeared in both groups.
Calendula flowers contain triterpene saponins, flavonoids and essential oil. These active ingredients promote tissue repair and have an anti-inflammatory effect. Calendula extracts also show antibacterial activity against staphylococci and E. coli. A similar effect is assumed for anaerobes relevant to bacterial vaginosis. The vaginal environment can be stabilized by the astringency and mucous membrane protective effect of calendula.
7. propolis
Propolis, the “putty resin” produced by bees from resins, is valued in many traditional medicines as a natural antibiotic. In one study, it was shown to cure over 70% of cases. Propolis contains a broad spectrum of antimicrobial substances (flavonoids such as galangin, phenolic acids, etc.), which are also active against anaerobic germs in bacterial vaginosis. In addition, propolis disrupts the formation of biofilms and has an antioxidant effect.
8. neem (Azadirachta indica)
The neem tree is known as a “healing tree” in India and many parts of Africa. Neem oil in particular has pronounced antimicrobial and spermicidal properties. In a pilot trial in India, vaginal capsules containing pure neem oil were applied to women with chronic discharge for 15 days. The results were promising: in 93% of women, the abnormal discharge improved significantly and in almost 100% of cases, the pathogenic germs were eliminated.
9. lemongrass (Cymbopogon olivieri)
Cymbopogon olivieri (a species of lemongrass) is used in Iranian folk medicine to treat infections. A double-blind study with 90 patients tested a vaginal herbal product made from C. olivieri against metronidazole gel. The lemongrass gel reduced burning, itching, odor, abnormal discharge, pH and clue cells as effectively as metronidazole. Cymbopogon species contain citral as the main component, which has an antibacterial and antifungal effect. The decisive factor, however, is the direct killing of germs of bacterial vaginosis, while lactobacilli are less affected.
10. pomegranate (Punica granatum)
Pomegranate peels and flowers are traditionally used for infections and mucosal disorders. Some studies have investigated pomegranate extracts (often as a vaginal gel) and, in addition to good clinical results, found a reduction in inflammatory parameters in vaginal secretions. Pomegranate contains polyphenols (ellagitannins), which have an astringent and antimicrobial effect. Inhibitory effects have been observed in vitro against relevant germs such as Gardnerella and Prevotella. Pomegranate extracts are also highly antioxidant and could reduce the local inflammation associated with bacterial vaginosis.
There is no standard solution
The list of alternative methods can only serve as a small excerpt of what is possible. Important: Do not carry out any “wild” self-experiments, but ideally seek expert advice.
There is no standard solution. Every woman and every vaginal flora is different. Therefore, not all changes should be tackled at once, but gradually. A holistic approach, ideally by an expert, is necessary.
Supporting diagnostics
An analysis of the vaginal flora using molecular biological methods can be carried out to support this. A microscopic analysis by a GP is simply pointless because it is not meaningful. As mentioned above, the “bad” bacteria also exist in the vaginal flora, but only in small quantities in healthy vaginal flora.
What is the ratio of bacteria to each other? Which populations are dominant? These are the crucial questions. Conventional methods such as microscopy and Gram staining can provide no or only inadequate answers. Even if many conventional doctors don’t like to hear this: It’s a fact. Microbiology is already much more advanced today. But the possibilities must be used, even if they are not yet paid for by the health insurance companies. It is unacceptable for optimal methods to be dispensed with due to the health insurance companies’ cost-cutting programs!
Away from old thinking – towards new paths
As we have seen above, the decisive factor is the mindset. Without a change in attitude towards bacteria and a reduction in stress factors, very few measures will be crowned with success.
We need to move away from the old thinking of “a few bad bacteria that need to be destroyed” and towards a holistic perspective – towards an understanding that microbiological balances, as they exist in a healthy vaginal flora, are dynamic and fluid.
This may seem challenging at first glance, but this new way of thinking offers an incredible opportunity. Because with patience and a holistic approach, bacterial vaginosis can be influenced – and a sustainable stabilization of the vaginal flora can finally be achieved.
Therefore: Never despair as a sufferer. There are plenty of paths that can be taken with patience and confidence. Cheer up!
Note on the upcoming seminar
If you want to know more: The studies, lots more information and additional measures to combat bacterial vaginosis will be covered in our new online course from fall 2025. Sign up for our newsletter if you would like to be informed in good time as soon as our course goes online.
Further reading
- Farr A. et al (2023). Bacterial Vaginosis: Guideline of the DGGG, OEGGG and SGGG (S2k-Level). Obstetrics and Gynecology, 83(11): 1331-1349. DOI: 10.1055/a-2169-8539
- Vodstrcil LA. et al (2021). Bacterial vaginosis: drivers of recurrence and challenges in partner treatment. BMC Medicine, 19(1): 194. DOI: 10.1186/s12916-021-02077-3
- Neggers YH. et al. (2007). Dietary intake of selected nutrients affects bacterial vaginosis in women. Journal of Nutrition, 137(9): 2128-2133. DOI: 10.1093/jn/137.9.2128
- Laue C. et al (2018). Effect of a yoghurt drink containing Lactobacillus strains on bacterial vaginosis in women – a double-blind, randomized, controlled pilot trial. Beneficial Microbes, 9(1): 35-50. DOI: 10.3920/BM2017.0018
- Chieng WK. et al. (2022). Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women – a systematic review and meta-analysis of RCTs. Frontiers in Nutrition, 9: 938838. DOI: 10.3389/fnut.2022.938838
- Cohen CR. et al (2020). Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis. New England Journal of Medicine, 382(20): 1906-1915. DOI: 10.1056/NEJMoa1915254
- Ma L. et al (2022). Vitamin D deficiency increases the risk of bacterial vaginosis during pregnancy: a meta-analysis of observational studies. Frontiers in Nutrition, 9: 1016592. DOI: 10.3389/fnut.2022.1016592
- Krasnopolsky VN. et al. (2013). Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Medicine Research, 5(4): 309-315. DOI: 10.4021/jocmr1489w
- Surapaneni S. et al (2021). Recurrent bacterial vaginosis: an unmet therapeutic challenge. Experience with a combination pharmacotherapy long-term suppressive regimen . Sexually Transmitted Diseases, 48(10): 761-765. DOI: 10.1097/OLQ.0000000000001420
