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Evidence Based

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Your Guide to Using Probiotics for BV (Bacterial Vaginosis)

Written by Dr. Michael Ruscio, DC on June 24, 2025

Written by Dr. Michael Ruscio, DC on June 24, 2025 — Reviewed by Hilary Watts

• What Is Bacterial Vaginosis|
• Probiotics for BV|
• Antibiotic Pros and Cons|
• How to Choose a Probiotic|
• Diet for BV|

Most women know what it’s like to experience an annoying and uncomfortable vaginal infection. Thrush (caused by a Candida yeast infection) is perhaps the most familiar of these, but bacterial vaginosis (caused by bacteria) is also very common, affecting 30% of females aged 14–49 in the U.S. at least once 1.

The good news is that taking probiotics for bacterial vaginosis is a simple step that can bring great results. In this article we’ll look at what triggers bacterial vaginosis, how probiotics can help to treat and prevent it, and other ways to encourage good vaginal health.

What Is Bacterial Vaginosis?

Bacterial vaginosis (BV) is vaginal inflammation caused by an overgrowth of normal vaginal bacteria 1. 

In a healthy vagina, “good” lactic acid-producing bacteria occur in bigger numbers than the “bad” bacteria known as anaerobes. If anaerobe pathogens, such as Gardnerella vaginalis grow out of hand, this upsets the balance of microorganisms in your vagina, causing symptoms of BV 2.

Signs and symptoms of BV include 1:

• A thin, gray or white vaginal discharge with a fishy odor
• Painful urination and urinary tract infections
• Pain during sex 
• Vaginal itching 

Risk factors for BV may include:

• Recent antibiotic use 3
• Vaginal douching 1
• Smoking 4
• Multiple sexual partners 1 5
• Using an IUD 6
• Poor dietary habits 7
• Hormonal changes due to perimenopause and menopause 8

For most healthy women, a one-off episode of BV is of no serious consequence, but under certain circumstances, it can be more worrying. Specifically, the presence of BV increases the risk of 1:

• Acquiring a sexually transmitted infection (STI)
• Pregnant women delivering early 

Probiotics for BV

Research suggests that probiotics—supplements of beneficial live bacteria—can have many benefits for vaginal health, such as 9:

• Balancing the vaginal microbiota 
• Breaking up the sticky layers (biofilms) that harmful bacteria use to stick around and cause ongoing infections
• Helping the body’s immune system fight off infections better
• Producing substances such as lactic acid and hydrogen peroxide that keep the vagina acidic and stop harmful bacteria and yeast from growing

Clinical studies show that probiotics can work with antibiotics or alone for the treatment of BV and to prevent recurrent bacterial vaginosis.

Studies of antibiotics and probiotics together:

• In a meta-analysis (high-quality study of studies), BV patients who took probiotics were nearly six times more likely to be cured than those who used no probiotics. Antibiotics alone were a bit more effective than probiotics alone, but when probiotics were combined with antibiotics, the results were even better. Probiotics also cut the chance of BV coming back by about two-thirds 9.

Even if you would prefer to avoid antibiotics, you may get excellent results with fewer side effects by using probiotics alone. In addition to this meta-analysis, others have shown similar results when only probiotics are used to treat and prevent BV. 

Studies of probiotics alone:

• In another meta-analysis, probiotics given with or without antibiotics significantly increased the cure rate of bacterial vaginosis. Probiotics also reduced the BV recurrence rate, especially when used for a longer period of 1 to 3 months 10. 
• A systematic (methodical) review of studies found that oral and vaginal Lactobacillus probiotics were better than a placebo for BV treatment but not conclusively better than antibiotics. For BV prevention, long-term vaginal Lactobacillus species were better than oral or vaginal antibiotics 11.
• Probiotics are safe and can be useful for pregnant women with BV 12.

For vaginal health in general, a systematic review found that oral probiotics were—in addition to treating and preventing BV—effective against vaginal yeast infections, urinary tract infections, and human papillomavirus 13.

If you have bacterial vaginosis, antibiotics are a valid option to clear up symptoms. But it’s best to read the pros and cons section below (and then discuss with a trusted clinician) before deciding whether they are right for you.

What we can confidently say is that probiotics are safe, helpful, and have few (if any) side effects, so they may be the better option for many people. 

Either way, probiotic supplements are a good choice for BV, whether you take antibiotics or not. 

Antibiotics for BV: Pros and Cons

Doctors typically prescribe the antibiotics clindamycin or metronidazole for treatment of bacterial vaginosis, taken orally or as a gel inserted into the vagina 1.

The main benefit of antibiotics is that they usually act quickly and effectively for acute BV symptoms, such as itching and vaginal discharge.

However, for between one in 10 and one in five women, symptom improvement is not so fast, and antibiotic treatment may need to go on longer 1.

Even when symptoms do resolve with antibiotics, up to 80% of women experience a recurrence sometime in the future, for which another course of antibiotics will usually be prescribed 1. 

Antibiotics can also disrupt the acidity of the vagina, increasing the likelihood of recurrent BV 14. 

Probiotics can help get you out of this vicious cycle by correcting underlying microbial imbalances in both the gut and reproductive (genital) tract.

How to Choose Probiotics for BV

We’ve established that probiotics can be of great help for BV, but which type and dosage are best, and how often should you take them?

A meta-analysis found that the most effective strains were the Lactobacillus species L. crispatus, L. rhamnosus, and L. reuteri, but using one strain or more strains seems equally effective 9. The study also found that:

• Both oral and vaginal probiotics were helpful for initial treatment.
• Vaginal probiotics outperformed oral delivery in preventing BV recurrence, likely due to direct colonization of the vaginal environment.
• Effective probiotic regimens often used doses of at least 10⁸ CFU (colony-forming units), given daily for 7 to 14 days, or longer to prevent recurrence. 

From my clinical experience of women experiencing repeated vaginal infections, taking several probiotic strains at the same time to cover all “good bacteria” bases seems to work well. 

This is especially the case given that, in the clinic, women with BV are also likely to be experiencing a gut bacteria imbalance, too.

In fact, the gut and vaginal microbiome in females share similarities, and the gut microbiome may impact reproductive health by controlling estrogen balance 15.

The full implications of this aren’t understood, but at its most basic, a healthy gut = a healthy vagina.

Please make sure to discuss your BV treatment with a trusted healthcare provider before making a plan for self-treatment.

Diet for BV

Beyond consuming probiotics for BV, there isn’t a large body of research specifically linking diet to the condition. However, there is enough research to suggest that eating a balanced and nutrient-dense diet may help prevent BV 7. 

Furthermore, we are learning more about the powerful connection between the gut and vaginal health, known as the vagina–gut axis 16. The bacteria in your gut can influence vaginal health, and this is largely shaped by the foods you eat. 

For example, one study found that eating a high-fiber diet was linked to 88% lower odds of getting BV, while women who ate more sugary foods and refined carbohydrates (high-glycemic foods) were more likely to get BV 17.  

These results track with another study that found that women who ate more refined carbohydrates, fried foods, fatty meats, and sweetened beverages may be at higher risk for bacterial vaginosis 7.

Based on other research, we know that a Mediterranean diet, which is rich in dietary fiber and colorful vegetables and fruits, may support female reproductive health 18. So when it comes to BV, eating a Med diet or another nutrient-dense diet like the Paleo diet may help support your vaginal microbiome, especially when combined with probiotics. 

Probiotics and BV: A Recap

Bacterial vaginosis is caused by bacterial imbalances in the vagina and can often recur after treating it with antibiotics. But adding probiotics to your antibiotics can clear BV and prevent it from coming back. 

Probiotics can also treat and prevent BV by themselves while saving you from antibiotic side effects. Probiotics may be especially effective at preventing BV when taken regularly and combined with a diet of minimally processed foods to create a healthier microbiome. 

To support your vaginal health in the long term, focus on restoring balance in the gut and vaginal microbiomes through a combination of probiotics, healthy dietary habits, and smart lifestyle choices. For a step-by-step approach to improving your gut health—the foundation for better overall wellness—download our free Gut Reset Guide.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.