Psychosomatics of bacterial vaginosis
Bacterial vaginosis is an imbalance of bacteria in the vagina: thin discharge appears, often with a strong "fishy" smell, especially after sex. It is not a sexually transmitted infection and not a sign of poor hygiene. It is treated with antibiotics prescribed by a doctor. The Ladder method adds questions about shame and trust in yourself and does not replace a doctor.
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When to see a doctor
A gynaecologist or a sexual health clinic doctor makes the diagnosis by an examination and a swab. Treating yourself without a swab is risky: vaginosis is easy to mix up with thrush or an STI, and they are treated differently. The NHS advises seeing a doctor for any unusual discharge with a smell.
In the Ladder method
In the Ladder method bacterial vaginosis is not explained as "you are untidy" or "you have problems in your relationship". You are not to blame. The cause is the balance of bacteria, and treatment with a gynaecologist comes first. Questions to yourself belong alongside it, not instead of it.
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In the method the intimate area fits the image of trust and shame: how you feel about your body and whether you feel safe in it. It is an image, not the cause, and it does not replace treatment.
On the ladder this shows up as the steps "I am ashamed of my body" and "I do not trust closeness". You can work through them at your own pace when you feel calmer.
These are questions for reflection, not an explanation of what causes the condition and not a treatment.
More: signs, medicine, sources, questions
How it shows up
Book a doctor’s appointment if you notice:
- Thin greyish-white discharge
- A strong fishy smell
- The smell is stronger after sex
- Discomfort in the intimate area
- Often no signs at all
- Discharge and smell return after months
What medicine knows
"Friendly" lactic bacteria live in the vagina. With bacterial vaginosis there are fewer of them and others multiply. The NHS says the exact cause is unknown, that vaginosis is not classed as an STI, but sex can trigger it, and it in turn raises the risk of catching an STI.
The risk is higher with a change of partner, an IUD, douching and perfumed products for the intimate area. Many women do not notice any signs at all.
Signs according to the NHS: unusual discharge, greyish-white, thin or watery, with a strong fishy smell, especially after sex. Itching and soreness are not typical, that looks more like thrush, but it is hard to tell them apart without a doctor.
What the doctor does and what helps: an examination and a swab, then a course of antibiotic tablets, gel or cream. It often comes back within a few months; if it happens more than 4 times a year, a doctor may offer a longer course of gel (NHS). In pregnancy it should be treated, because there is a small risk of premature birth. Do not douche or use perfumes and foam in the intimate area.
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Frequently asked questions
Can bacterial vaginosis be from nerves?
No. It comes from a change in the balance of vaginal bacteria, and the exact trigger is not fully known (NHS). Stress is not proven to cause it, and it is not a matter of hygiene.
What does bacterial vaginosis mean in psychosomatics?
There is no proven "meaning". In the Ladder method it becomes a reason to ask yourself where you feel shame and whether you trust your body. It is a question to yourself, not a diagnosis.
Is bacterial vaginosis an STI and does my partner need treatment?
It is not classed as an STI, but sex can trigger it or pass it on. Partners with a vagina may need treatment too, so ask the doctor (NHS).
Related topics
Psychosomatics does not replace tests and treatment. Only a doctor can make a diagnosis.