It’s one thing to deal with the unpleasant odor and discharge of bacterial vaginosis (BV). But seeing blood on top of that can really amplify your worries. Why would BV cause bleeding? Understanding the possible mechanisms can help put your mind at ease (or at least prepare you to take the right action). Let’s break down how BV might lead to bleeding, and which symptoms should make you call your doctor.
How BV Might Cause Bleeding
In a perfect world, BV would stick to its textbook symptoms and nothing more. Typically, BV is all about a disrupted vaginal microbiome leading to discharge and odor, not blood. In fact, doctors generally say that BV itself doesn’t cause true bleeding. But there are a couple of ways an infection like BV could set the stage for a bit of blood to show up:
Inflammation of delicate tissues: BV can make the environment in your vagina less acidic and more irritating to the tissues. When the “good” lactobacillus bacteria decrease and “bad” bacteria overgrow, it can cause inflammation in the vaginal lining. Think of it like a mild rash inside your vagina – the walls can become raw and sensitive. Inflamed tissue has blood vessels that are more prone to breakage. If they get rubbed or jostled, they might leak a small amount of blood. This is one reason some women with BV report a pinkish discharge or light spotting, especially after vaginal intercourse. The physical act of sex can bump an inflamed vaginal wall or cervix, leading to a little bleeding.
Cervicitis (irritated cervix): Sometimes BV doesn’t just stay in the vagina; it can affect the cervix as well. The cervix is the lower part of the uterus that opens into the vagina. If it gets inflamed (a condition called cervicitis), it often becomes tender and can bleed easily on contact. Bacterial vaginosis has been associated with cervicitis in some cases. So you might not have bleeding directly from BV, but rather because BV contributed to an irritated cervix. If you notice spotting mainly after sex or a pelvic exam, an inflamed cervix could be the reason. Infections like chlamydia or gonorrhea are more famous for causing cervicitis, but even BV’s bacterial imbalance might make your cervix more susceptible to irritation and minor bleeding.
Bacterial irritation and toxins: On a microscopic level, the bacteria involved in BV can produce substances that irritate your cells. For instance, the chief BV bacterium (Gardnerella vaginalis) makes a toxin (called vaginolysin) that can poke holes in cells. Other bacteria often present in BV (like Mobiluncus) are also linked with tissue irritation. The result is that the overgrowth of bacteria in BV can weaken or inflame the vaginal lining, making it easier for tiny blood vessels to break. This mechanism is a bit invisible to the naked eye, but it’s happening at the cellular level. It helps explain why, even though BV isn’t “supposed” to cause bleeding, we occasionally see a little spotting in BV patients.
It’s important to put this in perspective: any bleeding potentially caused by BV is usually very light. We’re talking a few specks on the toilet paper or a slight pink tinge in your discharge. One medical study found that when women with unexplained vaginal bleeding were treated for BV, their bleeding issues often went away. That suggests BV was playing a role in their bleeding. So yes, BV can be involved in causing bleeding – but only indirectly, through irritation. It’s not going to cause heavy bleeding by itself.
Red-Flag Symptoms to Watch For
Now that we’ve covered why BV might lead to a little bleeding, let’s talk about when that bleeding (or other symptoms) signals something more serious. Not all symptoms are created equal. Some are minor inconveniences, and others are your body’s way of saying “hey, pay attention!”
Heavy or period-like bleeding: If you experience bleeding that is more than spotting – for example, you need a pad or tampon for it – that is not likely caused by BV. Significant bleeding is a red flag. It could mean something like a miscarriage (if you’re pregnant) or another condition. One concern with heavy, irregular bleeding is pelvic inflammatory disease (PID). PID is an infection of the upper reproductive organs (often from untreated STIs) and can cause uterine bleeding and pain. BV on its own does not cause heavy bleeding, so don’t ignore a heavier flow.
Bleeding with severe pain or fever: BV by itself usually doesn’t cause pain beyond mild discomfort, and it doesn’t cause fever. If you have bleeding that comes with sharp pelvic pain, cramping, or fever and chills, that’s waving a red flag. Severe pain with bleeding could indicate something like PID or an ectopic pregnancy. Fever could mean the infection has spread beyond just the vagina. These symptoms warrant immediate medical evaluation.
Persistent spotting over time: A tiny bit of spotting that happens once and then stops is usually not urgent. But if you are noticing small amounts of blood consistently – say, every day for a week, or every time after sex – you should get that checked. Persistent intermenstrual bleeding (bleeding between periods) isn’t a known feature of simple BV. This kind of pattern suggests an underlying issue like an STI (such as chlamydia), a cervical polyp, or hormonal imbalance. Basically, your body is telling you something’s going on that needs attention.
Unusual vaginal discharge color or odor: With BV, discharge typically is gray/white and has a fishy odor. If you start seeing a lot of yellow, green, or bloody discharge – or a really foul smell that’s different from the usual BV odor – it could mean there’s another infection in the mix. Trichomoniasis, for example, can cause yellow-green frothy discharge and sometimes accompanies BV. A strong foul smell with brownish discharge might indicate an old blood (from bleeding) or another infection. When discharge looks or smells off the charts, and especially if it’s tinged with blood, treat that as a sign to see a doctor.
Dizziness or faintness: This one is more about the amount of blood. If you ever bleed enough that you feel light-headed, dizzy, or faint, that’s an emergency situation. BV will not cause that kind of blood loss. Feeling faint from vaginal bleeding implies a significant hemorrhage or anemia, and you should seek medical care immediately.
In summary, a little spotting with BV can happen and is usually not an emergency, but anything more than that should be taken seriously. Trust your gut. If you feel like, “Hmm, this doesn’t seem right,” then it’s probably worth getting it checked out.
What To Do if You Notice Bleeding with BV
If you suspect that BV is causing you to spot, or you’re just not sure why you’re seeing blood: – Monitor it: Take note of the timing, amount, and any triggers. Did it happen right after sex? Is it just a one-off spot or does it recur? This info can help your healthcare provider. – Treat the BV: If you haven’t already, see a healthcare provider for proper BV treatment. Clearing the infection with antibiotics may resolve any mild inflammation-related spotting. Interestingly, once BV is treated, those little bleeding “surprises” often stop. – Get checked for other infections: Since we know other infections (especially STIs) frequently cause bleeding, it’s wise to rule them out. A doctor can easily test for things like chlamydia, gonorrhea, and trichomoniasis with swabs or urine tests. If one of these is present, treating it will likely stop the bleeding. – Follow up on red flags: If you have any of the red-flag symptoms mentioned – heavy bleeding, significant pain, fever, or if the spotting just won’t go away – don’t wait. Make an appointment with a doctor or go to urgent care. It’s important to address possible serious issues early.
The good news is that most of the time, spotting with BV turns out to be minor and manageable. The fix might be as simple as a course of antibiotics or a quick check for a treatable STI. Just keep in mind the difference between a slight nuisance (a drop of blood here or there) and a concerning pattern (bleeding that’s heavy or doesn’t stop). When in doubt, reach out to a medical professional for guidance. It never hurts to get checked, and it can save you a lot of worry in the long run.
References
- https://cedars-sinai.org/health-library/diseases-and-conditions/c/cervicitis.html
- https://lifemd.com/learn/bv-symptoms
- https://pubmed.ncbi.nlm.nih.gov/2361638
- https://patient.info/sexual-health/vaginal-discharge-female-discharge/bacterial-vaginosis