If you’ve ever searched online about bacterial vaginosis (BV) and bleeding, you probably found conflicting answers. Many sources insist that BV does not cause bleeding, yet some women swear they experienced spotting or bleeding when they had BV. So, what’s the truth? Let’s look at what medical studies and experts say, and then clarify when you should see a doctor about it.
What Experts Generally Say
The medical consensus has long been that BV itself isn’t a direct cause of vaginal bleeding. Gynecologists are taught that if a patient has vaginal bleeding outside of her period, they should consider things like hormonal issues, polyps, or infections like chlamydia – not BV. One expert resource notes that BV “should not cause vaginal bleeding” and advises doctors to look for another cause if bleeding is present. In general, unusual bleeding is not consistent with a straightforward BV infection.
However, this doesn’t mean BV is completely off the hook in every scenario. Clinicians acknowledge that heavy vaginal infections can cause a lot of inflammation. With BV, there is often inflammation of the vaginal lining and even the cervix. So, while BV isn’t known for causing bleeding, it might create conditions where bleeding becomes more likely (for example, after sex, due to an inflamed cervix). This nuance has led researchers to dig a bit deeper.
What Research Has Found
Interestingly, a few studies have documented a connection between BV and vaginal bleeding: – Treatment resolving bleeding: One study from Sweden focused on women who had unexplained vaginal bleeding alongside BV. They conducted a trial where they treated the BV with antibiotics. The result? Once the BV infection was cured, the women’s bleeding disturbances disappeared. In other words, their irregular bleeding stopped after the BV was gone. The researchers concluded that treating BV is important in patients who have symptoms like bleeding, not just discharge. This suggests that in those cases, BV was likely contributing to the bleeding. – BV and cervicitis: Cervicitis is an inflammation of the cervix, and it’s a known cause of spotting (especially after intercourse or a pelvic exam). A 2006 study in the Journal of Infectious Diseases looked at women with BV and found that 15% of them had cervicitis, even though most did not have the usual STI causes of cervicitis. Cervicitis can lead to easy bleeding (the cervix might bleed when touched). The implication is that BV, by disturbing the vaginal flora and reducing healthy lactobacilli, might predispose some women to cervicitis, which in turn causes bleeding. In that study, the majority of cervicitis cases were not due to chlamydia or gonorrhea – pointing a finger at BV’s role in cervical inflammation. – Other associations: Some research in obstetrics has observed that BV in pregnancy is linked to a higher incidence of first-trimester bleeding. It’s hard to say if BV directly causes bleeding in pregnancy or if both are results of a common underlying issue, but the correlation has been noted. (Regardless, if you’re pregnant and have any bleeding, BV or not, that’s a situation where you should be in contact with your doctor.)
What do these studies tell us? They indicate that while BV isn’t usually a lone gunman for causing bleeding, it can be an accomplice. BV can create an environment where the cervix and vaginal tissues are inflamed and fragile. In such an environment, you might see light bleeding or spotting, especially if there’s another trigger (intercourse, for example). The research indicates that BV can be involved in bleeding, but often indirectly.
It’s worth emphasizing that there’s no evidence BV causes significant bleeding on its own. When we talk about BV-related bleeding, we’re generally talking about light spotting or minor bleeding. If someone with BV is experiencing heavy or period-like bleeding, doctors will look for another cause even if BV is present.
When to Seek Medical Care
No matter what the cause, abnormal vaginal bleeding should be on your radar. Here are some guidelines on when to reach out to a healthcare provider, particularly in the context of BV:
If the bleeding is more than spotting: As mentioned, BV might cause very light bleeding in some cases. But if you’re soaking a pad, or the bleeding is similar to a menstrual flow, that’s not from BV. Heavy bleeding or bleeding with clots warrants prompt medical attention.
If you have bleeding with pelvic pain or fever: These symptoms together could signal something like pelvic inflammatory disease (PID) or another infection that requires urgent treatment. BV doesn’t cause fever or severe pain, so that combination is a red flag.
If you’re pregnant and have any bleeding: Do not assume it’s “just BV.” While BV should be treated in pregnancy due to other risks, any bleeding while pregnant needs immediate evaluation to ensure the safety of you and your baby.
If the spotting persists for a long time: A little streak of blood once might not be alarming. But if you’ve noticed spotting repeatedly over weeks, bring it up with your doctor. Even if you suspect BV is the cause, you’ll want confirmation. There could be a co-existing condition that needs addressing.
If you’re just unsure or anxious: Sometimes it’s hard to self-assess what “light” versus “heavy” spotting is, or you may not know if a symptom is significant. If you find yourself worrying about it, it’s better to get checked. A quick exam can rule out serious issues and usually includes a test for BV, STIs, and possibly a Pap smear if you’re due for one. The reassurance you’ll get is worth it.
Remember that you don’t have to figure it all out on your own. Doctors deal with questions about vaginal discharge and bleeding every day. It’s absolutely okay to say, “I have BV and now there’s some spotting, could these be related?” They can then use exams and tests to give you a clear answer.
Takeaway: The prevailing medical opinion is that BV generally does not cause bleeding. However, some studies and clinical observations show it can be associated with light bleeding in certain situations (likely through causing cervical inflammation). The safest approach if you notice bleeding with BV is to treat the BV and inform your healthcare provider about the bleeding. That way, they can make sure nothing else is going on. And if BV was the culprit after all, clearing the infection should take care of the problem.
References
- https://patient.info/sexual-health/vaginal-discharge-female-discharge/bacterial-vaginosis
- https://pubmed.ncbi.nlm.nih.gov/2361638
- https://pubmed.ncbi.nlm.nih.gov/16453256
- https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cervicitis.html