How to Prevent BV: What Actually Stops It From Coming Back

How to prevent BV is mostly about avoiding the things that can throw off the normal balance of bacteria in the vagina. That means skipping douching, avoiding unnecessary vaginal products, considering consistent condom use, and not smoking. If BV keeps coming back, though, prevention takes more than changing your hygiene routine. You may need to confirm that each episode is actually BV, look at possible sexual or contraceptive factors, and talk with a clinician about longer-term treatment or whether partner treatment makes sense.

Recurrent BV is common, even after appropriate treatment. ACOG reported in 2025 that up to 66% of women experience another episode within a year.

There has also been an important change in how clinicians approach recurrent BV. ACOG's 2025 guidance recommends that clinicians consider treating male sexual partners in some cases of recurrent symptomatic BV. That's a shift from older guidance, which did not recommend routine partner treatment.

TL;DR: Key takeaways

• BV can come back even after appropriate treatment. Recurrence is common and is not a sign that you're dirty or doing something wrong.
• The most useful prevention steps are simple: don't douche, avoid unnecessary intravaginal products, consider consistent condom use, and don't smoke.
• If you keep having episodes, don't assume every episode is BV. Testing matters, especially when symptoms keep returning.
• For people with multiple recurrences, twice-weekly metronidazole vaginal gel can reduce recurrences while you're using it. CDC notes that the benefit may not continue after suppressive treatment stops.
• ACOG's 2025 update says clinicians should consider concurrent treatment of male sexual partners for some adults with recurrent symptomatic BV. This is a newer recommendation, not a reason to automatically treat every partner.
• Probiotics are not a universal answer. One specific vaginal Lactobacillus crispatus product has shown promise in trials, but it is not the same thing as eating yogurt or taking a generic probiotic capsule.

Not sure whether your symptoms are actually BV? Try August AI's free Symptom Checker for a quick guide to what your symptoms may mean and how urgently you should seek care.

If your symptoms sound like BV, August's $39 online urgent care visit connects you with a US-licensed clinician who can review your symptoms, medical history, and previous treatment and decide whether treatment is appropriate. A video visit cannot perform a pelvic exam or collect a vaginal swab, so unclear, recurrent, or complicated cases may still need in-person testing.

Your hygiene isn't why BV keeps coming back

When BV returns, it's easy to think you must not be washing correctly. That's usually the wrong conclusion.

BV is not a hygiene failure. It's a change in the balance of bacteria in the vagina, and recurrence can happen even after appropriate treatment.

In fact, trying harder to clean the vagina can make things worse. Douching can disrupt the normal vaginal environment, and the CDC specifically says it may increase the risk of BV relapse. There is also no evidence that douching treats BV or relieves its symptoms.

The vagina does not need to be cleaned internally. Gentle external washing is enough.

So if you're trying to figure out how to prevent BV, start by taking things away rather than adding more:

• Don't douche.
• Avoid scented products inside the vagina.
• Don't repeatedly self-treat symptoms without confirming what they are.
• Consider condoms if condomless sex seems to be associated with your recurrences.
• If you smoke, quitting may help reduce your risk.

None of these steps guarantees that BV won't return. But they remove some of the factors known to disrupt the vaginal bacterial balance.

Why does BV keep coming back?

There isn't one explanation for recurrent BV.

BV involves a shift away from a vaginal environment dominated by protective Lactobacillus bacteria toward a more diverse group of bacteria. BV-associated bacteria can also form a polymicrobial biofilm on vaginal cells.

That helps explain why treating the current episode doesn't always prevent the next one.

Think of treatment as getting the bacterial imbalance under control. The harder part can be keeping the vaginal microbiome stable afterward.

Sexual activity can also matter. The CDC lists a new sex partner, multiple sex partners, lack of condom use, and douching among factors associated with BV.

And now there's another piece of the recurrence puzzle that clinicians are paying more attention to: sexual partners may contribute to recurrence in some relationships.

That doesn't mean BV is a conventional STI or that someone "gave" you BV. It means bacteria associated with BV can be present on male genitalia, and newer research suggests treating some male partners at the same time as the woman may reduce recurrence.

ACOG incorporated this newer evidence into its October 2025 guidance.

The first step in preventing recurrent BV: make sure it really is BV

There isn't one explanation for recurrent BV.

BV happens when the normal balance of bacteria in the vagina changes. Protective Lactobacillus bacteria become less dominant, while BV-associated bacteria become more abundant. These bacteria can also form a biofilm on vaginal cells, which may make BV harder to fully clear and help explain why it can return after treatment.

In other words, treating one episode doesn't always prevent the next one. The infection may improve, but the vaginal bacterial balance can still be prone to shifting again.

Sexual activity can be part of that picture. The CDC lists having a new sex partner, having multiple sex partners, not using condoms, and douching among factors associated with BV.

There is also growing evidence that sexual partners may play a role in recurrent BV. That doesn't mean BV is a conventional STI or that a partner simply "gave" you BV. Rather, bacteria associated with BV may be shared between sexual partners, and newer research suggests that treating some male partners at the same time may reduce the chance of recurrence.

That is a newer approach. ACOG now recommends that clinicians consider treating male partners when someone has recurrent symptomatic BV. It does not mean every partner needs treatment, but it gives clinicians another option to consider when BV keeps coming back.

What actually helps prevent BV?

1. Stop douching

If you're doing one thing differently, make this the first.

Douching can disrupt the normal vaginal bacterial balance and may increase the chance that BV comes back. It is not a treatment for odor or discharge.

You don't need to clean inside the vagina.

Wash the vulva the external genital area gently with water or a mild, unscented cleanser if you prefer. There is no need to use vaginal washes, sprays, deodorants, or other products internally.

2. Consider consistent condom use

Sexual activity is associated with BV, although BV is not classified as a traditional STI.

The CDC lists lack of condom use, a new sex partner, and multiple sex partners among factors associated with BV.

If you notice that BV tends to return after condomless sex, using condoms consistently may be worth trying.

This isn't about blaming a partner. Sexual activity can change the vaginal environment, and semen can temporarily raise vaginal pH.

Condoms may reduce that exposure and may help some people reduce recurrences.

3. Don't smoke

Smoking is associated with BV, and research suggests it may affect the vaginal microbiome.

That doesn't mean smoking is the reason every person develops BV. But if you smoke and you're dealing with repeated BV, quitting is one modifiable factor worth addressing.

And unlike many BV "prevention" products, quitting smoking has obvious benefits far beyond vaginal health.

4. Don't assume you need to change your contraception

Contraception is more complicated than "birth control causes BV."

The CDC says hormonal contraception does not increase the risk of BV and may actually be protective. BV prevalence has been reported to be higher among people using copper-containing IUDs.

That does not mean a copper IUD should automatically be removed.

If your BV became recurrent around the time you started using a copper IUD, bring up the timing with your clinician. It's a reason to have a conversation, not a reason to make a decision on your own.

5. Avoid unnecessary intravaginal products

Scented washes, sprays, deodorants, and other products marketed to make the vagina smell or feel "fresher" aren't necessary.

If you already have BV, trying to cover the odor with another product doesn't address the bacterial imbalance.

And some products can further disrupt the vaginal environment.

For BV prevention, boring is often better: leave the inside of the vagina alone.

When does BV become recurrent?

There isn't one universal cutoff used by every guideline to define recurrent BV.

For practical purposes, three or more episodes in a year is a useful point to have a specific recurrent-BV conversation with your clinician, particularly if the episodes have been confirmed rather than self-diagnosed.

The CDC uses the broader language of "multiple recurrences" when discussing suppressive treatment.

The important thing is not the number alone. It's the pattern.

If you're repeatedly taking a five- or seven-day course, feeling better, and then developing the same symptoms again, repeating that cycle indefinitely isn't a prevention strategy.

At that point, ask about:

1. Confirming the diagnosis.
2. STI testing when appropriate.
3. Reviewing sexual and contraceptive factors.
4. Whether partner treatment should be considered.
5. Whether suppressive treatment makes sense.

Maintenance metronidazole can reduce recurrences

For people with multiple BV recurrences, suppressive vaginal metronidazole is one of the better-established medical prevention strategies.

The CDC says that 0.75% metronidazole vaginal gel or a 750-mg metronidazole vaginal suppository used twice weekly for more than three months has been reported to reduce recurrences.

In practice, clinicians may use a suppressive course for around 4 to 6 months, depending on the patient's history and treatment plan.

Here's the part worth understanding before you start:

Suppressive treatment controls recurrence while you're using it. It isn't necessarily a permanent cure.

The CDC specifically notes that the benefit does not persist after suppressive therapy is discontinued.

That isn't a failure of the medication. It's a reflection of how recurrent BV works.

The goal is to give the vaginal microbiome a longer period of stability and reduce repeated symptomatic episodes. Your clinician can then decide what to do once the suppressive course ends.

What about the boric acid + metronidazole regimen?

For some people with multiple recurrences, the CDC describes another option:

• An oral nitroimidazole such as metronidazole or tinidazole, 500 mg twice daily for 7 days
• Followed by intravaginal boric acid 600 mg daily for 21 days
• Followed by 0.75% metronidazole vaginal gel twice weekly for 4 to 6 months

This is a clinician-directed recurrent-BV regimen, not a DIY treatment plan.

Boric acid is especially important to put in context because it is widely sold online.

It is not first-line treatment for BV, it should not be swallowed, and you shouldn't start it on your own simply because BV keeps coming back.

If you're pregnant or trying to conceive, ask your clinician before using it.

Partner treatment is now part of the recurrent-BV conversation

This is one of the biggest changes in BV guidance in recent years.

For years, routinely treating male partners was not recommended because earlier studies had not shown a clear reduction in BV recurrence. That was reflected in older CDC guidance.

Newer research has started to change that.

In the 2025 StepUp randomized trial, women whose male partners received treatment alongside them had a lower rate of BV recurrence within 12 weeks than women whose partners were not treated: 35% versus 63%. The trial was conducted in couples with a regular male partner and was stopped early after the benefit became clear.

Based on this newer evidence, ACOG updated its guidance in October 2025. It now recommends that clinicians consider treatment of male sexual partners for adults with recurrent, symptomatic BV.

That does not mean every partner automatically needs antibiotics. Partner treatment is something to discuss with a clinician based on the person's history, relationship, and recurrence pattern.

The update also recommends shared decision-making for people with same-sex partners and for some patients experiencing their first symptomatic episode of BV. ACOG notes that more research is still needed in these groups.

If you have confirmed BV that keeps coming back and have an ongoing male sexual partner, ask your clinician whether treating your partner at the same time makes sense for you.

What about female partners?

BV can occur in female sexual partners, and partners can share similar vaginal microbiome patterns. But the evidence and treatment recommendations are not as straightforward as the newer evidence for male partner treatment.

Don't assume that both partners should take antibiotics without a clinician reviewing the situation.

Do probiotics prevent BV?

This is one area where the marketing is ahead of the evidence.

There is some promising research on specific Lactobacillus strains, especially Lactobacillus crispatus. One example is Lactin-V, a vaginal preparation containing Lactobacillus crispatus CTV-05. In a clinical trial, it lowered the risk of BV coming back after treatment with metronidazole. But Lactin-V is not FDA-cleared and is not commercially available.

That's very different from saying, "Eat yogurt every day and BV won't come back."

There isn't good evidence that supermarket yogurt prevents recurrent BV. The same applies to generic probiotic supplements. A capsule that contains a Lactobacillus strain is not automatically equivalent to the specific vaginal product studied in a clinical trial.

The CDC currently does not recommend available probiotic products as a replacement or proven add-on treatment for BV.

If you want to try a probiotic, talk with your clinician first. Just don't use it instead of proven BV treatment, especially if you have symptoms or repeated recurrences.

What doesn't reliably prevent BV?

You don't need a complicated vaginal-health routine.

There is no good evidence that the following reliably prevent recurrent BV:

• Eating yogurt
• Taking random probiotic supplements
• Vaginal deodorants
• Douching
• Vaginal "detox" products
• Boric acid by itself
• High-dose vitamin D
• Special underwear
• Constantly changing soaps or cleansers

The CDC specifically notes that high-dose vitamin D has not been shown to reduce BV recurrence and is not recommended for that purpose.

If a product promises to "reset your vaginal pH" or permanently eliminate BV, be skeptical.

The vaginal microbiome is more complicated than a single pH number.

How long does it take for prevention changes to work?

Some prevention steps are worth starting right away. If you douche, for example, stopping is a good change to make now. But don't expect your recurrence pattern to change overnight.

BV happens when the balance of bacteria in the vagina changes, and it can come back weeks or months after treatment. So one recurrence doesn't necessarily mean a prevention step failed.

For people with recurrent BV, suppressive treatment is also measured in months, not days. The CDC includes twice-weekly metronidazole regimens lasting more than three months, with some treatment plans continuing for 4 to 6 months.

So don't judge prevention by asking, "I stopped using scented products three days ago. Why did I get BV again?

A better question is: Over the next several months, am I having fewer confirmed episodes?

That's a much more useful way to tell whether your prevention plan is actually helping.

When recurrent BV needs more than prevention advice

Not every episode of vaginal odor or discharge is BV.

You should arrange a clinical evaluation if:

• Symptoms don't improve after completing treatment.
• Symptoms return soon after treatment.
• You have repeated episodes.
• You have a new sexual partner or possible STI exposure.
• You have pelvic or lower abdominal pain.
• You have fever or chills.
• You're pregnant and have new vaginal symptoms.
• You're not sure whether the symptoms are BV, yeast, or another infection.

Seek urgent medical care for severe pelvic or abdominal pain, fever or chills with pelvic pain, heavy unusual bleeding, or other symptoms suggesting a more serious infection.

If you have fever, chills, and lower back pain, for example, don't assume you're dealing with BV. Those symptoms need a different evaluation.

The Conclusion: Preventing BV is about breaking the recurrence cycle

How to prevent BV starts with the simple stuff: don't douche, avoid unnecessary intravaginal products, consider condoms, and don't smoke.

But if BV keeps coming back, don't spend months trying different soaps, probiotics, or "vaginal health" products.

First, make sure it really is BV.

Then, if you've had multiple confirmed recurrences, talk with a clinician about the options that actually have evidence behind them:

• Suppressive metronidazole gel twice weekly for more than three months, often 4 to 6 months in clinical practice.
• A boric-acid-containing treatment sequence for selected patients with multiple recurrences.
• Partner treatment, particularly for some patients with recurrent symptomatic BV and an ongoing male sexual partner, following ACOG's updated 2025 guidance.
• Targeted prevention changes, such as stopping douching, using condoms consistently if appropriate, and quitting smoking.

And remember the most important part: recurrent BV is not a hygiene failure.

If it keeps coming back, that is a reason to change the treatment strategy not a reason to wash more.