Bacterial Vaginosis is an embarrassing problem, but one that more than a third of women face.

She had already spent a fortune on perfumes and pharmaceutical products but nothing worked. In desperation she tried vaginal douching, but this only made things worse.

Her self-esteem was shattered, her sex life was ruined, and she attended my clinic in tears.

Lucy had Bacterial Vaginosis (BV), a common vaginal infection that affects more than a third of women aged between 15 and 44 years.

It usually causes a light-grey discharge accompanied by an unpleasant vaginal odour, but many women who have this vaginal infection don’t get any symptoms.

BV is often suspected from the smell, but a formal diagnosis is made by taking a vaginal swab and analysing the bacteria at a lab.

Healthy vaginal flora is made up of the right mix of bacteria, but BV occurs when this balance is knocked out of kilter.

Apart from the unpleasant, fishy odour, BV breaks down the protective layer of vaginal mucous and causes inflammation of the vaginal wall. Less protective mucous and more inflammation increases the chance of sexually transmitted infections taking up vaginal residence.

BV can be dangerous when you’re pregnant as it increases the risk of having a premature delivery and can also cause an infection in a new born baby.

There’s a microscopic battle raging inside every woman’s vagina and perfect vaginal microbial equilibrium can be disturbed by menstruation, sex toys, penises, semen, retained tampons, soap, and even plain water.

We don’t know exactly why women develop BV, but we do know that the risk is increased by having a new sexual partner, having multiple sexual partners, and from having sex with women.

Once you’ve got BV, it’s hard to get rid of it.

Throughout childhood we’ve all been told that if something smells funny, we should wash it — but this is exactly the wrong thing to do with BV.

Vaginal douching exacerbates the problem because it not only gets rid of the stinky bacteria, it also gets rid of all the other bacteria you want to stay in there.

Smelly bacteria grows back fast and if there’s not enough favourable bacteria taking up space, the vagina struggles to regain equilibrium.

Doctors used to treat BV with a single dose of oral antibiotics, but we found that this only worked temporarily with symptoms returning within a few weeks or months.

We now recommend a more intensive treatment regimen including oral antibiotics or vaginal gel for at least a week, but even this regimen only works half the time.

Some recurrent or resistant BV infections require regular application of vaginal antibiotic cream for 4-6 months before it finally stops coming back.

Doctors and patients would like to have faster, more effective treatment options, but scientific research has been looking into vaginal health for a long time without much success.

We’ve known for a long time that Lactobacillus keeps vaginas healthy. This bacteria produces lots of lactic acid, making the vagina slightly acidic and discourages the growth of other bacteria, yeasts and viruses.

Until now, research was limited by what we could see through a microscope, but new technology enables us to look much more closely at the vaginal flora, even down to a genetic level.

Gene sequencing technology is being used to examine vaginal secretions and we are now able to document the exact genetic structure of the bacteria contained within vaginal discharge.

We used to think all Lactobacillus species were pretty similar and patients have tried probiotic treatments with variable success, but gene sequencing technology has shown us that not all Lactobacillus are created equal.

Healthy vaginal secretions contain high numbers of a specific species of Lactobacillus, Lactobacillus crispatus. This particular bacteria produces the optimal concoction of lactic acid, keeping the vagina at the perfect acidic level and strengthens the vagina’s protective mucous.

In our ongoing fight for healthy vaginas, current antibiotic treatments haven’t proved to be very effective, but probiotic vaginal pessaries could become the next best thing for BV.

But don’t count your Lactobacillus before they’ve hatched. Early studies have been promising, but we’re finding out that it’s a bit more complicated than pouring a bunch of probiotics into the problem area. It’s proving difficult to establish Lactobacillus as the predominant bacterial species due to influences from other bacteria and yeasts competing for vaginal real estate. At this stage, Lactobacillus is certainly not considered to be a “miracle cure”.

Until we invent the perfect probiotic pessary, what can we do for Lucy in the meantime?

Antibiotics are still the preferred treatment. Lucy should also stop spraying perfume into her vagina. She shouldn’t douche her vagina and she should shower rather than taking a bath, only washing the outer part of her vulva with plain water or soap.

Like Lucy, many women suffer in silence for months before seeing a doctor, but there’s no need to feel embarrassed or ashamed. Bacterial vaginosis can happen to anyone.

If you’ve noticed things aren’t quite right down there, don’t delay. Please see your doctor.

*Not her real name

Dr Brad McKay is a GP and host of Embarrassing Bodies Down Under. Find him at www.drbradmckay.com.au or follow him on Twitter @drbradmckay.