Do Baking Soda Treatments Help with Cytolytic Vaginosis?

Highlights from this article: 

• Cytolytic Vaginosis is a vaginal infection that is caused by an overgrowth of Lactobacillus. It’s relatively rare and sometimes mistaken for a yeast infection.  
• Lactobacillus thrives in acidic environments. Baking soda has been suggested as a treatment option to neutralize acids and increase vaginal pH. 
• While baking soda douches have been recommended in the past, more recent research shows that they end up doing more harm than good. 
• Baking soda Sitz baths are shown to be effective without the negative side effects, as the baking soda is used on the vulva rather than inserted directly into the vagina. 

If you have been diagnosed with Cytolytic Vaginosis (CV) and have been searching for relief, you may have come across the suggestion to use baking soda. But is this really a safe way to manage a CV infection? As with most things pertaining to vaginal infections, there’s some nuance. We’re sharing the latest research on whether baking soda is an effective way to manage CV symptoms along with the dos and don’ts of using it.  

First, a brief review of CV

Cytolytic Vaginosis (CV) is a condition that occurs when normally protective microbes, Lactobacillus, overgrow and cause vaginal irritation. Symptoms can include:

• Excessive or increased vaginal discharge, most often white and watery or cottage-cheese-like in consistency and appearance (similar to a yeast infection)
• Discomfort or pain during penetrative sex
• Itching or burning of the vagina and/or vulva
• Pain while urinating 

Symptoms for CV can also seem cyclical. Research suggests symptoms are more prevalent during the luteal phase of your menstrual cycle (after you ovulate, but before your period). 

Keep in mind, CV is rare. Only about 1.8-7.5% of the normal population have it. The rate goes up to 26% of women with recurrent vulvovaginitis, aka inflammation of the vulva/vagina due to infection. In order to be diagnosed, you must have a negative yeast culture (to rule out a yeast infection, which is a much more common vaginal infection). You’ll also need a microscopic examination of your vaginal flora. While an Evvy test can share helpful information to start the diagnostic process, like the amount of lactobacilli in your vaginal microbiome, a doctor needs to look at a sample under a microscope for this particular test. 

Given the lack of research, knowledge, and training on cytolytic vaginosis in the medical community (it was only discovered in 1991!), we suggest you specifically seek a vaginitis specialist who is familiar with cytolytic vaginosis. They can help guide you on the best way to diagnose and treat it!

How do I treat CV?

Before we get into baking soda, we need to talk about a few easy steps to take if your doctor has confirmed you’re dealing with CV. Since CV symptoms are caused by an overgrowth of Lactobacillus, your first steps should be to avoid:

1. Lactobacillus probiotics. In general probiotics can be helpful, but in this case you can have too much of a good thing. 

2. Products that lower pH or support Lactobacillus strains in the vaginal microbiome — such as boric acid, vitamin C, lactoferrin, or "pH balancing" products 

All of these can make your CV symptoms worse, so it’s best to stay away. 

Should I use baking soda washes in my vagina?

First, what is baking soda anyway? You’ve probably used baking soda in baking recipes, cooking recipes, deodorants, cleaning supplies, and antacids used to treat heartburn. Baking soda is the consumer name for sodium bicarbonate. It is a white powder that can be found as a crystal in nature, but is usually manufactured industrially to be sold as a white powder in grocery stores, generally in the baking supplies aisle. No matter how you’re using it, baking soda’s main function is to neutralize acids.

Since Lactobacillus thrives in environments with a low vaginal pH, meaning they like it more acidic, some researchers believe that CV symptoms can be alleviated by neutralizing acids in the vagina, therefore increasing the vaginal pH. 

The first study of CV (published in 1991 and still referenced over and over again in the more recent CV literature), suggests that sodium bicarbonate douches would be an effective treatment for CV. However, the past 30 years of research has shown us that douching is harmful to your vagina and vaginal microbiome. So are baking soda douches any different? 

A 2021 study found that while baking soda does limit Lactobacillus growth in pure culture, it also causes the vaginal epithelial cells to die and to produce more inflammation. The authors concluded that baking soda itself could cause disruption and inflammation to the lining of the vagina. In short, baking soda douches could cause more symptoms. A 2022 review of the literature stated that douching is no longer a recommended treatment option for CV.

What about other baking soda treatments (i.e., baking soda Sitz bath)?

Baking soda suppository

Another baking soda treatment option is using a baking soda suppository. One 2009 publication describing CV suggests using empty gelatin capsules filled with baking soda inserted intravaginally, twice weekly for every two weeks. Since this 2009 publication, other researchers and websites have cited this remedy. However, currently we are unable to find any clinical data assessing whether or not this form of treatment is effective. 

Baking soda Sitz bath

A baking soda treatment that has been studied more is a baking soda “Sitz bath,” in which the external area outside of the vagina (vulva) is soaked in a baking soda solution, rather than using the baking soda solution internally to wash the inside of the vagina. 

In a study published in 2021, 53 women with cytolytic vaginosis performed a baking soda Sitz bath by sitting in a solution consisting of one tablespoonful of NaHCO3 (sodium bicarbonate) dissolved in 4 liters of lukewarm tap water every other day for 10 days. Researchers saw that after one session, vaginal discharge ended in 43 of the 53 patients (81%) and that 94-96% of the patients had their discomfort resolved completely after the full course of treatment. While this is just one clinical study, the results are quite promising. More studies looking at external baking soda soaks, with a larger cohort of women, are warranted to establish this as standard treatment option for CV. 

Of all the baking soda treatments, a Sitz bath seems to be the most promising option that is backed up by a clinical study, but more studies are needed to standardize baking soda based treatment for CV. (As usual, the gender health gap rears its ugly head!)

If you think you might be dealing with CV, talk to a vaginitis specialist to talk about your options.