Can Stress Cause BV? Understanding the Connection to Vaginal Health

Stress is part of being human, but when it becomes chronic, it can quietly affect many parts of our health, including something most people don’t think about right away: vaginal health.

While stress doesn’t directly cause bacterial vaginosis (BV), it can play a part in setting the stage. Chronic stress affects hormone levels, immune responses, and bacterial balance, all of which can increase the risk of developing bacterial vaginosis. At the same time, bacterial vaginosis itself can heighten stress, creating a feedback loop that feels hard to break.

When stress hormones like cortisol stay elevated for too long, the body becomes less efficient at fighting off harmful bacteria. This hormonal and immune imbalance can lead to a decrease in protective Lactobacillus species, which normally help maintain a healthy vaginal ecosystem that keeps unwanted bacteria in check. Without enough of these good bacteria, harmful microbes can take over, increasing the risk of bacterial vaginosis.

Let’s take a closer look at how stress influences vaginal health, why the connection between stress and bacterial vaginosis is so complex, and what you can do to manage both your stress levels and your reproductive health.

The impact of chronic stress on vaginal health

When we experience psychological stress, our brains activate the “fight or flight” response. This helpful reaction releases stress hormones like adrenaline and cortisol that prepare us to tackle immediate challenges. While this response can be beneficial in short bursts, chronic stress — when it sticks around for a long time or keeps coming back — can have some downsides. It can wear down our immune system and throw off various bodily processes, including those that keep vaginal health in check. 

A weakened immune system means the body is less capable of maintaining a balanced vaginal flora. The vagina naturally hosts a mix of bacteria, but healthy conditions depend on a dominance of Lactobacillus, which keeps the vaginal pH slightly acidic. Chronic stress can shift this balance, allowing pathogenic bacteria to multiply.

The immune and microbiome changes that happen with chronic stress also alter vaginal pH. When the pH becomes less acidic, it creates an ideal environment for the anaerobic bacteria linked to bacterial vaginosis (like Gardnerella) to overgrow. This change doesn’t happen overnight, but over time, sustained stress and its effects on the immune system and hormones can tilt the vaginal environment in an unhealthy direction.

Can stress cause BV?

While it's not a direct cause, there seems to be a definite link between stress and bacterial vaginosis, but it’s not one-directional. Stress can increase the chances of getting BV, but having BV (particularly recurrent BV) can also make you feel more stressed, creating a feedback loop that’s tough to break.

When you experience ongoing stress, your body doesn’t just feel it emotionally; it translates into physiological changes. Chronic stress has been shown to alter the body’s microbiomes in both the gut and vagina. The vaginal microbiome plays a crucial role in maintaining vaginal health by keeping the pH low and preventing harmful bacteria from flourishing.

Under normal conditions, Lactobacillus bacteria dominate this vaginal flora. They produce lactic acid and hydrogen peroxide, which act as natural defense mechanisms. However, chronic stress can suppress these beneficial bacteria, either through suppressing the immune response or hormonal changes. When Lactobacillus levels drop, anaerobic bacteria such as Gardnerella, Prevotella, and Atopobium can take over, leading to bacterial vaginosis.

What makes this even more interesting (and frustrating) is that psychological stress doesn’t have to be extreme to have this effect. Even moderate but consistent stressors, like work pressure, money worries, or relationship conflicts, can lead to physiological changes that disturb the vaginal bacterial composition over time.

Research has shown that perceived stress — how much stress a person feels, regardless of external factors — is a strong predictor of BV incidence. A large longitudinal cohort study found that women who report higher levels of stress also have higher rates of bacterial vaginosis, even when other behavioral risk factors like sexual intercourse or hygiene practices were taken into account. This suggests that stress itself plays an important role in influencing your likelihood of developing bacterial vaginosis.

Experiencing recurring bacterial vaginosis feeds into this cycle, too. Vaginal symptoms like unusual discharge, a fishy odor, and itching can cause both physical discomfort and self-consciousness. Women with recurrent bacterial vaginosis may feel frustrated, anxious, or even ashamed, especially if treatments don’t seem to work long-term. This compounds psychological stress levels, creating a vicious cycle that affects both mental and physical health.

It's important to understand that our health is interconnected, especially when it comes to conditions like bacterial vaginosis. Treating the infection isn't just about the physical symptoms; we also need to think about the whole person and their emotional well-being. More and more healthcare providers are recognizing this and are starting to include support for mental well-being and stress management in their treatment plans for bacterial vaginosis. It’s all about taking care of you in a more holistic way. 

When patients understand that their stress levels can influence their vaginal health, it becomes easier to see bacterial vaginosis not just as a vaginal infection, but as a condition that thrives when the body’s natural systems are under strain. Stress management, therefore, isn’t just a mental health strategy; it’s also a preventive measure for bacterial vaginosis and overall reproductive health.

Management and prevention of bacterial vaginosis

Treating and preventing bacterial vaginosis isn’t just about popping a prescription. Sure, antibiotics are the standard (and usually most effective) treatment, but they mostly fix the immediate problem and don’t always get to what’s really causing it. Stress could be a piece of the puzzle, and finding ways to handle it may go a long way toward keeping bacterial vaginosis from coming back — especially if you’ve already tried everything else.

A comprehensive approach to bacterial vaginosis focuses on both physical and emotional health. On the physical side, antibiotics may be necessary to clear the infection, but lifestyle adjustments help maintain balance afterward: 

• Avoid douching, which can disrupt the vaginal microbiome.
• Practice safe sex to minimize the introduction of new bacteria.
• Eat a nutrient-rich diet that includes plenty of fruits, vegetables, whole grains, and fermented foods to support your body’s natural defences and nourish the microbiome.
• Consider probiotic supplements containing vaginal Lactobacillus species to help restore balance, like Evvy Women’s Complete Probiotic and Vaginal Probiotic Suppositories. 
• Reduce stress with mindfulness meditation, yoga, and deep breathing exercises, which have been shown to lower cortisol levels and improve immune function. Easier said than done, we know.
• Prioritize adequate sleep, aiming for seven to nine hours per night to allow the body to rest, support hormonal balance, and strengthen your body's immune response.
• Exercise regularly to help maintain physical and emotional stability, even if it’s just going on daily walks or doing some gentle stretching. 
• Monitor your vaginal microbiome to understand how psychological stress may be affecting your vaginal health. Evvy’s Vaginal Health Test can reveal shifts in your bacterial balance, helping you identify whether stress or other factors might be disrupting your microbiome and guiding you toward personalized care and prevention strategies.
• Remember that bacterial vaginosis is nothing to be ashamed of! Talking openly about vaginal health (especially with a sexual partner) helps normalize the conversation and supports overall well-being.

Every woman’s body is unique, but one thing is clear: vaginal health is deeply connected to mental health. The more we recognize and respect this connection, the more we can support ourselves in a holistic, compassionate way.

FAQ

Can stress throw off your pH balance?

Yes, psychological stress can affect your body’s natural pH balance, including in the vagina. When you’re under chronic stress, your body produces more stress hormones like cortisol, a hormone that can weaken your body's immune response and alter bacterial balance. This shift can reduce the protective lactobacilli and make the vaginal environment less acidic, which allows harmful bacteria to grow more easily. A healthy vaginal pH is typically slightly acidic, helping protect against vaginal infections. 

Can BV be stress-related?

Yes, bacterial vaginosis can be linked to stress. While stress doesn’t directly cause bacterial vaginosis, it can create conditions that make it more likely to develop or return. Chronic stress raises cortisol levels, which can weaken your immune system and disrupt the vaginal microbiome. When protective Lactobacillus bacteria decrease, harmful bacteria can overgrow, leading to bacterial vaginosis. Studies have shown that women with higher stress levels are more likely to experience bacterial vaginosis or recurrent infections.

How does stress affect vaginal health?

Stress impacts vaginal health by influencing hormones, immune function, and the balance of bacteria in the vaginal microbiome. When stress becomes chronic, elevated cortisol levels can suppress the immune system, making it harder for the body to maintain healthy levels of protective Lactobacillus species. This shift can lead to a higher vaginal pH and an overgrowth of harmful bacteria, increasing the risk of infections like bacterial vaginosis or yeast infections. Stress can also worsen existing symptoms or delay healing.

Can BV become chronic if I’m stressed?

Yes, stress can make bacterial vaginosis more persistent or recurrent. Chronic stress affects the immune system and hormonal balance, which can disrupt the vaginal microbiome and make it harder for the body to maintain healthy bacteria. This creates an environment where BV-causing bacteria can thrive, even after treatment. If stress isn’t managed, bacterial vaginosis may come back more frequently.

How can I manage stress-related BV triggers?

Managing stress-related bacterial vaginosis begins with taking care of both your mind and body. Practice relaxation techniques such as mindfulness, deep breathing, or yoga to help calm your nervous system and reduce cortisol levels. Prioritize getting enough sleep, maintaining a nutrient-rich diet, and incorporating regular movement to boost your immune function and support a balanced microbiome. Avoid douching and harsh soaps, as these can disrupt vaginal bacteria. If you're feeling overwhelmed by stress, consider seeking therapy or participating in mindfulness-based stress reduction programs. Additionally, testing your vaginal microbiome with Evvy can help you understand how stress is impacting your balance and provide personalized steps to restore your vaginal health.