Your Guide to Effective Cytolytic Vaginosis (CV) Treatment

If you've 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 cytolytic vaginosis infection?

As with most things related to vaginal infections, there’s some nuance. We’re sharing the latest research on the best cytolytic vaginosis treatment, and whether baking soda is an effective way to manage cytolytic vaginosis symptoms (along with the dos and don’ts of using it).  

What is cytolytic vaginosis?

Cytolytic vaginosis — also known as lactobacillus overgrowth syndrome or Doderlein's cytolysis — is a condition that happens when normally protective bacteria, Lactobacillus, overgrow and cause vaginal irritation.

Usually, Lactobacilli are the good guys. They produce lactic acid to keep an acidic pH and prevent other bacteria or other pathogens from over-multiplying. That said, you can have too much of a good thing. When Lactobacilli overgrow and produce too much lactic acid, they can start to irritate.

Symptoms of cytolytic vaginosis 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 peeing.

Symptoms for cytolytic vaginosis can also seem cyclical. Research suggests symptoms are more common during the luteal phase of your menstrual cycle (after you ovulate, but before your period). Having diabetes mellitus may also make you more likely to develop cytolytic vaginosis. Lactobacilli use glucose (sugar) as energy, so excessive blood sugar (as in diabetes) provides a steady food source for the bacteria.

It's important to differentiate cytolytic vaginosis from bacterial vaginosis, as both conditions can present with similar symptoms but require different treatments. Bacterial vaginosis is characterized by an imbalance in the normal vaginal flora (vaginal dysbiosis), often with a decrease in Lactobacilli and an increase in anaerobic bacteria like Gardnerella or Prevotella. Another key difference between the two infections is that bacterial vaginosis causes watery, gray vaginal discharge with a foul or fishy smell — while cytolytic vaginosis causes vaginal discharge similar to a yeast infection.

Keep in mind that cytolytic vaginosis is rare. Only about 1.8-7.5% of people have it. The rate goes up to 26% of women with recurrent vulvovaginitis, aka inflammation of the vulva and vagina due to infection.

To be diagnosed, you must have a negative yeast culture (to rule out a yeast infection, which is a much more common vaginal infection). Cytolytic vaginosis can have symptoms similar to vaginal candidiasis. 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 number 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 you get a correct diagnosis and find effective treatment.

Treatment for cytolytic vaginosis

Unlike vaginal yeast infections or bacterial vaginosis, cytolytic vaginosis doesn't respond to traditional solutions like antibiotics or antifungal treatments. Right now, there aren't official treatment guidelines for it, but the goal of treatment is to reduce the number of lactobacilli by increasing your pH level.

Before we get into treatment options, we need to talk about a few easy steps to take if your doctor has confirmed you’re dealing with cytolytic vaginosis.

Since cytolytic vaginosis symptoms are caused by an overgrowth of Lactobacillus species, your first step should be to avoid any triggers, such as:

• Lactobacillus probiotics. In general, probiotics can be helpful, but in this case, you can have too much of a good thing.
• Products that lower vaginal pH or support Lactobacillus strains in the vaginal microbiome — such as boric acid, vitamin C, lactoferrin, or “pH balancing” products that contain lactic acid.

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

Can I wash my vagina with baking soda to balance vaginal pH?

Baking soda is the consumer name for sodium bicarbonate. It’s 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.

You’ve probably used baking soda in baking recipes, cooking recipes, deodorants, cleaning supplies, and antacids used to treat heartburn. 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 cytolytic vaginosis symptoms can be alleviated by neutralizing acids in the vagina, therefore increasing the pH.

The first study of cytolytic vaginosis (published in 1991 and still referenced over and over again in the more recent 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 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 cytolytic vaginosis.

What about other baking soda treatments?

Baking soda suppository

Another treatment option is using a baking soda suppository. One 2009 publication suggests using an empty gelatin capsule 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’re unable to find any clinical data assessing whether or not this form of treatment is effective. 

Baking soda Sitz bath

A 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 Sitz bath by sitting in a solution consisting of one tablespoonful of 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 a standard treatment option for cytolytic vaginosis. 

Of all the 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 cytolytic vaginosis. (As usual, the gender health gap rears its ugly head!)

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

FAQ

How do you stop lactobacillus overgrowth syndrome?

Baking soda Sitz baths are shown to be effective in curbing Lactobacillus overgrowth because they neutralize the vaginal pH. Avoiding possible triggers (such as taking probiotics) may also be helpful.