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Vaginal Health: Bacterial Vaginosis, Yeast Infections and Probiotics, by the Evidence

Bacterial vaginosis came back within a year in more than half of women in one study, and a 2025 trial found treating male partners too cut recurrence. Most women who self-diagnose a yeast infection turn out to have something else, and store-bought vaginal probiotics have little proof behind them.

By Kymata Health editorial teamLast verified October 10, 2026

Medical review pending. Written by our editorial team from the studies and documents cited below; a credentialed clinician has not reviewed it yet. Educational only, not medical advice.

Key takeaways

  • After standard oral metronidazole, bacterial vaginosis (BV) recurred within 12 months in 58% of the women followed (68 women) in a cohort study [3].
  • In a 2025 randomized trial that was stopped early for benefit, treating the male partner with oral and topical antibiotics cut BV recurrence at 12 weeks from 63% to 35% [4].
  • Only 33.7% of 95 women buying an over-the-counter antifungal for a self-diagnosed yeast infection actually had one in a 2002 study [6].
  • The CDC says no studies support probiotics as add-on or replacement treatment for BV, and no substantial evidence supports them for yeast infections [1][2].
  • The FDA has not cleared or approved any energy-based device for vaginal "rejuvenation" or for vaginal symptoms of menopause [8].

Guides in this hub

  1. Bacterial Vaginosis That Keeps Coming Back: What the Trials ShowMore than half of women had bacterial vaginosis again within a year of standard treatment in one cohort. A 2025 trial found that also treating male partners cut recurrence, though a 2026 meta-analysis says the question is not settled.
  2. Vaginal Probiotics vs Placebo: What the Trials Show for BV and Yeast InfectionsA vaginal Lactobacillus crispatus product cut BV recurrence in a 2020 trial, but it is not on the market. For yeast infections, probiotics added to antifungals helped short term in low-quality trials, and the CDC does not recommend them as treatment.
  3. Recurrent Yeast Infections: Fluconazole, Boric Acid and Oteseconazole ComparedRecurrent yeast infection means three or more episodes in a year. Weekly fluconazole kept 91% of women symptom-free for 6 months in the main trial, but most relapsed after stopping. Many women who self-treat do not have a yeast infection at all.

Where to start

Vaginal itching, soreness and discharge are not specific to one cause [2], and BV and yeast infections need different treatment. The CDC recommends oral or vaginal metronidazole or vaginal clindamycin for symptomatic BV [1], and antifungal azoles, many sold over the counter, for uncomplicated yeast infections [2].

Getting tested matters. In one study only about a third of women who self-diagnosed a yeast infection had one [6], and the CDC advises a clinical exam and testing if symptoms persist after an over-the-counter product or return within 2 months [2].

When it keeps coming back

BV recurrence is common: 58% of the women followed in one cohort had BV again within a year of treatment [3]. Our BV recurrence guide covers the 2025 partner-treatment trial and the CDC's suppressive regimens.

Recurrent yeast infection, three or more episodes in a year, affects fewer than 5% of women [2]. Weekly fluconazole for 6 months is the CDC's maintenance regimen [2]; our recurrent yeast guide covers it, boric acid and oteseconazole.

Probiotics and microbiome products

An investigational vaginal Lactobacillus crispatus product, Lactin-V, cut BV recurrence vs placebo in a 2020 trial, but the CDC notes it is not FDA cleared or commercially available [5][1]. Probiotics sold in stores are a different matter; our probiotics guide separates the trial evidence from the marketing.

Douching may increase the risk of BV relapse, and no data support it for treatment or symptom relief [1].

Regulatory and legal notes

  • In July 2018 the FDA warned against energy-based devices (laser or radiofrequency) for vaginal "rejuvenation" or cosmetic vaginal procedures, citing burns, scarring, painful sex and chronic pain; it has not cleared or approved any such device for those uses or for vaginal symptoms of menopause, incontinence or sexual function [8].
  • Oteseconazole (Vivjoa) was approved by the FDA on April 26, 2022 to reduce recurrent yeast infections only in women who are not able to have children; the FDA notes it may harm an unborn baby [7].
  • Vaginal probiotics and microbiome-test products are not FDA-approved treatments for BV or yeast infections; the CDC says Lactin-V, the product with the strongest trial, is not yet FDA cleared or commercially available [1].

Other names you will see

Listed for completeness. We have no paid relationship with these brands and do not link to them.

  • Evvy: Sells an at-home vaginal microbiome test ($159 on its site, October 2026). Evvy says the results are not designed to diagnose a condition on their own and that a clinician must confirm any diagnosis.

References

  1. [1]Bacterial Vaginosis: Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control and Prevention, 2021.
  2. [2]Vulvovaginal Candidiasis (VVC): Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control and Prevention, 2021.
  3. [3]High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis, 2006. PMID 16652274
  4. [4]Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med, 2025. PMID 40043236
  5. [5]Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med, 2020. PMID 32402161
  6. [6]Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol, 2002. PMID 11864668
  7. [7]Drug Trials Snapshots: VIVJOA (oteseconazole). U.S. Food and Drug Administration, 2024.
  8. [8]Elective Female Genital Cosmetic Surgery: ACOG Committee Opinion No. 795. American College of Obstetricians and Gynecologists, 2020.

Dietary supplements are not intended to diagnose, treat, cure or prevent any disease, and these statements have not been evaluated by the FDA. Prescription options need a licensed clinician. Talk to your clinician or pharmacist before starting anything new, especially if you take prescription medicines, are pregnant or breastfeeding.

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