The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis

Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis. PLoS ONE 8(9): e74378. doi:10.1371/journal.pone.0074378 The Burden of Bacterial Vaginosis: Women's Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis Jade E. Bilardi 0 Sandra Walker 0 Meredith Temple-Smith 0 Ruth McNair 0 Julie Mooney-Somers 0 Clare Bellhouse 0 Christopher K. Fairley 0 Marcus Y. Chen 0 Catriona Bradshaw 0 Adam J. Ratner, Columbia University, United States of America 0 1 Department of Epidemiology and Preventative Medicine, Monash University , Melbourne , Australia , 2 Melbourne School of Population and Global Health, The University of Melbourne , Melbourne , Australia , 3 General Practice and Primary Health Care Academic Centre, The University of Melbourne , Melbourne , Australia , 4 Centre for Values, Ethics and the Law in Medicine and Sydney School of Public Health, The University of Sydney , Sydney , Australia , 5 Melbourne Sexual Health Centre, Alfred Health , Melbourne , Australia Background: Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women's experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women. Methods: A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis. Results: Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, 'dirty' and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women's self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence. Conclusion: Women's experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis. - Funding: In the conduct of this study a small grant was utilised from the Australian Lesbian Medical Association www.almas.org.au)and ACON (www.acon.org. au). Dr Jade Bilardi is in receipt of a National Health and Medical Research Centre (NHMRC) Early Career Fellowship GNT1013135. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Bacterial vaginosis (BV) is a common condition affecting between 10%30% of women in developed nations [1,2], including the United Kingdom and United States but in excess of 50% of women in rural sub Saharan Africa [3]. Symptoms of BV include vaginal malodour often likened to a fishy odour and a thin, off white homogenous vaginal discharge [4,5]. BV has been associated with serious sequelae including miscarriage, preterm delivery and increased risk of HIV and sexually transmitted infections (STIs) [68]. While the aetiology of BV is still unclear, it appears to be a polymicrobial condition which is associated with a profound disturbance of the normal vaginal flora. Whether BV is sexually transmitted remains unclear, however epidemiological studies have shown strong evidence of an association between BV and sexual activity [2,9,10]. Cross-sectional studies of women who have sex with women (WSW) have also reported a higher prevalence of BV than found in heterosexual women [1115]. Current recommended treatment for BV is with oral or vaginal antibiotics, however current studies have shown recurrence rates of up to 60% within 12 months of treatment [16]. To date, only one other qualitative study has specifically explored the experiences and impact of recurrent BV on women. In a mixed methods study by Payne et al [17] of 23 African American women experiencing recurrent BV, women commonly reported feeling embarrassed and frustrated by the symptoms of BV. Their concerns and self-consciousness around malodour led them to try various self-help remedies, including douching and manual vaginal washing, in order to have a sense of control over their symptoms. Past studies have found that practices such as douching, which are commonly used by women experiencing vaginal conditions, are associated with a higher incidence of bacterial vaginitis [1820]. Overall, the study found that recurrent BV impacted negatively on womens social, personal and work relationships, significantly affecting their quality of life [17]. These findings are also supported in a broader qualitative study of womens experiences of vaginitis (thrush, BV and trichomoniasis) in a primary care setting, which also found that vaginal symptoms could cause extreme anxiety and distress to women, impacting heavily on their social and sexual lives [21]. While there is little data on the psychosocial impact of recurrent BV on women, there is considerable data on the adverse psychosocial sequelae experienced by individuals diagnosed with genital herpes and human papillomavirus (HPV). A number of qualitative and mixed methods studies [2224] have found that individuals with genital herpes or HPV commonly experience significant anxiety, self-blame and embarrassment around their diagnosis, and fear disclosing their status to others. Individuals often report feeling stigmatised, experiencing lowered self-esteem and concern around future sexual interaction and relationships [2224]. The aim of this study was to use qualitative research methods to explore the experiences and impact of recurrent BV on women. This study has been reported in accordance to the Consolidated criteria for reporting qualitative research (COREQ) guidelines [25]. Further findings from this study will be reported in an upcoming paper. Ethics Statement Ethical approval for this study was granted by the Alfred Hospital Ethics Committee, Victoria, Austr (...truncated)