By Riva Preil The #1 cause of vaginal complaints in America is due to bacterial vaginosis (BV). BV is due to the vagina becoming less acidic than it should be which creates and imbalance in the various vaginal bacteria. This creates an unpleasant fish odor in the vagina, and it can also result in increased vaginal discharge and itching and/or burning. Pain is generally not associated with BV. BV is best diagnosed through a wet prep, as opposed to a vaginal culture (which does not help in the differential diagnosis of BV). Doctors often perform a vaginal pH test to assess the level of acidity in the vagina. A pH of greater than 4.5 is considered abnormal. Furthermore, a microscopic analysis of vaginal wall cells can be performed to check for clue cells, bacteria filled cells which are unique to BV. BV is not considered a sexually transmitted disease, however it is associated with sexual activity with multiple partners has been connected to BV. It is also associated with intrauterine device (IUD) implantations as well as hygienic douching (this should actually be avoided to prevent killing the vaginal lactobacilli which create the necessary acidic environment in the vagina). More than 50% of women with BV actually do not demonstrate any signs or symptoms. BV is NOT the same as a yeast infection, however many women often mistaken BV for a yeast infection, which is usually not accompanied with a foul odor. When women make this mistake and treat themselves with over the counter anti-yeast medication, they will not feel better because the underlying problem, BV, has not been treated. Therefore, it is important for an accurate diagnosis to be made in order to properly treat the problem, especially because BV tends to recur. Although there is currently no cure for BV, symptoms can be managed through medications such as Flagyl and clindamycin. Some women also find the vaginal acidifying moisturizer, Replens, helpful. BV mediation, as all medication, should be discussed with oneâ€™s primary care physician. In addition, BV is considered by the pelvic floor muscles as a â€œtraumaâ€, and it may cause pelvic floor muscle tightness and trigger points. Pelvic floor physical therapy can be very beneficial for reducing the musculoskeletal dysfunctions associated with BV.