What is Aerobic Vaginitis?

Aerobic vaginitis (AV) is a form of vaginitis first described by the Belgium OB/GYN Dr. Donders in 2002. It is characterized by a decrease in vaginal lactobacillus along with inflammation, atrophy, and the presence of predominantly aerobic bacteria. The aerobic bacteria may come from four possible sources: fecal contamination, skin, bladder, and the intimate partner. Common causative bacteria include E. coli, Enterococcus, Group B streptococcus and Staphylococcus.

What Is the Difference Between AV and BV

AV stands for aerobic vaginitis but BV stands for bacterial vaginosis. Vaginitis and vaginosis may have similar symptoms. What is the difference? It’s important to learn their differences to diagnose and treat these conditions.

Vaginitis is an inflammation of the vagina. Five cardinal signs of inflammation are: pain, heat, redness, swelling, and loss of function. It can be caused by various infections. Each infection has its own symptoms and treatments. AV bacteria are more invasive and can cause inflammation in the tissue and often have more severe discomfort symptoms. 

Bacterial vaginosis (BV) is an imbalance of bacteria in the vagina. Harboring bacteria in the vagina is normal. Under health condition, the vagina is dominated by friendly bacteria Lactobacillus. When BV occurs, anaerobic bacteria like Gardnerella vaginalis starts to overgrow, causing unpleasant odor and discharges. However, BV bacteria are less invasive. They may grow on the surface of the tissue without causing inflammation inside the tissue. BV does not always show symptoms. When BV shows symptoms, they are often milder than those of AV.

Symptoms of AV

AV is an inflammation in the vaginal tissue. Symptoms include:

• Burning
• Itchiness
• Visible redness 
• Abnormal discharge
• Painful intercourse
• Vaginal soreness 

In comparison with AV, BV doesn’t always cause symptoms. However, symptoms of BV can include: 

• A fish-like odor that may intensify after intercourse
• A thin, gray discharge 
• Extreme itchiness and irritation on the vulva
• A burning sensation when you pee

Desquamative Inflammatory Vaginitis

Desquamative Inflammatory Vaginitis (DIV) is an uncommon vaginitis.

Symptoms include abundant vaginal discharge (including purulent discharge), burning, irritation, and painful sex.

Vaginal mucosa may appear redness, swelling, spotted bleeding, and erosions. Lab testing may show various cocci (Streptococcus, Staphylococcus, and Enterococcus), E. coli and other aerobic and/or facultative bacteria.

Due to aerobic bacterial infection, DIV is considered an extremely severe case of AV.

Diagnosis

If you have been treated for yeast or BV, but did not find relief, your condition may not be yeast or BV. If you are postmenopausal, your vaginitis may be AV. For a clear diagnosis, it is important to see a doctor. The doctor may do a swab sample. By examining a slide under a microscope, the doctor may find abnormal bacteria. AV is often associated with three key features:

1) vaginal atrophy (shrinking)
2) inflammation (reddish skin)
3) abnormal bacteria (microscope observation)

Vaginal microbiome test can detect AV. The following labs can do a vaginal microbiome test.

It costs $85 - $150 per test. It is expensive but you may ask them if their test is covered by your medical insurance, Medicare, Medicaid, or HSA account.

We have negotiated with Juno a group discount for our NeuEve customers. All these companies use the same NGS (next generation sequencing) technology and are all dumb proof with the same quality. Thus, we would recommend that you try Juno because it offers us a group discount to our customers.

Once diagnosed, the doctor may provide treatment. Your doctor may also refer you to a specialist in women’s health or infectious diseases.

Conventional Treatment

If your condition is diagnosed as AV, the treatment may target the three major features: atrophy, inflammation, and abnormal bacteria. The treatment may include topical steroids to reduce the inflammation, topical estrogen to reduce atrophy, and an antibiotic to clear abnormal bacteria. But, due to decreased resistance to infection, AV often recurs after treatment.

These treatments have some problems. Topical steroids reduce inflammation. But they can also reduce resistance to infection. Estrogen cannot be used in the long term due to cancer risk. Topical antibiotics for treating BV are not effective for AV. Injectable or oral antibiotics are used to treat AV. But repeated use may result in yeast infection.

Anaerobic bacteria cause BV. Aerobic bacteria cause AV. There are many topical antibiotics for BV. Few are available for AV.

A New Natural Remedy for AV Relief

Is there a better solution? The answer is “Yes.” NeuEve is all-natural and can clear AV safely without side effects.

We have developed the first self-care product AV NIL for clearing AV. It has been through 8 rounds of product testing and improvement. Each round we had about 20 customers who participated in the testing.

The product is offered on our website and also on Amazon. Each pack has 3 suppositories. 

Some participants with a milder case found relief after using 1 pack of 3 AV NIL suppositories. More had a moderate case and found relief after using 2 - 3 packs. A few had a stubborn case and found relief after using more than 3 packs. 

Some of these participants were physicians themselves and they used all available antibiotics that doctors could prescribe. One of them had 19 different antibiotics, but all had failed. They found relief after using AV NIL as well. 

These participants wanted to purchase AV NIL so that when AV happens again in the future they could have a product handy to clear it. To meet our customers' need, we decided to put the product on the market, so that more women with stubborn AV may benefit from this natural product.

To understand how AV-Nil clears bad bacteria, you may find this article helpful:

How does NeuEve kill bad bacteria without using antibiotics?

Maintenance to stop AV from coming back

After AV is cleared, it frequently recurs. AV-causing bacteria may easily come back to cause a re-infection from other sources. These sources are called "reservoirs." 

There are 4 possible reservoirs that may harbor aerobic bacteria to re-infect the vaginal tract after it has cleared the unwanted bacteria.

• The bladder, which often harbors E. coli, Enterococcus, etc.
• The colon, which often harbors E. coli, Enterococcus, group B streptococcus, etc.
• The skin, which often harbors Staphylococcus, etc.
• The intimate partner, who may carry bacteria from you before you used AV NIL. 

1) Reduce bacterial load in the bladder 

Summer is the season to have more frequent urogenital infections.

Hot weather may cause more sweating. As a result, you may have less urine in the bladder. Without frequent urinations to flush the bladder, your bladder may grow bacteria. Some bacteria may cause urinary tract infections (UTIs). Other bacteria may be mobilized to the vagina to cause vaginal infections.

Therefore, it is important to keep good hydration, especially in the summertime, for the health of the bladder and the vagina.

You may take supplements and drink a lot of water described in this article to reduce bladder bacterial load:

Dietary supplements for preventing recurrent UTIs (https://help.neueve.com/kb/dietary-supplements/dietary-supplements-for-preventing-recurrent-utis)

2) Reduce unwanted bacteria in the colon 

Fecal materials are made of f thousands of different bacterial species. But only some of them may cause AV infections in the vagina.

To reduce unwanted bacteria in the colon, you may take probiotic pills and/or eat more probiotic foods like yogurt, kefir, kimchee, and sauerkraut (pickled sauerkraut not canned).

Additionally, you may change your lifestyle to avoid fecal contamination:

1) Changing synthetic fiber underwear to 100% cotton and changing it at least once a day.
2) Wiping from front to back, not from back to front to reduce the risk of fecal contamination.
3) Washing butt at least once a day with a mild soap.

3) Reduce unwanted bacteria on the skin 

The skin is not a sterile surface. Millions of bacteria grow on the skin. The most common bacterium is Staphylococcus. If you have this bacterium in your vaginal microbiome lab report, its source may be your skin.

To reduce Staphylococcus on the skin, the best method is to wash the skin with a gentile soap.

4) Reduce unwanted bacteria in the partner 

If you had sex and AV re-appeared, your partner may be a reservoir. 

Men do not get AV. This means that even if men may harbor AV-related bacteria, it may be temporary. While you are doing AV treatment, it would be a good idea to refrain from having sex for at least 2 weeks. You should let your partner to clean well with soap and keep good hydration to flush the bladder with strong urine pressure. This way, after your AV is cleared, your partner will also be clean.

If the infection is associated with group B streptococcus, the partner may be a carrier. Even though he may not have any noticeable symptoms, a study showed that spouses of group B infected women are tested positive for the same type of group B streptococcus in their urine. Thus, men can be a source of re-infection for all AV pathogens. Since men do not develop AV infections, their carrier status may be temporary and may not last for two weeks. It would be a good idea to refrain from having sex for at least 2 weeks while you are treating your AV infection.

5) Boost immune resistance against infections

It is difficult to clear bacteria from all possible reservoirs. An alternative method is to boost the immune resistance of the vagina against infections.

Using NeuEve products can help you boost the vaginal immune resistance. 

After AV is cleared. If you are premenopausal, you can do 3-month maintenance by using NeuEve BV Clear (age <40) or Gold (age 40-50), using one suppository per week, skipping the menstrual period week. If you are AV-free for 3 months, you may be AV-free for a long time.

However, if you are postmenopausal, a common cause of AV is vaginal atrophy. When the vaginal lining skin is healthy and not atrophied, it has a normal cell exfoliation, like dandruff shedding from the scalp. As a result, bad bacteria like E. coli attached to the vaginal lining skin surface are removed by cell exfoliation regularly. But if the vaginal lining skin is atrophied, the thickness of the vaginal lining skin shrinks from about 40 layers to just one layer. Exfoliation stops. Bacteria can attach to the skin surface longer, ultimately causing infection.

After AV is cleared, it may come back to cause recurrent infection. The reason is that the cause of AV, vaginal atrophy, is still there. If you reverse vaginal atrophy, the normal skin surface cell exfoliation will resume and attached bacteria will be removed regularly. AV may not come back

Therefore, to stop AV from coming back, the key is to relieve vaginal atrophy.

This article explains why maintenance is important.

NeuEve Silk (age >55), Silver (50-55), and Gold (<50) can help reverse vaginal atrophy. If you start with a lower phase like Silk, you can move up a phase after 1-4 months. You should reach the highest phase Gold for the best result to clear and stop infection.  After using NeuEve suppositories for a few months, the atrophied lining skin becomes thicker, and vaginal cell exfoliation resumes. This increases the resistance of the vaginal lining skin to infections. AV may not come back.

How long do I need to do the maintenance for vaginal atrophy relief? This depends on how long you you wish to remain sexually active. If you want to keep your sex life for 20 more years, you will need to keep the maintenance for 20 more years. The reason is that vaginal atrophy is not a disease that can be cured. It is an aging outcome, like wrinkles. If you stop applying cream on the face, wrinkles will show up. Likewise, if you stop applying NeuEve, vaginal atrophy will return and you will have painful sex. Infections like AV will come back. The NeuEve Gold is the longest-lasting product as you only need to use it once a week.

However, if you are not sexually active after AV is cleared, you can use NeuEve Gold for 1 month and use the NeuEve Balm Cream for continuous maintenance. One jar lasts 3-4 months.

Meeting Dr. Donders

In 2019, Dr. Chang visited Dr. Donders in Europe. They discussed the new treatment for AV.

Disclaimer: This article is for information purposes only. It is about natural products, nutrients, and/or methods for managing vaginal odor or microbial imbalance-related discomforts (not a true infection). It is not medical advice for the treatment of any diseases.

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Product review for AV NIL

Emily, August, 2023

Worth it!

I had AV for 3.5 years. I got it after breastfeeding when my estrogen was low. It took 2 years and many doctors telling me there was “nothing wrong” to get the proper diagnosis. And even then I had to ask to be tested for it! Don’t give up! It took me 5 rounds of AV-nil success. I had a very stubborn case. And after the fifth round, I still felt “off” down there until I had used vaginal probiotics for a few nights. I know from previous testing that I had almost no protective bacteria! All that to say - if you’re on the fence - it’s worth it! The NeuEve team responds quickly if you need help or if it doesn’t work the first time for you. If you’re reading this review, you’ve been to many appointments already, and this is less than the cost you will pay there. I’m now using oral and vaginal probiotics and feel much better. And gold for maintenance. Your life can and will get better! There is hope!

Helped me clear cytolytic vaginosis (CV)

Anonymous, August, 2023