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 are from fecal contamination, such as the E. coli bacteria.

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 do 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:

- www.Evvy.com

- www.juno.bio

- www.ombrelab.com

- https://microgendx.com

It costs range $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.

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 6 rounds of product testing and improvement. Each round we had about 20 customers who participated in the testing.

Many participants have found relief after using 3 or more AV-NIL suppositories.

Some of these customers wanted to purchase AV-NIL so that when AV happens again in the future they will 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.

The price is $70/pack. Each pack has 3 suppositories. For a mild case of AV, 1 pack may clear it. For a stubborn case, we recommend 2-3 packs.

At present, we are selling it internally only to our existing customers or customers who have previously joined our private Facebook support group - Pelvic health allies. The reason is that we do not want to launch a product and then receive a last-minute feedback reporting a side effect. If this happens, since we only sell it internally, we can inform our existing customers with the side effect, so that they can manage it accordingly.

If you are interested in purchasing the product, please contact help@neueve.com for assistance. You need to tell us how many packs of AV-NIL you want. 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

It is important to perform health maintenance after AV is cleared. If you are premenopausal, you can do 3-month maintenance by using NeuEve Gold, 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.

NeuEve Silk (age <55), Silver (45-55), and Gold (<45) can reverse vaginal atrophy. If you start with a lower phase, 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 will 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.