How to Manage Stubborn BV and BV Associated with Vaginal Dryness?


What is BV?

BV is bacterial vaginosis. It is not a true infection but rather a disruption in the balance of normal bacteria in the vagina.

BV is also known as nonspecific vaginitis. It results from an overgrowth of bacteria present in the vagina. It is different from infection by external bacteria.

BV is very common. It affects about 29% of women in the US.

Gardnerella is one type of bacteria that participates in the development of BV. Symptoms of BV include vaginal discharge and odor.

Symptoms of BV
When to See a Doctor for a checkup?

BV symptoms are like symptoms of other infections. It’s important to get a diagnosis from a doctor. See a doctor if you:

15 Things Your Gynecologist Wants You to Know | Best Health Magazine
See an OB/GYN to confirm BV diagnosis
  • Have a new vaginal discharge along with an odor
  • Have a new partner or more than one partner (You might need to rule out a sexually transmitted disease.)
  • Used a yeast medicine but still have symptoms
What causes BV?

A friendly bacteria called lactobacillus colonizes the vagina. It keeps your vagina acidic so bad bacteria don’t overgrow. If your lactobacillus reduces, more bad bacteria grow up, and you get BV.

What causes BV
Older women often have vaginal dryness, which weakens resistance to BV
How is BV treated?

Doctors may prescribe antibiotics (metronidazole, clindamycin, or tinidazole) to treat BV. This could be a tablet you take or a cream or gel you put into the vagina. It may take 5 to 7 days to finish the medicine.


Since BV can spread through sex, don’t have sexual contact until you complete the treatment.

A major problem in BV treatment is recurrence. If that happens, the doctor may let you take antibiotics again for a longer time.

Using antibiotics for the long term may cause side effects. These include yeast infection and bacterial drug resistance.

Besides antibiotics, other products are available over the counter for BV management. These include:

  1. Antiseptics, such as essential oils, boric acid, hydrogen peroxide, baking soda, etc.
  2. Acidifiers, such as vinegar, yogurt, acid gel, etc.
  3. Probiotics, such as Lactobacillus pills or suppositories.
  4. Prebiotics, such as oligosaccharide.
  5. Vaginal douches, such as Summer’s Eve. Its goal is to get rid of odor, but it flushes out good bacteria and disturbs the vaginal microbiome. Doctors do not recommend douching because it actually increases the risk of BV.
What is the odds of recurrence after my BV clears?

A significant feature of BV is recurrence.

Scientific literature says that BV may recur in about 80% of cases within 3 months. These include relapse or reinfection. Thus, your BV may recur at the same high rates after the initial clearance. This does not mean the initial treatment is not successful. When recurrence occurs, your BV becomes recurrent BV.

There had been no methods to stop BV recurrence before the creation of NeuEve. With NeuEve, you can reduce the recurrence rate to zero by practicing maintenance. For more information, check this article out: How to stop BV from coming back?

How to tell if my BV is a stubborn case?

If your BV is not cleared or comes back after repeated treatments, you may have a stubborn case.

Two types of stubborn BV

  1. Superbug. Your BV symptoms showed up after an extensive or long-term antibiotic treatment. Or your BV symptoms are not cleared by many rounds of treatments. This means that your BV may have a superbug that resists all these treatments. This type is easy to manage. By changing to a new and/or stronger treatment or by increasing the dosage, you can clear it and find relief. We designed a BV Finisher formula. It has 3x increased concentration than BV Clear. This formula has worked well for clearing tough BV cases that other products had failed. It is available on Amazon and on our own website. But, due to an increased concentration, its potential of irritation has also increased. It is only good for premenopausal women without a health issue.
  2. Weak resistance. Your BV is cleared by treatment, but it comes back shortly afterward. This means that your body may have weakened resistance to BV. This type is harder to manage and is the main subject of this article.

Vaginal dryness weakens the vaginal lining skin, rendering it less resistant to BV. The cause is estrogen reduction. Women suffer from vaginal dryness often complains painful intimacy.

When do women develop vaginal dryness?

The female hormone estrogen supports the development of the woman’s reproductive tissues. These include the vagina. A healthy reproductive-aged woman has a high level of estrogen. Her vaginal lining is thick and well moisturized (1).

Estrogen Hormone Level over Time
The estrogen level in a woman gradually declines with aging after menopause.

Yet, after a woman reaches menopause, the production of estrogen declines (2). Her vaginal tissue becomes dried. Resistance to infection declines. Bacteria and yeast can easily infect the dried vaginal tissue. Thus, vaginal dryness often results in vaginal infection, which is also called atrophic vaginitis. Major symptoms include dryness, odor, and painful intimacy.

Besides menopause, other conditions may also cause vaginal dryness at a younger age. These conditions include:

 On birth control pills

 Hormonal IUD (Mirena)



• Certain diseases like lichen sclerosuslichen planuslupusSjogren’s syndrome, Celiac disease, and polycystic ovary syndrome (PCOS), that affect vaginal skin or a woman’s hormonal level.

• Cancer therapy, especially breast cancer treatment.

• Side effects of medications like antihypertensives, antidepressants, and antiallergics.


What are the symptoms of vaginal dryness?

Vaginal dryness may cause a range of symptoms, including dryness, painful intimacy, itching, and burning. It may also cause a foul odor as it often coexists with bacterial vaginosis (BV).

Vaginal dryness may cause burning, itching, painful intimacy, & odor

Before a woman reaches menopause, BV is simply BV. But after menopause, BV often coexists with vaginal dryness and is more difficult to manage. 

The most common cause of vaginal dryness is estrogen reduction. But some other health conditions listed above may also cause vaginal dryness.

When associated with vaginal dryness, BV may be difficult to clear or easy to recur. Due to dryness, natural lubrication reduces. Intimacy may become painful. Vaginal tissue tearing injures may occur. Open wounds may cause bacterial infections, increasing the difficulty in managing BV.

To help clear BV in a postmenopausal woman, doctors often prescribe estrogen cream. Estrogen can help ease vaginal dryness.

Yet, many women, especially breast cancer survivors, cannot use estrogen. The reason is that estrogen may cause breast cancer to return.

Can the vagina protect itself from bacterial infections?

Yes. It can when it is healthy without dryness.

Before menopause, estrogen promotes a thick, multi-layered vaginal lining skin.

Left: Multiple layered vaginal lining superficial cells peel off daily to remove attached bacteria. Right: after menopause, only 1 layer of superficial cells remains and surface cell peeling stops and bacteria attached to the skin surface are not removed naturally.
Left: Multiple layered vaginal lining superficial cells peel off daily to remove attached bacteria. Right: after menopause, only 1 layer of superficial cells remains and surface cell peeling stops and bacteria attached to the skin surface are not removed naturally.

On top of the vaginal lining are many layers of superficial cells. The top layer of the superficial cells shed daily to renew its surface. This process is vaginal cell exfoliation, like dandruff shedding from the scalp. This causes bacteria attached to the surface to shed and flushed out. The flushed debris becomes a part of vaginal discharge.

Vaginal Exfoliation
When vaginal lining cells exfoliate, attached bacteria are removed naturally.

As a result, the second layer of the skin that is free of bacteria becomes a new top layer. Like peeling an onion, the cells in the damaged old top layer peeled off. The renewed top layer is cleaner and free of damages.

Vaginal Lining Cell Exfoliation is like Onion Peeling
Vaginal lining cell exfoliation is like onion peeling.

This regular skin cell exfoliation renews the surface. It protects the vagina from bacterial infection or overgrowth.

Protection decreases with birth control, breastfeeding, or after menopause

With birth control, breastfeeding, or after menopause, estrogen levels decrease. As a result, vaginal dryness may occur. The multiple superficial cell layers of the vaginal lining may shrink to a single layer. Cell exfoliation may decrease, potentially leading to bacterial accumulation in the vagina. This can make it more susceptible to developing BV.

Managing BV with vaginal dryness can be challenging

When BV occurs with birth control, breastfeeding, or after menopause, it may be difficult to manage due to vaginal dryness. While antibiotics can reduce bacteria on the surface of the vaginal skin, the reduced mucus secretion and exfoliation of vaginal skin cells may allow bacteria to stay longer and grow back shortly after treatment, leading to recurrent BV.

Treatment options for BV with vaginal dryness

1. Antibiotics may not work well

When a woman develops BV and visits a doctor, the doctor may prescribe antibiotics. Antibiotics can be effective in managing the initial episode of BV.

However, after treatment concludes, BV often recurs. The doctor may prescribe antibiotics again, but BV may recur yet again. Repeated use of antibiotics can lead to side effects, including drug resistance and yeast infections.

2. Vaginal estrogen may be effective but unsafe

In addition to antibiotics, the doctor may prescribe an estrogen cream like Premarin. Applying estrogen cream to the vagina can help restore hormone levels, which may alleviate vaginal dryness and manage BV. This is because estrogen promotes the growth of thicker vaginal lining, which facilitates the shedding of surface cells along with unwanted bacteria.

While estrogen can be effective, it may also increase the risk of various health conditions, including breast, ovarian, and uterine cancers, as well as uterine fibroids, gallbladder stones, stroke, heart disease, dementia, blood clots in the legs, etc. Therefore, women with a family history of these conditions should be cautious about using estrogen.

Premarin is pregnant horse urine

A recent study by scientists at Harvard University provided new evidence indicating that estrogen not only promotes but also directly causes breast cancer. This new discovery further confirms the cancer risk associated with estrogen. 

Some estrogen products are from horse urine and may involve animal cruelty. Many animal lovers are against using this type of estrogen.

3. Probiotics may fail to provide relief

All life forms need water to grow, which might explain the absence of life on Mars. Likewise, the probiotic lactobacillus requires moisture to thrive. Introducing lactobacillus to a dried vagina can be likened to placing fish in a dried-up pond. Therefore, probiotics may not be effective for managing BV in women with vaginal dryness. 

4. NeuEve – Safe and effective home remedy

NeuEve products are safe alternatives to estrogen. NeuEve works by nutritional supplements. It provides nutrients to promote the healing of the dried vaginal lining skin. This article explains how NeuEve reverses vaginal dryness without using hormones.

Clearing Stubborn BV by Boosting Resistance
When BV is associated with vaginal dryness, relieving dryness can help clear BV.

Topical nourishment by NeuEve can make vaginal skin grow thicker. As a result, surface skin cell shedding in the vagina can become more frequent. It reduces the attached bacteria and the risk of BV.

NeuEve is a natural product, not a drug. Thus, a doctor’s prescription is not required. NeuEve can be an effective home remedy for self-treatment of vaginal dryness-related BV.

Women on birth-control, IUD, or breastfeeding can start with Silver and move up to Gold

To date, NeuEve has helped more than 100,000 women with vaginal dryness and BV to find relief. Many gynecologists and urologists have been recommending NeuEve.

5. What are the right products to start?

For relieving BV in peri- or postmenopausal women, the NeuEve Gold suppository is the best. But, if a woman has a severe type of vaginal dryness, she may be sensitive to the strong product. We have designed 5 milder products, Silver, Silk, Sensitive Silk, Cream and Sensitive Cream. You can choose the right product based on your age and severity of vaginal dryness. If you choose a milder product, you can move up a level later. Once you move up to the Silver or Gold level, your BV will clear.

NeuEve BV Product Selection Chart

These products can help make the vaginal lining more moist, thicker, and more resilient, but it takes time. Some customers report relief within a day, but full recovery may take several weeks or months, depending on the severity of the vaginal dryness.

Many customers with persistent recurrent BV have found relief using NeuEve. For breast cancer survivors, NeuEve has offered an alternative option, providing relief from vaginal dryness and BV.

The following three articles can help you choose appropriate NeuEve products. Your age and health condition guides the selection. If you are over 70, read this article.

Is BV after menopause treated differently?

Which formula is right for clearing my BV?

How to stop BV from coming back?

How to clear BV or AV with NeuEve Gold, Silver, or Silk suppositories or cream?

6. Dietary supplements

The reduction of estrogen leads to vaginal dryness and weakens the vaginal lining. While supplementing with estrogen can alleviate this dryness, it carries a risk of cancer. Nutritional supplements can also help relieve vaginal dryness. For example, menopause can lead to osteoporosis, but supplementing with calcium and vitamin D can help reverse this condition. Therefore, we recommend the following dietary supplements to potentially enhance the effectiveness of NeuEve:

a) One A Day Multivitamin W/Minerals Tablet. The multivitamin with minerals tablet can help prevent deficiency of certain vitamins and/or minerals. Some are specially formulated for women or women over 50. If you are not taking this pill, we recommend that you do. Even if you are taking it now, we recommend that you take additional supplements detailed as follows.

b) Calcium, magnesium, zinc, and vitamin D3+K2. These are the most important supplements that you need to take after menopause. Without vitamins D3 and K2, calcium may not distribute well. Additionally, vitamin D correlates to urogenital health in older women. It also correlates to BV in pregnant women. Calcium is essential not only for bones but also for mucus gland secretion. If you are postmenopausal with vaginal dryness, you may have osteoporosis and may be at risk of fracture. Therefore, managing osteoporosis can help relieve vaginal dryness. 

c) Fish oil (or flaxseed oil) for omega-3 Eat a lot of fish if you like to eat fish. Fish provides omega-3 and also collagen proteins that support your skin. If you do not like fish, you can take flaxseed oil pills instead.

d) Sea buckthorn oil for omega-7. This fatty acid helps you to revive mucus glands and keep moisture in the oral cavity, eyes, and vagina. You can find this supplement on

e) Collagen and/or gelatin. Collagen is a major protein in your body, and gelatin is a degraded form of collagen. Thus, they have identical nutritional values. They may both improve your skin, joint, gut, hair, and bone health. Due to aging, collagen synthesis reduces. A common sign is the wrinkles of skin. Thus, supplementing collagen/gelatin can help make the atrophied vaginal lining stronger. You can take collagen powder or pills. Or, you can eat collagen in various foods, like Jello, Gummy bear, pork rind, or vegan collagen. For enough supplement, it is important to keep a daily dosage of 2.5-15 grams of collagen/gelatin. You can buy collagen here.

If you are postmenopausal, we recommend that you take all supplements listed above.

If you are younger and the only problem is recurrent BV, you may still lack certain nutrients. Vitamin D deficiency (or a lack of sun exposure) contributes to recurrent BV. If you do not want to take all the suggested nutrients, at least you should take a vitamin D3 daily supplement. This supplement has relieved recurrent BV in pregnant women.

7. Intimate partner

Bacterial vaginosis (BV) is not considered a sexually transmitted infection. Yet, during intimacy, microorganisms and semen can interrupt the vaginal ecological system. When bad bacteria overgrow in the vagina, BV occurs. The source of bad bacteria could be from the partner or indigenous to the woman. You may find this article helpful:

Can Men Get or Spread BV?

Men do not get BV. At least, they do not show symptoms. But, this does not mean they cannot be a carrier. If you are suffering from BV, the chance is high that your partner may become a carrier. Even though men do not show symptoms, men can pass BV back to women. This may be a cause for BV to recur.

Expedited Partner Therapy
Male partner may be a carrier for BV

During treatment, you should refrain from having intimacy for at least two weeks. The BV-related bacteria in the male can die out with time. A 2-week flushing period may clear up most carried microorganisms in the male partner.

Say Goodbye to Recurrent BV with NeuEve
Say “Goodbye” to recurrent BV with NeuEve


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.



Customer reviews on NeuEve from BV clearance after menopause

"I am a young cancer survivor that was forced into menopause early from my cancer treatments. This is the only product that has worked long term for me.

I struggled with BV issues for some time and obviously vaginal atrophy from pelvic radiation, since using this product I have not had one single reoccurrence of BV. I have since recommended this product to a few of my friends all of whom are either pre-or post-menopausal with similar issues (odd odor, less natural lubrication) and they all seem to love it and recommend it.

I would say initially I was skeptical; I have been using this for about 6 months and my honest opinion is that this product is exactly what the packaging states. Please keep in mind I produce no natural hormones and have been in hormone replacement therapy for 5 years, nothing has worked as well as this product. It is safe, effective, and works quickly."


"I'd just like to say thank you!!!

I've suffered for several years with BV and vaginal dryness. I've been prescribed everything under the sun from my physician and have tried many home remedies. Nothing has worked!!!

Also, my physician failed to tell me that BV can be caused by perimenopause and vaginal dryness.

When I stumbled upon your website while looking for yet another home remedy, I read your home page and thought wow, my symptoms are right there!!! So I took a chance and ordered the BV Clear and the Silver. From the time, I used the first suppository, I felt relief!!!! and the odor and itchiness are gone!!!

I have never written a review or emailed anyone about a product but I just had to do this because I am eternally grateful to your company for making such an amazing product!!! My struggles are over!!!!

Again, thank you so very much for taking this problem seriously and making a product that truly works!!!!! There are a lot of women out there suffering the way I have and I will without a doubt recommend your product to any woman!!!!!! This has really changed my life!!!"


"I have had itching and resulting burning from the constant itching, which are symptoms of BV and vaginal atrophy, I also had a horrible darkening of my vagina and painful intercourse. I also have symptoms and signs of Lichen Sclerosus.

I ordered the product to see whether I could get rid of this horrible nightmare of a year and a half of itching. I waited until I completed the 3 suppositories before writing a review so that I could give an honest assessment of how this product worked for me. I completed the full BV Clear, using one suppository every 3-5 days (with a break between for my menses).

On the first night, due to the damage from scratching it burn and was irritated for about a minute or so. On the outside areas that burned, I wiped with an unscented, lint-free wipe. After the sensation subsided I was so overjoyed! The itching minimized and the product felt like it was “working” and I was able to fall asleep without scratching myself raw, my vagina also felt different, as if blood was circulating around the area and plumping it up.

After my menses, I used 2nd suppository. There was no burning and the itching was still progressively getting less and less (this was far better results than the medications that I was prescribed that didn't do anything but burned constantly with no relief from the burning or itching).

I used the last suppository and there was no burning except in areas where I had irritated (and areas where the LS bumps were). But even in those areas, the bumps were not as pronounced or itchy, or painful as before. After using the 2nd suppository, I realized that my prayers for relief were answered and I immediately ordered another BV Clear AND the NeuEve Assorted Suppository Kit and the NeuEve cream.

My only regret (in my haste to try anything that may have worked for me), I didn't order the NeuEve vulvar itching Cream in my first order, since I still had itching around my vulvar and believed that may have helped me also to completely stop the constant itching whiles using the suppositories."


" I am so happy to have found NeuEve. I have been suffering from BV after some long-term antibiotic use. I ordered silver after some research on vaginal atrophy.

I also found that NeuEve has a product BV Clear. These products are a lifesaver!!! After just one use the BV has cleared! My Dr. kept prescribing more antibiotics to treat BV and they never worked. I am so happy to have found NeuEve! I will continue with the silver and gold! "


  • elizabeth

    i think neu eve products are TOP shelf quality and: worth the cost! i’m so glad there are healthy products like this out there and that an m.d. created this one! my OBGYN would like materials sent to his office of yours for him to recommend to other patients like me, who are not comfortable using hormones.
    his name is dennis reed and he is in cottonwood az

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Dr. Renjie Chang

About the Author

Dr. Renjie Chang's medical and pharmaceutical experience:
- OB-GYN in the Peking Union Hospital in China
- a faculty member of OB-GYN at University of Oklahoma Health Sciences Center
- drug developer at the Abbott Laboratories in Chicago
- Founder of Lavax Inc, where she developed an innovative vaginal microbicide for preventing sexually transmitted disease with grants from NIH and Gates Foundation
- Founder of NeuEve, an all-natural women's health company