Plenty of women complain of a “fishy smell down south.” But they are filled with trepidation to talk to their doctor, health care practitioner about their fishy-like vaginal odor.  Of course when thinking of odor, itching or something going on “down there,” doctors will first look at infection, sexually transmitted diseases or yeast overgrowth. Then you are down the rabbit’s-hole with testing for STDs and on loads of antibiotics for yeast.

I remember the first time I had a “situation downstairs.”  I was 18 years old and told my primary care doc, Dr. Yam. Dr. Yam had been my doctor since I was six years old. He and I had been through a lot in that time. From mononucleosis to the time my mom thought I had breast cancer at nine years old.  It turns out I was developing “early.” When I was 18 years old and told Dr. Yam that “something was up downstairs.” He looked at me and said awkwardly, “well, I can have a look.” Ummmm, even after a breast exam at nine, I was not going to give Dr. Yam a “look.”  Much to his obvious relief, I said, “Naw, it’s okay.”

Yes, it is uncomfortable, awkward, embarrassing to say “I have a vaginal odor.”   But I assure you, it is common. Even my patients that I have a good rapport and a long history with, still have a hard time talking about vaginal odor.  They dance around the subject, saying they might have a “yeast infection,” “infection” or “something” going on vaginally. I usually have to ask, “does it smell a bit fishy?”  And they jump quickly too, “ YES! It does!” The odor is what they wanted to bring up in the first place but felt uncomfortable.

Like I said if you have a vaginal odor it does reflect anything about you as a person.  It does NOT mean there is something dirty, or not washed. I promise you, having a vaginal fishy odor doesn’t mean you are promiscuous or easy or not clean. If you have a fishy odor, you have an imbalance of the vaginal flora.

Once, I heard a wise Ob-Gyn say the vaginal canal is like a fish tank.  I thought it was an odd saying at the time. I love fish aquariums and have a few myself, so thought the term was intriguing.  For an aquarium to function correctly, it needs the right pH, the right organisms, the proper setup. The “aquarium” cannot be overloaded with “creatures.”  It cannot have stressors such as overfeeding or underfeeding or jostling or cleaning too much. Unless, you have had an aquarium, you have no idea what I just wrote. But if you have had an aquarium (or many), you know exactly what I am talking about.  It is all about the balance of the flora of the vaginal “aquarium.”

Having a fishy vaginal odor is not contagious. It means that the “aquarium” is not balanced. I tell my patients, if you are uncomfortable with the word, “fishy,” use amine instead.  It means ‘fishy’ without all the connotation.

If you have a fishy (amine) vaginal odor, you do not have an infection.  You do not have a yeast infection. You do not have an STD/STI (make sure to get tested if you are unsure, a new partner, unprotected, you know…). If you have a fishy vaginal odor, and all the infections are ruled out, it means you have an unbalanced “aquarium.”

Next question, how do I balance my “aquarium”?
The ‘fishy odor’ is usually from an overgrowth of Gardnerella vaginalis bacteria.  Gardnerella is a benign, normal occurring bacteria of the vaginal canal. If it grows too much then that is called, Bacterial Vaginosis or BV.  BV is Gardnerella growing out of control, and it causes vaginal swelling, thin liquid discharge, itching/pain, and an intense fish odor.

Usually, at that point, you might need antibiotic treatment.  But what is more common is a slight overgrowth of Gardnerella that causes no infection symptoms, just a “fishy odor.”  The fishy odor does seem to get worse after intercourse.

How does the fishy odor start and why does the Gardnerella grow?

It usually happens from a pH imbalance. Typically, the vaginal pH is on the acidic side. If the pH of the vaginal canal becomes too alkaline, that creates the perfect environment for Gardnerella to grow.  The Gardnerella will grow and grow and sometimes so out of control it becomes BV. Anyone that has ever had a fishy vaginal odor knows it’s super concerning.  And it can feel very isolating because you are hyper-aware of the smell, but mortified to tell anyone.

One of my patients is such a lovely, smart, interesting person. She would be a real catch for any fellow, but she would refuse even to date because she is horrified by her slight fishy vaginal odor.  I have another patient that will not have sex with her new, hunky boyfriend. All because of the fishy vaginal odor that she cannot get rid of.

I have had patients before coming to me that have taken rounds and rounds of antibiotics. Only to have the fishy odor disappear for a few days to 2 weeks and then come right back.

Now the real deal.  I am going to tell you how to prevent or rid yourself of the fishy odor.  You want to make the pH of your vaginal canal more acidic rather than alkaline.  The vaginal canal is naturally acidic being in a range of less than 4.5 pH.

Making the vaginal canal more acidic:

Seminal fluid is very alkaline. We all know what seminal fluid is and I am going to get seriously TMI here.  Do not let your male partner ejaculate inside of you. That is a sure way to alkalize the pH of your vaginal canal, hence a fishy odor.

Other ways to make the vaginal canal more acidic:

Probiotics (beneficial bacteria): Probiotics are healthy and naturally acidic. Taking a probiotic orally is not going to help a fishy vaginal odor.  Taking a probiotic orally is excellent for the colon and digestive system, but it is not going to balance your vaginal flora.

What you can do is take a probiotic capsule with specific types of beneficial bacteria.  Open the capsule and mix the powder with water and a make a paste. Then you can apply that paste to the vaginal opening. Do this at night, so it is less messy and wear a panty liner.  It is better than poking holes in the capsule and inserting it into the vaginal canal. Often the capsule doesn’t disintegrate well, and the beneficial bacteria is needed near the opening of the vaginal canal.

The next question is, what probiotic do I use? Not all the probiotics are the same.  For the vaginal canal, you want a probiotic that has Saccharomyces boulardii and Lactobacillus acidophilus.

Saccharomyces boulardii helps to acidify the vaginal canal and also helps to kill yeast, so it helps for the Gardnerella and if you have yeast issues as well.

Lactobacillus acidophilus makes up the majority of the beneficial vaginal flora in 70% of women.  It is helpful because it has lactic acid that keeps the pH of the vaginal canal in the proper range. In doing so, Lactobacillus can inhibit the growth of Gardnerella as well as Gonorrhoea, Staph aureus and Candida albicans (yeast).  By applying lactobacillus to the actual vaginal tissues, it can help recolonize the vaginal canal with this beneficial bacteria. And it can help reduce the pH to prevent other organisms from growing out of control.

I like the broad spectrum probiotic with Saccharomyces boulardii and Lactobacillus acidophilus by Orthomolecular Products called Ortho Biotic.

Boric acid: Using Boric acid vaginally is an excellent remedy to rid yourself of smelling like Pike Place Fish Market.  Which I a great place to visit (being originally from Seattle), but I can’t imagine what remedies those fish workers use for hand soap.

Back to the boric acid.  Using Boric acid vaginally at appropriate doses will not burn the mucous membranes of the vaginal tissues.  As the name states, it helps to create a more healthy acidic environment for the vaginal canal, but at the same time, it will not kill all the beneficial bacteria like antibiotics.

If you are prone to a vaginal fishy odor, primarily triggered by sex.  Then boric acid vaginally is also a great way to prevent Gardnerella overgrowth.  Use after intercourse and boric acid can help prevent a vaginal fishy odor. It also helps to kill yeast and to prevent urinary tract infections triggered by sex.  There is a homeopathic combination with boric acid called Yeast Arrest by Vitanica.

Yeast Arrest is gentle and used for both Gardnerella overgrowth and yeast infections.  Sometimes a person might need a stronger form of boric acid. Then you can get prescriptions of 600 mg boric acid vaginal capsules from your functional medicine doctor that works like a charm.

Douching: I’d like to think that douching is dated and not used anymore.  The vaginal canal is its own self-cleaning “aquarium.” You don’t want to mess with the vaginal flora by hosing out all the beneficial organisms and destroy it with chemicals and fragrances.  There is one exception. If you are prone to bacterial vaginosis or vaginal fishy odor from Gardnerella then making your own douche is helpful. Do not use the douches you buy from the local supermarket, but make it yourself.  Use 1/4th parts hydrogen peroxide and 3/4th part warm water. Use this homemade douche after intercourse to help prevent BV and yeast infections.

Avoid Antibiotics: If at all possible avoid antibiotics unless you really need them.  Antibiotics will kill all beneficial bacteria leaving an opening for Gardnerella, Candida, Clostridium difficile and many other unwanted species to take up residence in your vagina (not to mention colon). Indeed, antibiotics can be necessary for certain situations, but I have seen many women that have taken Diflucan or antibiotics for yeast or, and the infection comes back with a vengeance.

Many women live in silence about having a vaginal fishy odor.  But it is much more common than you would think. Having a fishy odor means the flora of the vaginal canal is out of balance.  This topic can be a touchy subject, but I think it is time to talk about it. A fishy vaginal smell means nothing about you as a person.  Having a fishy odor is not an infection, and you cannot “give or pass it” to anyone else. As mentioned above, make sure to get tested if you have a new partner or unprotected sex and so forth.  But a vaginal odor is common and benign and just about getting the flora and the pH of the vaginal canal back into balance.