Aerobic Vaginitis (AV)
Understanding aerobic vaginitis
Aerobic vaginitis (AV) is an inflammatory vaginal condition characterised by disruption of the normal Lactobacillus-dominant vaginal microbiome and an increase in aerobic bacteria. Unlike bacterial vaginosis (BV), which is often associated with minimal inflammation, AV typically involves inflammation of the vaginal tissues and can cause significant discomfort.
Many people living with AV have been treated repeatedly for thrush, BV or urinary tract infections without lasting improvement. Understanding the underlying ecology of the vaginal environment is often the key to breaking this cycle.
Common symptoms
Symptoms can vary in severity and may include:
- Vaginal burning or irritation
- Yellow, green or purulent vaginal discharge
- Vaginal redness and inflammation
- Pain during intercourse
- Vulval discomfort or soreness
- Abnormal odour in some people
- Urinary discomfort that may mimic a UTI
Symptoms often fluctuate and may worsen during hormonal transitions or following antibiotic use.
What causes Aerobic Vaginitis?
Aerobic vaginitis develops when the protective vaginal ecosystem becomes disrupted, often because of a lower tissue estrogen state.
Protective Lactobacillus species decrease, allowing inflammation-associated bacteria such as Escherichia coli, Enterococcus faecalis, Staphylococcus aureus and Group B Streptococcus to become more prominent. However, these organisms alone do not explain why AV develops.
The vaginal environment is influenced by a complex interaction between the microbiome, mucosal immunity, hormones, tissue integrity and local inflammation. Understanding these interactions helps guide a more personalised treatment strategy.
Why does AV keep recurring?
Recurrent AV is rarely explained by one microorganism alone.
Contributing factors may include:
- Reduced Lactobacillus abundance
- Changes in vaginal pH
- Hormonal changes, including perimenopause and menopause
- Vaginal dryness and reduced mucosal resilience
- Previous antibiotic exposure
- Altered immune responses
- Sexual factors
- Co-existing vaginal conditions
- Underlying skin or inflammatory disorders
For some people, AV may overlap with other inflammatory vaginal conditions, making accurate assessment particularly important.
Our ecological approach
At Intimate Ecology, we assess the whole clinical picture rather than focusing on one culture result or one bacterial species.
Your consultation may explore:
- Current symptoms and previous diagnoses
- Vaginal microscopy or microbiome testing where appropriate
- Hormonal status
- Menstrual or menopausal history
- Medical history and medications
- Sexual and relationship factors
- Lifestyle and general health
- Previous response to treatments
Treatment plans are individualised and may include nutritional and herbal medicines, dietary strategies, vaginal therapies, microbiome restoration, hormonal considerations and approaches that support mucosal health and reduce inflammation where appropriate.
When should you seek support?
You may benefit from assessment if you experience:
- Recurrent vaginal burning
- Persistent inflammation despite treatment
- Repeated diagnosis of thrush with negative cultures
- Recurrent urinary symptoms with negative urine cultures
- AV diagnosed on microscopy
- Symptoms during menopause or after childbirth
- Persistent discomfort despite multiple treatments
More than an infection
Aerobic vaginitis is not simply an infection to eliminate. It represents a disruption of the vaginal ecosystem, where inflammation, tissue health and microbial balance all play important roles.
Our goal is to understand why that disruption has occurred and develop an evidence-informed, personalised treatment plan that supports long-term vaginal health.
Ready to take the next step?
Book an online consultation with our clinical team or complete our Practitioner Matching Quiz to find the practitioner best suited to your needs.