Why Your Vaginal Infection Keeps Coming Back When You’ve Been Told Everything’s Fine

For eight months, Vallie Aris did everything she was told, seeing several different doctors for a vaginal infection that wouldn’t go away and taking round after round of antibiotics that left her worse off each time. Somewhere in that cycle, she realized she would have to go looking for an answer herself, and where that search led now helps women who keep asking why BV keeps coming back after every round of antibiotics.

On this episode of the Practitioners Rise Podcast, host Hailey Krajewski talks with Vallie Aris, nationally board-certified acupuncturist and herbalist at Eau Claire Acupuncture and creator of the Savvy Vagi program. They cover why BV, AV, and yeast infections so often return, how the vaginal microbiome shapes fertility and menopause, and why so many women are told everything looks fine when they know it doesn’t. Vallie first joined the show alongside her colleague Jamie Wilcox to talk about Hormones, Fertility, and Vaginal Health, and this time the conversation goes deep into vaginal health.

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Why Does BV Keep Coming Back After Antibiotics?

In Vallie’s experience, recurrent infections usually return for two reasons. The infection was often never properly identified in the first place. And each round of antibiotics also wipes out the beneficial bacteria that protect the vagina from reinfection.

Vallie explains that the standard approach is often to prescribe antibiotics based on symptoms alone. When women are tested, it’s typically a swab for a handful of pathogens. She has seen a local clinic test for 20 to 25, which she considers a step in the right direction, but it’s still a narrow window.

“There are literally thousands of microbes that could be the problem. And so if you don’t figure out which one it is, or which ones, then how can you target those?”

The second problem is what antibiotics leave behind. Even when a medication isn’t targeting the right pathogen, it is still killing off lactobacillus, the protective bacteria a healthy vagina depends on. Vallie points to National Institutes of Health figures showing that somewhere between 60 and 80 percent of BV treated with antibiotics comes back. The next step is usually a different antibiotic, which can do even more damage. Most of the women who come to Vallie have been through four or five rounds. By that point, she says, the vaginal tissue itself is getting thinner and drier and starting to atrophy, which leaves a lot more to come back from.

One of her patients found her through a Reddit thread. She was 58 and post-menopausal, and she had been caught in that cycle of recurrence for eight years. Along the way she tried antibiotics, boric acid, probiotics, homeopathy, and estrogen cream. Her advanced microbiome test showed five different strains of BV and no beneficial bacteria at all. At the end of her two-month Savvy Vagi protocol she was symptom-free with a normal pH, and she was waiting on her retest results at the time of recording.

What Is the Vaginal Microbiome, and How Are BV, AV, and Yeast Different?

The vaginal microbiome is the community of bacteria living in the vagina. In the gut, diversity is the goal. A healthy vaginal microbiome is different: it is dominated by just a few strains of lactobacillus.

Vallie describes lactobacillus as the vagina’s soldiers, keeping the environment acidic and killing off harmful bacteria. In her words, they set up houses along the vaginal wall so nothing else can move in, and in exchange, the immune system leaves them alone.

When that balance is disrupted, women usually notice one or more of these changes:

• a new odor
• discharge that turns yellow or even green
• itching or discomfort
• dryness or painful sex

Vallie breaks down the three most common culprits:

• Bacterial vaginosis (BV) typically involves anaerobic bacteria, which don’t need oxygen to survive. It often comes with a fishy odor.
• Yeast tends to produce a thicker, cottage cheese-like discharge.
• Aerobic vaginitis (AV) involves bacteria that do need oxygen. Vallie calls it sneaky because it may not change odor or discharge at all. She says AV isn’t widely recognized by the conventional medical community yet, and that antibiotics don’t work well for it.

“By the time women get to me, it’s not just one thing. It’s usually BV and AV, or it’s AV and yeast.”

That’s why she treats everything at once. If only one infection is addressed, the other keeps degrading the environment and leaves room for the first one to return.

The same principle applies to recurrent UTIs, a connection Hailey hadn’t heard before. Vallie explains that bacteria can translocate, or move back and forth, between the vagina and the urinary tract. An infection harbored in the vagina can keep reaching the bladder, so treating the urinary tract with antibiotics each time misses the source. Her clinic treats the urinary tract with herbs and addresses the vaginal microbiome at the same time, which she says is what finally breaks the cycle.

What Does Treating Recurrent Vaginal Infections Without Antibiotics Look Like?

For Vallie, it starts with comprehensive microbiome testing to find out exactly what’s there. From those results, she builds a customized protocol that clears the imbalance and restores healthy tissue without pharmaceuticals.

Savvy Vagi works in a few stages:

1. Free consultation. Vallie hears a woman’s full history, including symptoms, past testing, and treatments.
2. At-home microbiome test. The test kit is mailed directly to the patient.
3. Two-month protocol. If the results show an imbalance, the patient receives a protocol targeted to her specific results. Vallie says there usually is an imbalance by the time someone finds her.

The protocol combines herbs, vitamins, organic plant oils, omega-6s and omega-7s, and probiotics. It uses no antibiotics or pharmaceutical antifungals, which Vallie considers much harsher on the vaginal landscape. The goal isn’t only to rebalance the microbiome. It is also to restore vaginal tissue to its original thickness and moisture, which is protective in its own right.

The whole program is virtual. Follow-ups happen throughout the two months, and Vallie is available by email or phone in between. At the end, she and the patient decide together whether to retest or extend the protocol a few more weeks.

She knows some women hesitate to bring any of this up. Vallie finds that hesitation tends to ease once a call begins. Part of the reason is that she talks about this every day and gets right into it. Part of it is that many patients have never been listened to this way before.

“They’re told everything’s okay, and they know that not everything’s okay. They know that something’s going on.”

Can the Vaginal Microbiome Affect Fertility?

Yes. Vallie says an imbalanced vaginal microbiome can lower fertility rates even when it causes no symptoms. It’s one of the clearest causes she finds in women diagnosed with unexplained infertility.

“I don’t love that term, because I think there’s always an explanation. We just have to find it.”

She’s careful to say the microbiome isn’t the only factor behind unexplained infertility, but it is one of the easiest to identify. Every woman who now comes to Eau Claire Acupuncture with that diagnosis takes the microbiome test. When imbalances turn up, Vallie asks her to hold off on trying to conceive while they restore everything. She has seen many of these women become pregnant within the next couple of months after completing Savvy Vagi.

Part of her reasoning goes beyond conception. Vallie explains that a mother’s vaginal microbiome seeds her baby’s microbiome at birth. That early exposure plays an important role in the development of the infant’s immune system and, she says, increasingly in long-term health. She sees it as one piece of the puzzle that is simple to check and can help set the next generation up well.

Near the end of the episode, Vallie reads a testimonial from a 33-year-old patient preparing for IVF. The patient had two failed embryo transfers using her last embryos, and her doctor wasn’t sure what had gone wrong, since the same protocol had worked before. She’d had years of sinus infections and antibiotics after her first son, and no one had connected the dots. After Savvy Vagi, she had a successful transfer on the very next round. She was 27 weeks pregnant with a little girl when she wrote it.

Are Vaginal Dryness and Painful Sex a Normal Part of Menopause?

They’re common, but Vallie is clear that painful sex is not a normal part of aging, and there’s a lot women can do about it.

During perimenopause, estrogen begins to drop long before most women recognize the change. Vallie points out that hot flashes come close to the end of the line. They are often preceded by symptoms such as:

• increased anxiety or depression
• trouble sleeping through the night
• joint pain

Falling estrogen also decreases lactobacillus. That lowers the vagina’s protection against infection and sets the stage for vaginal atrophy. Dryness and painful sex are the two complaints she hears most.

“Sex should not be painful, and it is not just a normal part of aging.”

One patient was 73 and had stopped having sex with her husband because of the pain. After she completed the Savvy Vagi program, her husband came to her two-month follow-up just to thank Vallie, because they were able to be intimate again.

Postpartum is another vulnerable window. Pregnancy and birth bring major hormonal shifts along with physical trauma to the vagina. Vallie says it’s common for imbalances to show up afterward, including the recurring yeast infections Hailey sees so many moms posting about.

How Can I Protect My Vaginal Health Every Day?

Vallie’s top recommendation is to be sparing with antibiotics of any kind. Even a course prescribed for a sinus or ear infection can throw off the vaginal microbiome.

“I’m not against antibiotics, but using them when they need to be used and there’s not an alternative.”

At Eau Claire Acupuncture, her team uses ozone therapy to clear sinus and ear infections and herbs for digestive infections. Vallie used to have chronic sinus infections herself and no longer does. Once she learned about ear insufflation ozone therapy for her kids’ recurring ear infections, they never needed antibiotics again.

Beyond that, she keeps the basics simple:

• Cleansing: Use a dedicated vulva cleanser instead of soap, and avoid anything fragranced. Her pick is Love Wellness, which she also uses for shaving.
• No douching: She never recommends it because it is so disruptive.
• Menstrual products: Choose organic cotton with no bleach, chemicals, or fragrance. Because the vagina is highly vascular, it absorbs what it comes into contact with. She likes Cora, including their applicator-free tampons. She also considers added botanicals unnecessary, since anything introduced into that environment risks disruption.
• Menstrual cups: Vallie doesn’t see anything inherently wrong with medical-grade silicone cups. One did disrupt her own microbiome, though, so she sticks with organic tampons.
• Probiotics: For women without symptoms who want to maintain vaginal health, she suggests a women’s or vaginal probiotic containing Lactobacillus crispatus, the strain shown to be most protective. Standard digestive probiotics usually won’t include it.

For anyone already dealing with a recurrent infection, she’s clear that a customized plan is needed rather than an off-the-shelf supplement.

This episode reflects Vallie’s clinical experience and personal research. It’s shared for educational purposes and isn’t a substitute for individualized medical advice from your own healthcare provider.

Quick Answers

Why does BV keep coming back after antibiotics? Vallie says the infection often isn’t fully identified, and antibiotics also kill the protective lactobacillus, which leaves the vagina more vulnerable. She cites National Institutes of Health figures showing 60 to 80 percent of antibiotic-treated BV recurs.

What is AV? Aerobic vaginitis is an imbalance caused by bacteria that need oxygen to survive. Vallie says it can occur without any change in odor or discharge, and that antibiotics don’t work well for it.

Can recurrent UTIs be connected to vaginal health? Yes. Vallie explains that bacteria can move between the vagina and urinary tract, so an infection harbored vaginally can keep causing UTIs.

Can the vaginal microbiome affect fertility? Vallie says an imbalance, even one without symptoms, can lower fertility rates, and she tests every patient diagnosed with unexplained infertility.

What probiotic should I look for to support vaginal health? For maintenance, Vallie recommends a women’s or vaginal probiotic containing Lactobacillus crispatus.

About Vallie Aris

If you’ve been told your symptoms are normal and something in you knows better, start with Vallie’s free guide on the Savvy Vagi page or book a free consultation. And if this conversation could help a friend who’s been quietly dealing with the same thing, send it her way.