Spot the Symptoms of Bacterial Vaginosis, Yeast Infections, and Cytolytic Vaginosis

The Vaginal Ecosystem Is a Drama Queen

Your vagina is a complex microbial metropolis—bacteria, yeast, immune cells, and hormones trying their best to coexist. Most days, they do it beautifully. And then there are the days when everything decides to unravel at once.

Three of the most common culprits behind vaginal discomfort—bacterial vaginosis (BV), yeast infections, and cytolytic vaginosis (CV)—share overlapping symptoms. Itching, burning, odd discharge, irritation during sex, pain while urinating. The usual hits. And because they overlap, women are misdiagnosed constantly.

Before you decide you’re cursed, broken, unclean, or destined to spend your life Googling symptoms at 2 a.m., take a breath. These conditions are different, treatable, and far more common than anyone admits aloud.

Below is the very unsexy—but deeply clarifying—breakdown.

What’s the Actual Difference Between These Infections?

Bacterial Vaginosis

BV is what happens when the “unruly houseguest” bacteria overstay their welcome. The most notorious one is Gardnerella vaginalis, which multiplies when the protective lactobacilli step aside.

Caused by:
Overgrowth of anaerobic, BV-associated bacteria, most commonly G. vaginalis.

Looks like:
Thin, gray or white discharge.

Feels like:
Burning, itching, and the infamous fishy odor—the kind that inspires immediate Googling and a personal crisis.

Cytolytic Vaginosis

Cytolytic vaginosis sounds intimidating, but here’s the twist: it isn’t actually an infection. It’s an overachievement problem. Your helpful lactobacilli become a little too enthusiastic, producing excess acid and damaging vaginal cells in the process.

Caused by:
An overgrowth of lactobacilli leading to excessive acidity and breakdown of vaginal epithelial cells.

Looks like:
White discharge that can mimic a yeast infection.

Feels like:
Itching, burning, pain during intercourse—eerily similar to a yeast infection, which is why CV is frequently misdiagnosed.

Yeast Infections

Yeast infections occur when candida—usually Candida albicans—decides to take over the neighborhood. They affect both the vagina and the vulva and tend to arrive right when you have weekend plans.

Caused by:
Overgrowth of Candida, most commonly C. albicans.

Looks like:
White, clumpy, cottage cheese–like discharge.

Feels like:
Redness, swelling, intense itching, dryness, burning with urination, and discomfort during sex.

How to Tell Them Apart When They All Feel the Same

Misdiagnosis is practically tradition at this point. Many women get treated for yeast infections when the real issue is BV. Others double down on antifungals when they’re actually dealing with CV. Shame, secrecy, and the lack of standardized testing do not help.

Here is the simplest rule:

Fishy smell + thin discharge = likely BV
Cottage cheese discharge + intense itching = likely yeast infection
Yeast-like symptoms but recurring or resistant to treatment = consider CV

If you feel like you’re stuck in symptom déjà vu, you probably are.

Treatment Options

For BV

Antibiotics such as metronidazole or clindamycin, or in some cases, boric acid suppositories to help restore a healthy vaginal environment.

For Yeast Infections

Antifungal medication—oral or vaginal—designed to stop fungal overgrowth. Your clinician will select the best formulation based on your symptoms and history.

For Cytolytic Vaginosis

Because CV is caused by too much acidity, treatment focuses on elevating vaginal pH. This often involves sodium bicarbonate (baking soda) douches or sitz baths and avoiding probiotics that contain lactobacilli.

How These Conditions Interconnect

A healthy vagina maintains a moderately acidic pH—just enough to keep pathogenic bacteria away while supporting beneficial lactobacilli. When the pH shifts too far in either direction, things unravel. BV nudges pH too high. CV makes it too low. Yeast thrives when the environment is disrupted by anything from antibiotics to hormonal changes.

These conditions are less separate diagnoses and more different outcomes along the same spectrum of imbalance.

Supporting the vaginal microbiome, managing pH, and recognizing symptoms early are the closest things we have to superpowers.

Medically Reviewed by: Meghan Blake, MD

References

Suresh A, Rajesh A, Bhat RM, Rai Y. Cytolytic vaginosis: A review. Indian Journal of Sexually Transmitted Diseases and AIDS. 2009;30(1):48–50. doi:10.4103/0253-7184.55490
Hacısalihoğlu UP, Acet F. A clinicopathological diagnostic and therapeutic approach to cytolytic vaginosis: An extremely rare entity that may mimic vulvovaginal candidiasis. Journal of Cytology. 2021;38(2):88–93.
Mitchell C, Manhart LE, Fredricks DN. Prevalence and microbiology of bacterial vaginosis. Frontiers in Cellular and Infection Microbiology. 2021.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines. CDC.
Harvard Medical School. Modifying the vaginal microbiome.
Cleveland Clinic. Understanding Candida albicans.
Stock images and microbial photography: CDC Public Health Image Library, Getty Images.