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Podcast Family. As the producer of the show, I just have a quick disclosure. This quickie episode will deal with mature content, so listener discretion is advised. Oh, my. Podcast family, welcome to another quickie episode of the Clinical Pearls no Spin podcast. Podcast family. Remember that interspersed within our regular format, we're going to release a few episodes periodically and randomly, I guess, as we need to called quickies. That's where we give you quick information. And that's exactly what we're doing in this episode because a question came in that is both kind of of simple and complex at the same time, and it has to do with bv, obviously. We've covered bacterial vaginosis many times on this show in the past, including the recent recommendation for partner therapy, especially with recurrent cases. And I wanna relate this back, of course, to things in print. So very quickly, let me just give you two recent articles that came out on bv. Neither of them are mind blowing. There's stuff kind of we already know, but. But because we also want to let you know what's hot in press, I'm going to answer the question about bv, but I want to give you these two references right off the bat just so I can knock those out. Okay. The first is from February of 2026, and it's in Critical Reviews of Microbiology. And that title is Bacterial Vaginosis Advancing Insights into Microbial Dysbiosis. There's nothing mind blowing in that one. It's pretty much what we know. But it's a good review from a microbiological aspect or perspective on BV. The second one is also from February 2026, but this is from Current Opinions in Infectious Disease. Current Opinions in Infectious Disease. This is the Kim publication. Now the title of this is Advances in Treating Bacterial Vaginosis Recognizing Sexual Transmission and Pipeline of Therapies. This kind of touch on the idea of treating male partners, especially with recurrent cases, as agog endorses, even though of course that study had some issues. But it's worth investigating. Treating Partners when patients are having recurrent bv. Okay. Now that's especially true for male to female transmission or heterosexual contact. All right, you can go back to the archives and listen to, you know, treat Male Partner for bv. We have a podcast on that. And then we talked about ACOG's clinical practice update debate about treating male partners. And there are two publications from two separate journals from February 2026. Nothing mind blowing, but the one that's, that's on the evolving pipeline of therapies is kind of neat. Talks about maybe they're going to have some medications that target the biofilm that forms in the vagina that kind of protects BV organisms. But the point is there's new medications that are coming and we're definitely going to cover them on this show when they make progress. Right? So this is more kind of a theoretical, kind of bench work stuff, but nice out of current opinions and infectious disease. But that's not where we're trying to go here. Remember, I'm trying to be quick here because this is our quickie episode. So here's a question that came in regarding bv because it's complicated, okay? The question that one of our podcast family members has is, can a virgin, okay, can a virgin get bacterial vaginosis? Now, right off the bat you're like, well, I guess. And you'd be correct. BV is much more common in patients who are having sexual contact. However, even though it's rare in non sexual women, virgins can in fact absolutely get BV. Now, it wasn't long ago, I think it was 2016, and you can look it up on, on PubMed or through Google search. We published a report on a patient that came into our group who was a college professor, right? Very educated and was virginal. Now, by her account, never had any kind of male penetration. I mean, she just didn't do that. She wasn't married, she never had a steady boyfriend. And in her mind that's something that was left off for marriage. Now, this patient came in with severe abdominal pain. Looked like classic PID for which we did the whole workup. Cultures were negative. We found no common, you know, genital pathogens. But on ultrasound, sure enough, had dilated tubes that look like hydrosalpinges together with tube ovarian abscess. Right? Gave her antibiotics, did laparoscopy because she didn't get better after antibiotics. After two to three days, confirmed tube ovarian abscess that grew out E. Coli on aspiration. Now, first of all, your question should be, wait, if she's virginal, how did this happen? Well, right after her proximal period, again, proximal to when she got sick, she douched, right? She was a very frequent douching patient. She just did that. That's what she did culturally. And that is the one tie, according to the data, that's an independent risk factor for, for non sexual transmission of bacterial vaginosis. Now, our title of this publication, again, you can search for it on Google or PubMed, is non sexual PID in a virginal patient. Resulting in catatonic conversion disorder. So that's how deep this went. In other words, she just couldn't take the idea that she had something that sexual women got. Cause she understood what PID was, even though we told her that it most likely came from her douching history. That just kind of wigged her out and she straight up went catatonic. I mean, we had the whole brain workup, including a spinal tap, to make sure it wasn't meningitis. And the prevailing thought, based on neurosurgery and neurology, was that she had a kind of a catatonic conversion reaction based on the diagnosis. Fascinating. So we wrote that up. That's in the literature because it's so rare, right? Non sexual PID resulting in catatonic conversion disorder. So, yes. And this patient, again, had no sexual contact now in the literature. Now here's where I says it's gonna get a little tricky here in the literature, douching is the one standalone factor that's been linked to virginal patients getting bv. Okay? Because it changes the microbiota of the vaginal ecosystem. That makes sense. It's also possible that nulliparous patients who are virginal may get maybe change in the microbiota, maybe with an iud. Now the question is, well, why would a non sexually active patient have an iud? And that's easy. I mean, just for menstrual suppression or dysmenorrhea or whatever, heavy menstrual bleeding. There's a variety of non contraceptive reasons why a patient may have something like a progesterone releasing IUs to control menstrual symptoms. Okay? And those strings potentially may change the microbiota in the vagina, leading to bv, although that's much more likely with a copper device. Okay? So, yes, there are factors that can lead a virginal patient down the road to bacterial vaginosis. Even though. Even though it is much, much more common in sexually active women, it's very rare in sexually naive patients. But if the conditions are correct, yes, a virginal patient may absolutely get bv. But here's the bigger issue and the bigger question. And here's what I asked our podcast family member who asked the question. It's what does a virginal status mean to that patient? Okay, so let me explain. So, and we've got pain. Remember, I'm the gynecologist for a major university, although we have a big team who also takes care of these patients, and I take care of these 18 year old, 19 year old patients who, you know, come for the first time away from home and are going to a, you know, women's doctor and I'll ask them, you know, are you sexually active? They go, oh, no, I'm a virgin. Well, that's not what I asked you. Are you sexually active? Because some patients relate absence of penetration as virginal status, which is correct. However, oral genital contact is different. All right, so oral genital contact, which is a form of sex, that's why it's called oral sex, increases the risk for BV in the recipient patient. Okay, so this is where patients can be a virgin, meaning they've never had penile penetration of the vagina. But oral genital contact absolutely is published as a risk factor for BV even without penetration. Okay, now, by the way, that isn't have anything to do with male or female. I mean, it could be, you know, two women, it doesn't matter. The point is, is that oral genital contact to the recipient, either by introduction of oral bacteria into the vagina or by changing it a ph. By sexual arousal, whatever, oral sex absolutely is a risk factor for bv, and that's how a patient who is virginal can still get bacterial vaginosis. So this is, this is the big deal here, guys. So we got to make the distinction. When a patient says she is virginal, we have to ask her, what does that mean? We've also had patients, of course, who are virginal, meaning never had vaginal penetration, but they have oral sex or they have anal sex. That's our patient population. And that's something that we've written up in the Journal of College Health as well, so that the term virginity means something a little bit different to different patients. Oral sex, specifically receptive oral sex, increases BV frequency, likely through mechanical transfer of bacteria and introduction of oral microbiota to the vaginal environment. Okay, now this has been looked at in different publications. One was published out of the Infectious Disease Society of America that showed that receptive oral sex was independently associated with incident BV with a hazard ratio. Guys, listen to this. Remember, this is just oral sex with a hazard ratio of 3.52.
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so it is possible for a virginal patient, meaning who's never had penile vaginal intercourse, to absolutely get BV because of other sexual contact. Okay? Now if a true virginal patient has never had penetration, nor has ever had receptive or genital contact and doesn't douche, that would be really, really unlikely. But still possible. Okay? So remember, everything's possible, but it's not very probable. So this is something that I thought this would be a good one for a quickie episode, no pun intended. As BV relates to sexual activity, it doesn't have to be penetration. Receptive oral sex has been independently associated with a high incident bv and also for recurrence. All right, so this is why BV is not just related to penile penetration. It is also part of non coital sexual behaviors, including digital genital contact. By the way, anything that can change the microbiota of the vagina can do that. And it's also been reported with digital genital contact. That was published all the way back in 2010 in BMC infectious diseases. The title of that was the Epidemiology of Bacterial Vaginosis in Relation to Sexual Behavior. And some girls may consider, you know, hey, as long as it's not, you know, a penis in there, as long as it's a finger. So digital genital contact is totally they can still maintain their virginity because it wasn't a penis. So this is why the term virgin or virginity needs to be explored. So the easy answer was, can a virgin get bv? Sure, of course. Especially if they're having receptive oral genital contact or they douche or they have some other mechanical disruption of the microbiota like IUD strings, or they have some other non coital sexual behavior like digital genital contact. Podcast Family, we're about to wrap up this quickie episode. But this reminds me, guys, this whole issue of what is sex? Oh, oh, Mr. Clinton. Do you all remember this? I mean, I was in medical school when ex president, former president Bill Clinton, you know, said, I did not have sex with that woman. Remember that? I did not have sex with that woman. And then figured out, well, all right, all right, I did. I did. Right? But it was oral sex. And then there was this whole debate, as well as oral sex, really sexual. The answer is yes. Yes, absolutely. Says everybody who has treated oropharyngeal gonorrhea or oropharyngeal chlamydia. And the fact that oral receptive genital contact increases the risk of BV in receptive women. So, Mr. Clinton, yes, oral sex is indeed sex. So can a virgin get bv? I thought this was interesting as a quickie episode. I hope you found it helpful. And now that we've done all that, Michael, thank you. Let's bring it home. This is Dr. Chapa's obgyn clinical pearls no spin podcast.