The vaginal microbiota in bacterial vaginosis (BV) typically has low abundance of lactic acid producing lactobacilli. Lactic acid has properties that may make it effective for treating BV and/or restoring an optimal lactobacillus-dominated vaginal microbiota. We conducted a systematic review to describe the effect of intravaginal lactic acid-containing products on BV cure, and their impact on vaginal microbiota composition. The optimal vaginal microbiota of reproductive aged women is typically characterized by dominance of lactic acid producing Lactobacillus species including Lactobacillus crispatus, Lactobacillus gasseri and Lactobacillus jensenii Lactic acid containing products have been evaluated for BV treatment in clinical trials, and several over-the counter lactic acid-containing products are marketed to treat BV or support optimal vaginal microbiota. However, the use of these products is not recommended by any treatment guidelines. We conducted a systematic review with two objectives: 1) to describe the effect of intravaginal lactic acid-containing products for BV cure (assessed using an established diagnostic method), and 2) to describe the impact of intravaginal lactic acid-containing products on the vaginal microbiota (assessed using molecular methods). Studies were eligible if they were randomized controlled trials (RCT) where an intravaginal lactic acid-containing product was assessed in comparison to either no treatment, a placebo or a recommended antibiotic treatment for BV. No restrictions were placed on number of participants enrolled. Studies of pregnant women and post-menopausal women were excluded.