Bacterial Vaginosis (BV) and ovarian cysts are common gynecological conditions that frequently lead people to question whether they are related. BV is a highly prevalent imbalance of the vaginal microbiome, while ovarian cysts are fluid-filled sacs that develop on the ovaries. Understanding the distinct origins and mechanisms of both conditions is necessary to definitively address this concern. This article will explore the nature of BV and the established causes of ovarian cysts to clarify the relationship, or lack thereof, between the two.
What Bacterial Vaginosis Is and Its Complications
Bacterial Vaginosis is a condition defined by the disruption of the natural bacterial balance within the vagina. A healthy vaginal environment is typically dominated by Lactobacilli bacteria, which produce lactic acid to maintain a protective, acidic pH level. When BV occurs, there is an overgrowth of various anaerobic bacteria, such as Gardnerella vaginalis and Mycoplasma hominis, leading to a higher, less acidic vaginal pH.
The most recognizable symptom of BV is often a thin, grayish-white discharge accompanied by a distinctly “fishy” odor, which can become stronger after intercourse. Although many people with BV experience no symptoms at all, the condition is associated with significant health complications if left untreated. The loss of the protective Lactobacilli layer and the resulting inflammation can compromise the mucosal barrier of the upper genital tract.
This disruption facilitates an ascending infection, which links BV to the development of Pelvic Inflammatory Disease (PID). PID is an infection and inflammation that moves upward from the vagina and cervix into the uterus and the fallopian tubes. The bacteria associated with BV have been recovered from the upper genital tract in women diagnosed with acute PID. PID can cause long-term reproductive issues, including tubal-factor infertility and ectopic pregnancy.
The Established Origins of Ovarian Cysts
Ovarian cysts are extremely common, and the vast majority arise from the normal processes of the menstrual cycle, independent of any infectious cause. These are classified as functional cysts, and they are directly related to hormonal fluctuations during the reproductive years. The two main types of functional cysts are follicular cysts and corpus luteum cysts.
Follicular cysts form when the follicle containing the developing egg fails to rupture during ovulation, continuing to grow and accumulate fluid. Corpus luteum cysts develop after the egg has been released, when the remaining tissue seals up and fills with fluid or blood instead of shrinking. These functional cysts are almost always benign and typically resolve on their own within a few weeks or menstrual cycles.
Pathological cysts are not linked to the menstrual cycle and result from abnormal cell growth within the ovary. Examples include dermoid cysts, which develop from germ cells and can contain various tissues like hair or fat. Cystadenomas originate from the cells covering the outer surface of the ovary and are usually filled with watery fluid or mucus. Endometriomas, often called “chocolate cysts,” are caused by endometriosis, where tissue similar to the uterine lining grows on the ovary and bleeds to form a dark, blood-filled cyst.
Evaluating the Link Between BV and Cyst Formation
Bacterial Vaginosis does not directly cause the common types of ovarian cysts that form as part of the normal menstrual cycle or due to abnormal tissue growth. The established origins of functional and pathological cysts are hormonal and cellular, respectively, and do not involve the types of bacterial infection associated with BV. Therefore, the simple presence of BV does not increase the risk of developing a follicular cyst or an endometrioma.
However, the complication of untreated BV—Pelvic Inflammatory Disease—introduces a different kind of mass formation known as a tubo-ovarian abscess (TOA). A TOA is a late-stage, severe complication of an ascending infection, where the fallopian tube and ovary become engulfed in an encapsulated pocket of pus. This mass is an inflammatory, infectious collection rather than a simple fluid-filled sac arising from hormonal activity.
While a TOA is distinct from a typical ovarian cyst, it is a complex cystic mass that can be challenging to differentiate from an ovarian cyst or an endometrioma during initial physical examination or imaging. The presence of fever, elevated inflammatory markers, and acute pain usually suggest an abscess rather than a hormonal cyst. Because the symptoms of infectious pelvic masses and non-infectious cysts can sometimes overlap, it is important to seek medical evaluation for a proper diagnosis.