Bacterial vaginosis (BV) is a common vaginal condition. Many individuals wonder if it can still affect them after a hysterectomy. This article explores the relationship between BV and hysterectomy, clarifying why BV remains a consideration post-surgery.
Understanding Bacterial Vaginosis
Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance of bacteria in the vagina. Normally, “good” bacteria (lactobacilli) outnumber “bad” bacteria, but an overgrowth of certain bacteria leads to BV. Symptoms often include a thin, gray, white, or greenish vaginal discharge and a foul-smelling, “fishy” odor, especially after sex. Vaginal itching or a burning sensation during urination may also occur.
BV is not a sexually transmitted infection, but it can be associated with sexual activity, particularly with new or multiple partners. Douching can also disrupt the vaginal environment. About half of individuals with BV experience no symptoms.
Understanding Hysterectomy
A hysterectomy is a surgical procedure involving the removal of the uterus. This surgery is performed for various reasons, including conditions like uterine fibroids, abnormal bleeding, or certain cancers. Different types of hysterectomies exist: a partial hysterectomy removes only the uterus, leaving the cervix intact, while a total hysterectomy involves removing both the uterus and the cervix.
In some cases, the ovaries and fallopian tubes may also be removed during the procedure, which is known as an oophorectomy and salpingectomy, respectively. It is important to note that even after a hysterectomy, the vagina typically remains in place. In total and radical hysterectomies where the cervix is removed, the top of the vagina is sutured closed, forming what is known as a vaginal cuff.
Bacterial Vaginosis After Hysterectomy
It is possible to develop bacterial vaginosis even after a hysterectomy. This is because BV is an imbalance of bacteria within the vagina, and the vagina remains present after the removal of the uterus. The vaginal cuff, which is the closed end of the vagina formed after a total hysterectomy, can still host a bacterial environment. The vaginal microbiome, the community of microorganisms residing in the vagina, can still be disrupted.
Changes in the vaginal flora post-hysterectomy can create conditions conducive to bacterial overgrowth. While the uterus and cervix are not part of the endocrine system, the removal of ovaries during a hysterectomy (oophorectomy) can lead to a sudden drop in estrogen levels. Lower estrogen levels can cause vaginal tissues to become thinner and drier, which may influence the vaginal environment and its susceptibility to imbalances. However, BV can occur even if ovaries are left intact.
Common risk factors for BV, such as douching or new/multiple sex partners, continue to apply after a hysterectomy. The stress of surgery or antibiotic use during recovery might also temporarily alter the vaginal flora, potentially increasing BV development. Studies indicate that having BV can increase the risk of post-operative infections, such as vaginal cuff cellulitis.
Symptoms and Seeking Care
The symptoms of bacterial vaginosis after a hysterectomy are generally consistent with those experienced by individuals who have not had the surgery. These can include an unusual vaginal discharge that may be gray, white, or green, often accompanied by a strong, “fishy” odor. Vaginal itching or a burning sensation during urination may also be present. However, it is important to remember that some individuals with BV may not show any symptoms.
If these symptoms appear, it is important to consult a healthcare provider for an accurate diagnosis. Self-diagnosis and self-treatment are not advised, as the symptoms of BV can sometimes mimic other vaginal conditions that require different treatment approaches. A healthcare professional can perform an examination and tests, such as analyzing vaginal discharge for “clue cells” or checking vaginal pH, to confirm a BV diagnosis. Treatment for BV typically involves antibiotics, which can be prescribed as pills or vaginal gels or creams.