Why You Can Still Get BV After Hysterectomy: What To Know

Right after my hysterectomy, I assumed I’d be free of all things gynecological—no more periods, no cramps, no worries. But a few months later, something felt off. The familiar, fishy odor returned, along with that watery discharge I hadn’t missed. It felt unfair. How could I possibly have bacterial vaginosis when I didn’t even have a uterus anymore? Turns out, *you absolutely can get BV after a hysterectomy*, and it’s more common than many realize.

Why BV Can Still Happen After a Hysterectomy

Bacterial vaginosis isn’t caused by your uterus—it’s all about the vaginal microbiome. When the healthy balance of bacteria in your vagina is disrupted, harmful bacteria can overgrow and cause BV. So, even if you’ve had a total hysterectomy (removal of the uterus and cervix), your vaginal environment can still be affected.

Still Got a Vagina? You Can Still Get BV

A hysterectomy doesn’t remove the vagina (unless it’s a radical hysterectomy for cancer). Most women retain their vaginal canal, and that’s where the good and bad bacteria live. So, unless your hysterectomy was incredibly extensive, your vagina is still very much vulnerable to bacterial shifts.

Hormonal Changes Can Trigger Imbalance

If your ovaries were removed during surgery (oophorectomy), you’re likely dealing with a sudden drop in estrogen. Lower estrogen levels can thin the vaginal walls, reduce lubrication, and make it harder for good bacteria (like *Lactobacillus*) to thrive. That hormonal dip? It can absolutely make room for BV-causing bacteria to take over.

What BV Feels Like After a Hysterectomy

BV doesn’t change its game just because you’ve had a hysterectomy. The symptoms are pretty much the same, though some might feel more intense due to a more sensitive post-surgical vaginal tissue:

• Watery or thin grayish-white discharge
• Strong, fishy vaginal odor (especially after sex)
• Mild irritation or itchiness
• Increased discharge without infection symptoms like fever or pain

If you’re noticing these, especially the smell—yep, I know that smell—you might be dealing with BV. For deeper insights on symptoms, this guide on vaginal odor breaks it down clearly.

Is It BV or Something Else?

After hysterectomy, your immune response and vaginal flora might shift in a way that mimics other infections. Yeast infections, for example, can present similarly but require different treatment. So how do you tell?

1. Smell: Yeast doesn’t smell fishy. BV does.
2. Discharge texture: BV discharge is thin and watery. Yeast is thick and clumpy.
3. Itch level: BV may itch, but yeast infections tend to itch like crazy.

If you’re unsure, don’t guess. Consider reviewing the differences in this BV vs. Yeast guide or consult your doctor.

Why It Keeps Coming Back (Yes, Even Now)

Recurring BV after hysterectomy is frustrating. I’ve personally gone through cycles of antibiotics and then—bam—it’s back in two weeks. Here are some possible reasons why:

• Low estrogen post-oophorectomy or menopause
• Sexual activity—especially without condoms
• Use of perfumed soaps, washes, or douching
• Antibiotic use for unrelated conditions

This detailed breakdown on BV relapses after antibiotics helped me recognize patterns in my own flare-ups.

Effective Treatment Options After Hysterectomy

The go-to meds for BV—like metronidazole or clindamycin—still work after hysterectomy. But for many women (me included), treatment needs to go beyond a single prescription. It’s about restoring balance and keeping it that way.

Conventional Treatments

• Metronidazole (oral or gel): Often the first line of treatment. Read more about how metronidazole works.
• Clindamycin (cream or pill): Alternative if you react poorly to metronidazole
• Boric Acid Suppositories: Helpful for balancing pH, especially for chronic BV (details here)

Complementary & Natural Support

• Daily oral probiotics
• Vaginal estrogen cream if your estrogen is low
• Natural oils like tea tree oil—but be cautious and always test for sensitivity first

Protecting Your Vaginal Health After Surgery

After surgery, I became more mindful of what I use and do. Keeping your vaginal flora balanced is about building habits that protect—not disrupt. Here’s what’s worked for me:

• Avoid douching (seriously, just don’t)
• Stick with unscented soaps
• Use condoms if you’re sexually active
• Let your vagina breathe—ditch the tight synthetic underwear
• Load up on fermented foods and cut back on sugar (here’s why sugar matters)

If you’re looking for a full breakdown of long-term solutions, I highly recommend the guide on long-term BV prevention. It’s practical and super helpful.

For more on the topic and broader understanding, explore the full BV causes and risk factors page. You can also dive into the primary overview here: Bacterial Vaginosis Main Guide.

Dealing With BV After Hysterectomy During Intimacy

This is the part nobody really talks about. BV after hysterectomy can put a dent in your sex life—not just physically but emotionally too. The odor, discomfort, and the constant “is it coming back?” anxiety makes it hard to feel confident. I’ve been there. I avoided intimacy for weeks, feeling embarrassed even though my partner was totally supportive.

What helped? Open communication, lots of lube, and honestly, a sense of humor. Also—condoms. Even in long-term relationships, they can help reduce the transfer of semen (which affects vaginal pH). If your symptoms flare up after sex, this deep dive into BV and sexual activity is a must-read.

Tips for Managing BV and Intimacy

• Always use lube – estrogen changes post-hysterectomy can lead to dryness
• Use condoms to prevent semen-triggered pH changes
• Communicate with your partner – the more you talk about it, the less awkward it becomes
• Post-sex hygiene – rinse with water, no soap, and pee after

If BV persists or worsens after intimacy, speak with your gyno. You might need suppressive therapy or vaginal estrogen cream for long-term balance.

Can BV After Hysterectomy Be Prevented?

You can’t completely “BV-proof” your vagina, but you can make it a hostile environment for the bad bacteria. After my third BV episode post-hysterectomy, I revamped my entire routine—and it’s been working.

What Worked for Me

1. Probiotic supplements: I take them daily, especially after antibiotics.
2. Switched to cotton underwear: No more synthetic lace all day.
3. Stopped using scented anything: No more “feminine” washes or bath bombs near that area.
4. Adjusted my diet: Less sugar, more fermented foods. This helped more than I expected. Read more in this BV diet guide.

Consistency is key. Most of us go back to old habits when things improve, but I learned the hard way—BV loves a careless routine.

When You Should See a Doctor

Let me say this clearly: *don’t tough it out*. Just because BV isn’t life-threatening doesn’t mean it’s harmless. Recurring BV can lead to irritation, increase the risk of STIs, and if left untreated in menopausal women, can cause significant discomfort due to thinning tissues.

See a doctor if:

• The odor is strong and doesn’t go away after a few days
• You’ve already tried over-the-counter or natural treatments with no luck
• You’re experiencing itching, pain, or discharge changes
• You’ve had more than 3 BV episodes in 6 months

Also—don’t self-diagnose too confidently. Use this helpful guide on self-diagnosing BV if you’re not sure.

BV in Postmenopausal or Surgically Menopausal Women

If your hysterectomy pushed you into early menopause, or if you’re already postmenopausal, you’re in a different BV landscape. Estrogen levels play a huge role in vaginal pH and bacterial balance.

In these cases, vaginal estrogen therapy—a cream or ring—can be game-changing. It helps thicken the vaginal lining and encourages good bacteria to flourish. For many, this is what finally keeps the BV at bay.

Talk to your provider if you think your hormonal shifts are triggering recurrent BV. You can also read more about treatment adjustments for different hormonal states—it applies to surgical menopause, too.

Maintaining Vaginal Health Long-Term

There’s no quick fix. But once I built a new normal around supporting my vaginal health, things stabilized. BV hasn’t returned in months—and that’s a win.

My Long-Term Toolkit Includes:

• Daily probiotics (oral + occasionally vaginal ones)
• Switching to pH-balanced personal products
• Hydration and fiber-rich diet (your gut and vagina are more connected than you think)
• Vaginal estrogen (prescribed by my OB-GYN)

This guide on BV prevention tips gives even more useful routines to build into daily life. Trust me—small changes, done consistently, add up fast.

If this article helped clear things up, or if you’re dealing with this and want a full overview of what BV is, how it starts, spreads, and gets treated, check out the full guide on Bacterial Vaginosis.

Gwenna Aazee

Dr. Gwenna Aazee is a board-certified Internal Medicine Physician with a special focus on hypertension management, chronic disease prevention, and patient education. With years of experience in both clinical practice and medical writing, she’s passionate about turning evidence-based medicine into accessible, actionable advice. Through her work at Healthusias.com, Dr. Aazee empowers readers to take charge of their health with confidence and clarity. Off the clock, she enjoys deep dives into nutrition research, long walks with her rescue pup, and simplifying medical jargon one article at a time.