Can Bacterial Vaginosis Cause Pelvic Pain?

Bacterial vaginosis (BV) occurs when bad vaginal bacteria outweigh the good vaginal bacteria required to maintain a healthy vaginal environment. [1]

This imbalance can lead to BV symptoms like unusual vaginal discharge, often described as thin, grayish-white, and with a strong fishy odor. Additionally, BV may cause itching, burning during urination, and discomfort during intercourse. [1]

All that said, can bacterial vaginosis cause pelvic pain? Put simply, it depends. Find out more below.

The Connection Between Bacterial Vaginosis and Pelvic Pain

It's crucial for individuals at risk, such as those with multiple sexual partners or a history of BV, to undergo regular screening, even in the absence of symptoms. [1]

For roughly 16% of patients with bacterial vaginosis, symptoms are evident. However, 84% of bacterial vaginosis cases are asymptomatic, meaning that many people may have BV without experiencing any noticeable symptoms. [1] Asymptomatic BV can still lead to complications if left untreated, such as an increased risk of contracting a sexually transmitted infection (STI), complications during pregnancy, or pelvic inflammatory disease (PID). [1]

Specifically, the change in vaginal flora caused by bacterial vaginosis may cause PID—and PID may lead to pelvic pain. [3]

What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease occurs in women and people assigned female at birth (AFAB) when harmful bacteria travel from the vagina and into the reproductive organs. Impacted organs can include the [4]:

• Uterus – In pelvic inflammatory disease, the uterus can become infected, leading to inflammation of the uterine lining (endometritis). This inflammation can cause pelvic pain, abnormal uterine bleeding, and discomfort during intercourse.
• Fallopian tubes – PID often affects the fallopian tubes, causing inflammation (salpingitis). Inflammation in the fallopian tubes can lead to scarring, narrowing, or blockages, which can impair fertility and increase the risk of ectopic pregnancy.
• Ovaries – In PID, the ovaries can also become infected and inflamed (oophoritis). Oophoritis can cause pelvic pain, particularly on the side where the affected ovary is located. In severe cases, it may lead to the formation of ovarian abscesses.
• Cervix – The cervix, the lower part of the uterus that connects to the vagina, can also be affected by PID. Inflammation of the cervix (cervicitis) is a common feature of PID and can cause vaginal discharge, pain during intercourse, and abnormal bleeding, especially after intercourse.

The most common types of harmful bacteria that cause pelvic inflammatory disease are those associated with a sexually transmitted infection (STI), such as untreated gonorrhea or chlamydia. However, that isn’t always the case, and untreated bacterial vaginosis may also be the cause. [4]

Pain or tenderness in the pelvic region or lower abdomen can feel like a dull ache and may worsen during sexual intercourse. [4] Other PID symptoms include abnormal vaginal discharge, fever, nausea, irregular periods, and burning during urination. [4]

If left untreated, the effects of pelvic inflammatory disease can be serious. Scarring of the reproductive organs may lead to [4]:

• Chronic pelvic pain
• Ectopic pregnancy
• Infertility
• Tubo-ovarian abscess

Treatment Options

To reduce the risk of pelvic pain, it’s important to treat bacterial vaginosis before it develops into pelvic inflammatory disease. Most commonly, a healthcare provider will prescribe a gel or cream antibiotic to be applied directly into the vagina for up to seven days. [1] These include [1]:

• Metronidazole
• Clindamycin

If you do begin to experience pelvic pain, it’s critical to speak with a healthcare provider right away. If the BV has developed into PID, a healthcare provider will prescribe additional antibiotics to treat the infection. In cases where BV and PID occur at the same time, the bacteria caused by BV are often isolated from the upper genital tract. As such, metronidazole is a common antibiotic that has been found to treat both conditions, which can be taken together with more traditional PID treatment options like [5, 6]:

• Ofloxacin
• Levofloxacin
• Ceftriaxone plus doxycycline
• Cefoxitin and probenecid plus doxycycline

All that said, antibiotics will not reverse the scarring caused by pelvic inflammatory disease. This scarring can continue to cause pelvic pain and infertility even after the infection has been treated. Further, studies show that 20% of people with pelvic inflammatory disease can experience chronic pelvic pain. [4]

Therefore, early detection and prompt treatment of both recurrent bacterial vaginosis and pelvic inflammatory disease are crucial to prevent long-term complications.

Prioritize BV Assessment and Treatment With Everlywell

Bacterial vaginosis can disrupt the balance of bacteria within the vagina, which can lead to abnormal discharge, an unpleasant smell, and vaginal irritation. If left untreated, the infection can spread to the reproductive organs, which may cause pelvic pain, tenderness, and soreness.

If you believe you’re experiencing a vaginal infection, Everlywell provides a convenient way to find answers. With our bacterial vaginosis online treatment option, you can seek care from a licensed healthcare provider from the comfort of home—no appointment necessary.

Simply fill out your health profile and symptoms, and a healthcare provider will review your condition within 24 hours of submission. If applicable, they can prescribe antibiotics that you can pick up at your local pharmacy.

It’s that easy.

1. Bacterial Vaginosis (BV). Cleveland Clinic. Accessed May 15, 2024. Medical Citation URL.
2. Bacterial Vaginosis. WHO. Accessed May 15, 2024. Medical Citation URL.
3. Taylor B, et al. Does bacterial vaginosis cause pelvic inflammatory disease? Sex Transm Dis. Accessed May 15, 2024. Medical Citation URL.
4. Pelvic Inflammatory Disease. Cleveland Clinic. Accessed May 15, 2024. Medical Citation URL.
5. Pelvic Inflammatory Disease. CDC. Accessed May 15, 2024. Medical Citation URL.
6. Haggerty C, Ness R. Newest Approaches to Treatment of Pelvic Inflammatory Disease: A Review of Recent Randomized Clinical Trials. Clinical Infectious Diseases. Accessed May 15, 2025. Medical Citation URL.