BV for 20 years that won't clear? It may not be BV

Author: Aunt Vadge
Qualified Naturopath | BHSc(N)

Last reviewed: June 30, 2026

Dear Aunt Vadge,

I had a complete hysterectomy for endometriosis last year. I’ve battled with “BV” my whole life, starting in my 20s. I don’t believe it’s BV — maybe it’s a different bacteria. What type of doctor do I need? My current gynecologist says he won’t test for anything else. I’m hurting and need help.

Thank you,
MM.
Age 44, United States

Dear MM,

I want to back your instinct, because I think it’s sharp: lifelong “BV” that never truly clears is very often not BV at all. It gets that label by default, then treated with the same antibiotics over and over, which is exactly why it never ends — so let’s widen the lens.

And there’s one big clue your gynaecologist may be skating past: your complete hysterectomy.

If your ovaries came out too, your oestrogen will have dropped sharply, and low oestrogen changes the vaginal tissue and its whole microbiome — which can cause irritation, discharge and discomfort that looks like BV but is actually atrophic and hormonal, and it’s treated completely differently (it doesn’t respond to antimicrobials at all).

On top of that, stubborn “BV” is frequently aerobic vaginitis, different bugs entirely (like E. coli or Strep) that standard BV treatment won’t touch.

So what to ask for: a comprehensive vaginal microbiome test (PCR or NGS), not a basic BV swab, because that shows everything actually there so you stop guessing; an honest look at whether this is oestrogen-related given your surgery, which reframes the whole problem; and a full STI screen if that’s not been done recently, just to close it off.

If your current gynaecologist flatly won’t test further, that’s your cue to find one who will, or a menopause-literate provider, since the hysterectomy angle matters here.

In the meantime, grab some vaginal pH strips (cheap online) and test at home — it’s a quick way to point the finger, since BV and aerobic vaginitis run alkaline (high) while an overly acidic reading points elsewhere — and our free Killing BV guide walks through the whole picture and home approaches, with the free support section there to email us directly if you get stuck.

Twenty years is long enough to have been fobbed off; the thing that finally cracks cases like yours is identifying what’s really there, and you’re already asking the right question.

Best,
Aunt Vadge

This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.