Is Bacterial Vaginosis Associated with an Increased Risk of Pelvic Organ Prolapse in Women? : A Comprehensive Systematic Review

Introduction: Bacterial vaginosis (BV) is the most common vaginal infection in reproductive-aged women, characterized by depletion of protective Lactobacillus species and overgrowth of anaerobic bacteria. Pelvic organ prolapse (POP) is a prevalent pelvic floor disorder with significant morbidity. Although both conditions share common risk factors such as aging, parity, and estrogen decline, whether BV independently increases POP risk remains unclear. This systematic review aims to synthesize available evidence on the association between BV and POP. Methods: A comprehensive systematic review was conducted using predefined screening criteria. Studies were included if they involved adult non-pregnant women, assessed BV as an exposure, measured POP as an outcome, provided clear diagnostic criteria for both conditions, and employed observational designs. Data extraction encompassed study characteristics, BV and POP assessment methods, effect measures, confounders, and temporal relationships. Results: Twenty-two sources were reviewed, including primary studies, systematic reviews, and narrative reviews. Only one primary study (Cheng et al., 2022) directly examined the BV-POP association in 358 postpartum women, finding significantly higher BV incidence in the pelvic floor dysfunction group (p