Infection After Hysterectomy: Fever, Wound and Vaginal Cuff Infections and Warning Signs

Infection is the most common complication after a hysterectomy, and one of the main things people worry about once they are home. Most infections are mild, show up in the first two weeks, and clear with antibiotics. A few need a drain or a stay in hospital, and very rarely an infection becomes serious. The key is knowing which changes are part of normal healing and which ones mean you should call your surgeon.

This guide explains the types of infection that can happen after a hysterectomy (in the skin incisions, at the top of the vagina, deeper in the pelvis, and elsewhere in the body), how common they are, what fever after surgery does and does not mean, the warning signs to watch for, how infections are treated, and what you can do to lower your risk. It is based on patient information from MedlinePlus, the NHS, the Royal College of Obstetricians and Gynaecologists (RCOG) and the CDC, guidance from the American College of Obstetricians and Gynecologists (ACOG), and large studies of US hospital data.

Key points

• Surgical site infection is the most common complication of gynecologic surgery. In large US studies, about 2 to 3 in every 100 women had one within 30 days of a hysterectomy.^{[7][8][9][13]}
• Infections are less common after vaginal and laparoscopic hysterectomy than after an open (abdominal) operation.^[8][11]
• Contact your surgeon for a fever above 100.5°F (38°C), a wound that is red, warm or draining thick yellow or green fluid, or a bad-smelling vaginal discharge.^[1][2]
• A slight temperature in the first day or two after surgery is common and usually not caused by infection. A fever that starts or returns after you are home is different and needs a call.^[11]
• Most infections are treated with antibiotics. Some need a collection of pus drained, and occasionally a return to the operating room.^[5][6]
• Confusion, very fast breathing, a racing heart, shivering or feeling very unwell with an infection can be signs of sepsis. Call 911.^[14][15]

Types of infection after a hysterectomy

Doctors call an infection in the part of the body where the operation took place a surgical site infection.^[6] After a hysterectomy, that can mean several different places, and some infections after surgery are not at the surgical site at all.

Incision (wound) infection

This affects the skin and the tissue just under it at the cuts on your belly: one larger incision after an abdominal hysterectomy, or several small ones after a laparoscopic or robotic operation. The RCOG describes it as red and painful skin around the scar.^[5] The wound may also feel warm, become more swollen or tender, or leak cloudy, thick, yellow or green fluid.^[1][6] A vaginal hysterectomy usually leaves no cuts on the belly, so this type is mostly a concern after abdominal and keyhole surgery. Our guide to hysterectomy scars and incisions shows what each type of incision looks like as it heals normally.

Vaginal cuff infection (cuff cellulitis)

After a total hysterectomy, the top of the vagina is stitched closed. This healing scar is called the vaginal cuff. Because the vagina naturally contains bacteria, the cuff can become infected. Doctors call this cuff cellulitis. Typical signs are a bad-smelling vaginal discharge or bleeding, fever, and pain low in the pelvis.^[1][5] The RCOG explains that heavy or smelly bleeding with a fever can mean an infection or a collection of blood at the top of the vagina (a vault haematoma), which can also become infected.^[5]

Pelvic abscess (deep infection)

Less often, infection forms a pocket of pus deeper in the pelvis, above the vaginal cuff. Doctors call these deep or organ-space infections. They tend to cause a higher fever, pain that gets worse rather than better, feeling generally unwell, and sometimes nausea or loss of appetite.^[5][8] They are usually found with a scan and treated with antibiotics, sometimes given through a drip in hospital, and some need the pus drained.^[5]

Infections that are not at the surgical site

• Urinary tract infection (UTI). Common after surgery, partly because of the catheter. Burning or stinging when you pee, or needing to go often, may mean a UTI; it is treated with antibiotics.^[4][5] More in our guide to bladder problems and UTIs after hysterectomy.
• Chest infection. Lying still and taking shallow breaths after surgery can lead to a chest infection, especially in people who smoke. Getting up and moving early helps prevent it.^[5] A cough that does not go away or trouble breathing needs a call.^[1]
• Vaginal yeast infection. Antibiotics can upset the natural balance in the vagina. Itching and a thick, white discharge are typical. See our guide to yeast infection after hysterectomy.
• C. diff diarrhea. After antibiotics, a few people develop an infection of the gut called C. diff, with watery diarrhea for several days, fever, stomach pain and loss of appetite. It can start days to weeks after the antibiotic. Contact your doctor if you get diarrhea during or after antibiotics.^[16]

How common are infections after a hysterectomy?

ACOG states that surgical site infection remains the most common complication of gynecologic procedures.^[7] Large US studies using the American College of Surgeons quality database give an idea of how often it happens:

• In 13,822 women who had a hysterectomy between 2005 and 2009, 1.6% developed a superficial infection (cellulitis) and 1.1% a deep or organ-space infection within 30 days.^[8]
• In more than 125,000 women who had a hysterectomy for non-cancer reasons between 2006 and 2015, 2.48% developed a surgical site infection.^[9]
• In a Michigan study of over 18,000 hysterectomies, the rate was 1.8%.^[13]

The route of surgery makes a clear difference. In the 2005 to 2009 data, superficial infection occurred in about 2.6% of abdominal hysterectomies compared with about 0.6% of vaginal and total laparoscopic hysterectomies. After adjusting for other factors, an open operation carried almost four times the risk of a superficial infection compared with a vaginal one.^[8][11] The study authors saw this as support for choosing the vaginal route when it is possible.^[8] You can read more about the different approaches in our guides to laparoscopic hysterectomy and vaginal hysterectomy.

Infection is also the main reason people go back into hospital. In a study of more than 40,000 hysterectomies, 2.8% of patients were readmitted within 30 days. Surgical site infection was the most common diagnosis, and 82% of readmissions happened within 15 days of going home.^[10] In other words, the first two weeks at home are when it pays most to watch for warning signs.

What raises the risk

Studies have linked these factors with a higher chance of infection after a hysterectomy:

• An abdominal (open) operation rather than a vaginal or laparoscopic one.^[8][9]
• A longer operation.^[8][9]
• A body mass index of 40 or more. In one study, it more than doubled the odds of a wound infection.^[8] See our guide to obesity and hysterectomy.
• Diabetes, especially when blood sugar is high around the time of surgery.^[8][11]
• Smoking.^[5][9][11]
• Bacterial vaginosis (BV) at the time of surgery. BV and trichomoniasis were linked to cuff infections in a study of abdominal hysterectomy, and untreated BV raises the risk of infection after gynecologic surgery.^[12][18]
• The reason for surgery. Infection was more common in women having a hysterectomy for endometriosis, pelvic pain, fibroids or heavy periods than for prolapse.^[9]
• Other health problems, such as lung disease or high blood pressure, and long-term steroid use.^[9][11]

Fever after a hysterectomy: what it means

Many people are told they “had a temperature” in the hospital and then worry that something went wrong. A raised temperature in the first 24 to 48 hours after surgery is common and is usually the body’s normal response to the operation, not an infection. A review of fever after laparoscopic hysterectomy found that between 0% and 15% of patients have a fever after surgery, depending on the hospital, and only a small share of those fevers turn out to be due to infection. In the first day or two, doctors usually watch and wait rather than start antibiotics.^[11]

Fever matters more when it starts or comes back later, once you are home, or when it comes with other symptoms. MedlinePlus advises contacting your surgeon if you have a fever above 100.5°F (38°C) after a hysterectomy.^[1][2] When you call, it helps to say:

• Your temperature, how you measured it and when.
• Whether you have taken acetaminophen (Tylenol) or ibuprofen, since these lower a fever and can hide how high it is.
• Any other symptoms: wound changes, discharge, pain, burning when you pee, cough, diarrhea or a swollen leg.

Doctors look for the cause of a fever after surgery in a few common places: the lungs, the urine, the wound, the veins (a blood clot can cause a fever) and, less often, a reaction to a medicine.^[11] That is why your doctor may examine your wound and your vagina, listen to your chest and check your legs, and may ask for blood tests, a urine test or a scan.

Normal healing or infection?

Some changes are expected while you heal and are easy to mistake for infection. This table compares common signs. It is a guide, not a diagnosis.

What you notice	Usually normal	Possible infection: call your surgeon
Skin around the incision	A thin pink line, mild bruising, some numbness, slight firmness under the scar	Redness that spreads or gets darker, the skin feels hot, swelling and tenderness that increase[1][5][6]
Fluid from the incision	A little clear or slightly pink fluid in the first days	Cloudy, thick, yellow or green drainage, or bleeding[1][6]
Vaginal bleeding or discharge	Light bleeding or discharge, red then brown then paler, without a bad smell, for up to about 6 weeks[4]	A bad or strong smell, heavier bleeding, clots, especially with fever or pain[1][4][5]
Pain	Gets a little better day by day	Gets worse after the first few days, or your pain medicine is not helping[1]
Temperature	Slightly raised in the first 24 to 48 hours in hospital[11]	Above 100.5°F (38°C), or a fever that starts after you are home[1][2]
Peeing	Going a bit more often at first	Burning or stinging, or being unable to pee[1][5]

For more detail on what is expected from the vagina in the weeks after surgery, see our guides to bleeding after a hysterectomy and vaginal cuff healing. For the overall recovery timeline, see hysterectomy recovery week by week.

How infections are diagnosed and treated

Your doctor will usually start by looking at the incision and, if your symptoms suggest it, doing a gentle internal exam to look at the vaginal cuff. Depending on what they find, they may take a swab of any drainage, test your blood and urine, or arrange an ultrasound or CT scan to look for a collection of fluid or pus in the pelvis.^[5][11]

• Antibiotics are the main treatment. Wound infections and urinary infections are usually treated with tablets at home.^[3][5][6] The type of antibiotic depends on the germ causing the infection.^[6] Take the whole course, even if you feel better quickly.
• Antibiotics through a drip in hospital may be needed for a more severe infection at the top of the vagina or deeper in the pelvis.^[5]
• Drainage. If pus has collected in the wound or the pelvis, it may need to be drained. A wound may be opened a little to let it drain, and a pelvic collection can sometimes be drained with a needle guided by a scan. Rarely, another operation is needed.^[5][6]

Most people recover fully once an infection is treated, though it can add some days or weeks to recovery. If you had to take antibiotics, watch for diarrhea and for vaginal itching afterward, as mentioned above.^[16]

How infections are prevented, and what you can do

What the surgical team does

ACOG recommends a single dose of preventive antibiotics, usually cefazolin, given through your IV shortly before a hysterectomy, with a higher dose for people with a higher body weight. The skin is cleaned with an antiseptic, often chlorhexidine with alcohol, and the vagina is cleaned too. Hair is clipped, not shaved, if it needs to be removed.^[7][11] Some surgeons test for bacterial vaginosis before surgery and treat it if it is found, which has been shown to reduce infections.^[18]

Before surgery

• Stop smoking if you can, ideally at least 30 days before surgery. People who smoke get more infections.^[6][11]
• Get your blood sugar under control if you have diabetes, working with your doctor.^[11]
• Do not shave near the surgical area in the days before surgery. A razor can irritate the skin and make infection easier.^[6]
• Mention unusual discharge, itching or a fishy smell before surgery, so BV or another infection can be checked and treated first.^[18]
• Tell your team about diabetes, allergies and your weight, since these affect your antibiotic and your risk.^[6]

Our guide on how to prepare for a hysterectomy covers the rest of your checklist.

After surgery

• Clean your hands before and after touching your wound or dressing. Family and friends should not touch it.^[6]
• Follow your wound instructions. After a laparoscopic hysterectomy, MedlinePlus says you can usually remove the dressing and shower the day after surgery if your skin was closed with stitches, staples or glue.^[1]
• No baths, pools or hot tubs until your surgeon says it is OK.^[1] See when you can take a bath after a hysterectomy.
• Nothing in the vagina (no tampons, douching or sex) until your surgeon says the cuff has healed. MedlinePlus advises waiting 8 to 12 weeks after a vaginal hysterectomy. Use pads for any bleeding.^[2][5]
• Get up and walk regularly and take some deep breaths to help prevent a chest infection and blood clots.^[5]
• Drink enough fluids and empty your bladder regularly.
• Check your wound once a day in good light, and take your temperature if you feel hot, cold or shivery.

When to call your surgeon, and when to call 911

Call your surgeon’s office (or the after-hours line) the same day if you have:^[1][2][5][6]

• A fever above 100.5°F (38°C).
• A wound that is red and warm, getting more painful or swollen, bleeding, or draining thick, cloudy, yellow or green fluid.
• A vaginal discharge with a bad smell, or bleeding heavier than light spotting.
• Pain that is getting worse, or that your pain medicine does not control.
• Pain or burning when you pee, or being unable to pee.
• A cough that does not go away.
• Nausea or vomiting, or being unable to eat or drink.
• Diarrhea during or after a course of antibiotics.^[16]
• Swelling or redness in one leg (this can be a blood clot).^[17]

Call 911 or go to the emergency room if you have:

• Signs of sepsis, especially with a known or possible infection: confusion or slurred speech, very fast breathing or shortness of breath, a high heart rate or weak pulse, shivering or feeling very cold, clammy or blotchy skin, or extreme pain or discomfort.^[14][15] Sepsis is a medical emergency.
• Heavy vaginal bleeding, or severe pain in your belly with fever and vomiting.^[5]
• Chest pain, sudden shortness of breath or coughing up blood, which can be a blood clot in the lungs.^[5][17]

Frequently asked questions

How long after a hysterectomy can you get an infection?

Most surgical site infections appear within the first 30 days, and the majority of hospital readmissions after a hysterectomy happen within 15 days of going home.^[8][10] Infections at the top of the vagina can still occur while the cuff is healing over the following weeks, which is one reason to keep anything out of the vagina until your surgeon says it has healed. Months or years later, a vaginal infection such as BV or thrush is unrelated to the surgery itself.

Is a low-grade fever after a hysterectomy normal?

In the first day or two after surgery, a slightly raised temperature is common and usually not caused by infection.^[11] Once you are home, a temperature above 100.5°F (38°C) is a reason to call your surgeon.^[1][2] If your temperature is lower than that but you feel unwell, have new pain, or notice wound or discharge changes, call anyway.

What does an infected hysterectomy incision look like?

An infected incision is usually red and painful, and the redness may spread out from the cut. It can feel warm or hot, look swollen, and leak cloudy, yellow or green fluid. A healing incision, by contrast, gradually becomes less tender and stays dry or leaks only a little clear fluid at first.^[1][5][6]

Can I get an infection after a partial (supracervical) hysterectomy?

Yes. Incision infections, urinary infections and deep pelvic infections can happen after any type of hysterectomy. Because the cervix is kept and the vagina is not opened, there is no vaginal cuff to become infected. In the 2005 to 2009 US data, the rate of superficial infection after laparoscopic supracervical hysterectomy was about 1.3%.^[11]

Will I need to go back to the hospital?

Most infections are treated with antibiotic tablets at home.^[3][5] A hospital stay is more likely for a pelvic abscess, an infection at the top of the vagina with a high fever, or if you are very unwell, so you can have antibiotics through a drip and, if needed, drainage.^[5]

Sources

1. MedlinePlus (U.S. National Library of Medicine). Hysterectomy – laparoscopic – discharge. medlineplus.gov
2. MedlinePlus (U.S. National Library of Medicine). Hysterectomy – vaginal – discharge. medlineplus.gov
3. NHS. Hysterectomy: risks. nhs.uk
4. NHS. Hysterectomy: recovery. nhs.uk
5. Royal College of Obstetricians and Gynaecologists. Abdominal hysterectomy: recovering well. Patient information. rcog.org.uk
6. Centers for Disease Control and Prevention. About surgical site infections. cdc.gov
7. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 195: Prevention of infection after gynecologic procedures. Obstetrics & Gynecology. 2018;131(6):e172–e189. pubmed.ncbi.nlm.nih.gov
8. Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. American Journal of Obstetrics and Gynecology. 2013;209(5):490.e1–9. pubmed.ncbi.nlm.nih.gov
9. Chen I, Choudhry AJ, Schramm D, et al. Type of pelvic disease as a risk factor for surgical site infection in women undergoing hysterectomy. Journal of Minimally Invasive Gynecology. 2019;26(6):1149–1156. pubmed.ncbi.nlm.nih.gov
10. Penn CA, Morgan DM, Rice LW, Harris JA, Rauh-Hain JA, Uppal S. Timing of and reasons for unplanned 30-day readmission after hysterectomy for benign disease. Obstetrics & Gynecology. 2016;128(4):889–897. pubmed.ncbi.nlm.nih.gov
11. Lachiewicz MP, Moulton LJ, Jaiyeoba O. Infection prevention and evaluation of fever after laparoscopic hysterectomy. JSLS. 2015;19(3):e2015.00065. pmc.ncbi.nlm.nih.gov
12. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. American Journal of Obstetrics and Gynecology. 1990;163(3):1016–1021. pubmed.ncbi.nlm.nih.gov
13. Till SR, Morgan DM, Bazzi AA, et al. Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone. American Journal of Obstetrics and Gynecology. 2017;217(2):187.e1–187.e11. pubmed.ncbi.nlm.nih.gov
14. Centers for Disease Control and Prevention. About sepsis. cdc.gov
15. NHS. Sepsis. nhs.uk
16. Centers for Disease Control and Prevention. About C. diff. cdc.gov
17. Centers for Disease Control and Prevention. About venous thromboembolism (blood clots). cdc.gov
18. Soper DE. Bacterial vaginosis and surgical site infections. American Journal of Obstetrics and Gynecology. 2020;222(3):219–223. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Always follow the wound care and aftercare instructions from your own surgeon, and contact them, or call 911, if you have a fever, a worsening wound, a bad-smelling discharge or you feel very unwell after a hysterectomy.