Vulvar Hygiene: Your Guide for a Healthy Vagina
If you're like most people who have a vagina, you’ve probably wondered or perhaps even searched for answers about your vaginal health. In fact, some of the top google searches include questions such as:
- ‘Why does my vagina smell?’ or ‘My vagina smells fishy’
- ‘Why does my vagina itch’ and ‘What are vaginal yeast infection symptoms’
- ‘What does ‘yellow vaginal discharge’ mean?’ and ‘Bacterial vaginosis symptoms’
Have you ever noticed how many different products are targeted towards feminine hygiene and more importantly, how many scented products there are? This sends a subliminal message that something is wrong with our body’s natural odor. Worldwide, these products are used and feminine hygiene practices vary depending on personal preference, cultural norms or religious practices, recommendations from health care providers, and yes,”Dr. Google.” Talking about vulvas and vaginas can feel shameful or embarrassing, so it's no surprise many turn to the internet for education on these topics.
In this blog, we want to provide you with answers to many of the common questions including healthy personal hygiene practices, vaginal odors, and what your discharge may be telling you. We’ll also go through some of the more common disorders including vaginal candidiasis aka vaginal yeast infection, and bacterial vaginosis. While we want to provide you with helpful information, we also want to help you understand your symptoms and when it may be necessary to seek care from a healthcare provider.
Before we dive into what is problematic, we need to understand what is normal.
Vaginal and Vulvar Microbiome (aka the ‘Environment’)
The vulva is the external part of your genitalia and has specific mechanisms to protect your genitourinary tract (vagina, uterus, bladder, etc) from infection. The vulva is a physical barrier (including your pubic hair!), but more importantly it also has its own microbiome (bacteria and other organisms) that maintain a healthy acidic pH which helps maintain a healthy environment and prevent infections from occurring. Our hormones, moisture, sweating, menses (periods), medications, health conditions, and the products we use can all influence this environment for better or for worse.
[Show stats in side box? Or some sort of diagram] - the following
- Premenarche (before puberty) - 7.0 (neutral)
- Reproductive age - 3.8-4.4
- 6.5-7.0 (without hormone replacement therapy or local hormones)
- 4.5-5.0 (with hormone replacement therapy or local hormones)
The pH which is a measure of how acidic or alkaline the environment is, is very important for healthy vaginas! A lower pH results in a more acidic environment whereas a higher pH results in a more neutral, or alkaline environment. As you can see in the chart above, once we hit puberty, our vagina’s become more acidic (low pH) due to the hormone fluctuations that occur at this time. Once we hit menopause, it reverts back to a more neutral pH (higher pH), unless one is on hormone replacement therapy. A higher pH (more alkaline) is associated with increased colonization with pathogenic microbes. Maintaining a healthy pH is crucial for ideal vulvovaginal health, next we will discuss the various factors that can impact the pH, including feminine hygiene products.
Bacteria is normal!
As humans, we have bacteria and other organisms that live in us. Different body systems have different types of species that all play a role in our overall health, but various factors (particularly those external factors) as well as diet and lifestyle can play a role in the balance of these organsisms. Of course there are bacteria that make us sick, but good bacteria that are out of balance may also cause issues. One of the main roles of the bacteria in this area is to create lactic acid which lowers the pH in order to prevent pathogenic bacteria from residing in our vulvas.
When there is an imbalance in the bacteria of our vulva, vagina, or genitourinary tract, this is when problems may arise.
Discharge is normal, and variations in discharge are also normal. Discharge is a combination of bacteria and old skin cells from the vaginal wall combined with mucus and fluid from the cervix and vagina. The amount of discharge and texture changes throughout the menstrual cycle. During the beginning of the menstrual cycle, vaginal discharge can be thick and sticky and becomes more watery and stretchy (like egg-whites) as estrogen rises, making it more sperm-friendly. Discharge can also be a white color, and normal discharge is relatively odorless. Bad smelling discharge is usually associated with an infection and can appear yellow, green, or gray-ish.
Vaginal pH, normal vaginal flora, and vaginal discharge together play a role in our bodies defense system in keeping us infection-free and healthy! The following are factors that influence or change one of these factors that may lead to compromised health.
Hormones are a huge factor in maintaining a healthy environment and changes with points in life where our hormones fluctuate, even during our menstrual cycles! There are many factors to consider that alter hormones. Internal factors would be things like our age, menstrual cycles, pregnancy, or infections; and external factors including hygiene practices, sexual intercourse, the use of antibiotics, hormone replacement therapies and potentially things that disrupt our own hormones such as birth control pills and medications used for hormonal suppression in certain conditions.
Feminine hygiene practices
In countries that adopt conventional or western medicine practices, many health conditions are treated using medications including antibiotics and we don’t often value more natural remedies as other cultures may, including vulvovaginal hygiene. In the last several years, there has been a shift in adopting more holistic therapies for a number of different conditions.
Personal hygiene practices vary among cultures, and we know that microbial diversity varies among different ethnic groups. Therefore, practices that may seem non-conventional or western medicine practitioners deem harmful, may not be for those individuals. These practices are often rooted in cultural or religious beliefs and have likely been used for hundreds of years. That being said, many people often will adopt these practices, but when taken out of context, they may cause harm if they impact the vulvovaginal environment.
Keeping this in mind, let's talk about some common practices.
Vaginal washing vs. Douching - “The vagina is self-cleaning”
If the vagina is self-cleaning, why douche? The question about the vagina being self-cleaning is one of the most common questions among women. When everything is healthy, yes, the vagina is self-cleaning, that does not mean you cannot wash your vulva. Remember, the vulva is the external parts, the vagina is internal and they are not made up of the same tissue.
Vaginal douching is a process that involves washing the inside of the vagina, usually involving a mixture of water and other ingredients such as vinegar or other acidifying agents, antimicrobial solutions, detergents, and/or preservatives. It is commonly used for personal hygiene, aesthetic reasons, preventing or treating an infection, cleansing after menstruation or sex, and to prevent pregnancy. While this has been a controversial topic for many years, it appears there really is no confirmed health benefits; on the other hand, it has been associated with an increased risk of pelvic inflammatory disease, alterations in the normal vaginal flora, and sexually transmitted infections (STIs).
Washing your vulva on the other hand is appropriate and may be necessary for those with vulvar conditions. Listed below are some safe guidelines:
- Wash the vulva gently with water and a hypoallergenic soap without a fragrance
- Do not overwash your vulva, once per day is recommended
- Look at the ingredient list - avoid chemicals and drying agents such as sodium lauryl sulfate, fragrances, coconut diethanolamide, parabens
- Avoid bar soaps and bubble baths
- Avoid vaginal deodorants
- Avoid antiseptics
- Use a product that was formulated and tested specifically for the vulvar area to ensure they are safe
Pubic Hair: To Shave or Not To Shave (or wax… or laser)
It may be shocking to some, but pubic hair actually plays a role in keeping your vulva healthy! It acts as a physical barrier to prevent unwanted microbes in the area. This is probably one of the most common practices, and people are often embarrassed and apologize for “not grooming down there.” It has been discussed that complete removal may increase one’s susceptibility to infection, but we need more data. However, what we do know is that these practices can be painful and may cause microtrauma to the skin and result in cuts and severe consequences may include significant irritation, infection, and spread of some STIs.
The bottom line here is that it is okay if you don’t feel like grooming, there are health benefits! If your personal preference is hair removal, that is fine too - just be careful if there are cuts or skin sensitivity. If you already have something going on, you may want to consider skipping your wax that month to avoid more irritation.
Clothing and menstrual products
Similar to the vulvar washes and soaps, it is ideal to use products that are not scented, change them frequently, and use the correct product. For example, if you experience urine leakage and it is significant enough for you to use a liner or pad, use one designed to absorb urine. Menstrual pads and incontinence pads absorb differently. Using the wrong product may result in residual urine (or menstrual fluid) on the skin and can lead to skin irritation due to excess moisture on the tissues.
The fragrances used in the majority of products also may cause irritation or sensitivities, especially in those already predisposed, and can alter the pH posing more risk of problems. Panty liners that are used for many reasons including “just in case” purposes need to have a breathable back sheet. Otherwise, this can result in a lot of heat and moisture, and alter the pH of the vulvar skin putting you at risk for problems.
Lube makes sex better and is necessary when using our vaginal dilators and wands. You want to use a water based lube with our products, but silicone or oil based lubes are absolutely safe for intercourse when not using condoms. When picking a lube, the pH should be similar to the vagina ranging between 3.8 - 4.5 and for rectal work 7.0 for water based lubes, plant-based, silicone, and oil-based lubes can’t be measured. For all lubricants, the osmolality should be less than 380 mOsm/kg. Avoid ingredients that can be irritating including glycerin or glycerol, parabens, glycols, nonoxynol-9, chlorhexidine gluconate, and cyclomethicone.
The Bottom Line
Feminine hygiene practices are used for various purposes and differ among culture and ethnic groups. When using a product, select a high quality product without harsh chemicals from a reputable company. Healthy vaginas (and vulvas) do not need extensive cleaning practices, and there is no need to clean the inside of a healthy vagina. Many of these practices are marketed to treat infections, which there is limited to no research for, and should not be used to treat infections, but may have a safe role in your own personal practices. If you are having symptoms indicating an infection, please see your healthcare provider to identify and treat the cause.
We hope this information is informative and useful to you in answering your questions. These issues impact so many and are often associated with pelvic floor dysfunction. If you experience painful sex, ask a healthcare provider if NewFlora’s tools are right for you.
- Chen, Y., Bruning, E., Rubino, J., & Eder, S. E. (2017). Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Women's Health, 13(3), 58-67. https://doi.org/10.1177/1745505717731011
- Martino, J. L., & Vermund, S. H. (2002). Vaginal douching: evidence for risks or benefits to women's health. Epidemiol Rev, 24(2), 109-124. https://doi.org/10.1093/epirev/mxf004
- World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI (2012) http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf