Vaginal and Vulvar Care: What you wish you would have been taught.

As women, we often go through our lives figuring things out on our own, wondering if what we're doing or what we were taught to do is actually the healthiest thing for our bodies. One area that I find is particularly confusing is vaginal and vulvar care.

With so many products being marketed and so much misinformation being given I quickly realized in my practice that my clients are often caring for their vagina and vulva in ways that are counterproductive to their intention of being healthy and clean. This inspired me to write the following post to set the record straight for my clients and for the rest of womankind. Enjoy.

Wash with water only. The vagina is naturally self-cleaning. Cleansers, detergents and perfumes can irritate the delicate skin and mucosa. This means no soap on your washcloth.

Yes. No soap. I'm not kidding.

You're probably confused right now. You're probably thinking, "but how do I clean her? How do I control the .... smell?" Keep reading.

Wear cotton or bamboo gusset underwear. Breathability of garments near the vagina contributes to a healthier environment for this area. Synthetic pads and liners can impede this breathability depending on their composition. I understand that at certain times of the month pads and liners may be desired; however, please don't make this a daily habit.

In fact, it's much better for you to change your underwear multiple times a day rather than wearing a liner. Your vagina will thank you. 

Look for products that are chlorine-free, plastic-free, and rayon-free. Bio-degradable is good too! Washable cotton pads and menstrual cups are good options too. Many common menstrual and incontinence products contain odour neutralizers and fragrances that may irritate the vulva. I have ready many articles claiming that most feminine hygiene products contain toxic ingredients. Read the ingredients on labels of pads, liners, tampons.

Use hypoallergenic non-scented laundry soap. Don't forget that your underwear is going to be touching your vulva so it's important to use hypoallergenic non-scented laundry soap to wash all garments that are going to contact this area. Wash all under garments before wearing for the first time. Double rinse if able.

Maintain moisture. Your vulva and/or vagina may crave some moisture. How does it communicate this? [Cue dialogue with vulva.] Possible sensations include visible dryness, itchiness, and a sensitivity to friction or contact of any kind. Just make sure that you are cleared of any medical condition(s) that could present themselves with these sensations.

If you've determined that yes, you do need more moisture, then there are a few options you can use on a daily basis as well as  some that can be used for sexual play.

Food grade oils and marketed moisturizers: Oils such as coconut oil, olive oil, almond oil, and avocado oil are simple and safe options. There are products that are specifically marketed for vulvar and vaginal moisture. There are some vaginal suppositories, and some products for the vulva (the external genitalia including, but not limited to, labia majora, labia minora, and the vulvar vestibule which is the area inside labia minora). Look for products that are glycerin free, paraben free, SLS free, DEA free, hypoallergenic, non toxic, pH balanced, non-warming/stimulating, propylene glycol free, and with ingredients that you can pronounce.

Lubrication for sexual play. Look for products that are glycerin free, paraben free, SLS free, DEA free, hypoallergenic, non toxic, pH balanced, non-warming/stimulating, propylene glycol free, and with ingredients that you can pronounce. Coconut oil can also be used for lubrication, but may not be compatible with condoms. Some lubricant lines make both thinner, silkier lubricants as well as thicker lubes.

Vaginal skin and mucosa are also affected by lower levels of estrogen that occur naturally throughout the menstrual cycle, in the postpartum period when breastfeeding, and in the perimenopausal and menopausal periods. Read my article on estrogen and vaginal and vulvar health to learn about symptoms and treatment for changes due to low levels of vulvar estrogen.

Biology of a Healthy Vagina

Natalie Angier, author and Pulitzer-prize winning science columnist for the New York Times and author of Woman: An Intimate Geography describes the the ecosystem of the vagina: A healthy vagina contains billions of bacteria. These microbes are lactobacilli, the same bacteria found in yogurt. In fact, a “normal” vagina will have a “slightly sweet, slightly pungent,” odor like the lactic acid smell of yogurt. Our bodies provide lactobacilli with food as well as shelter and moisture from the vaginal walls. The lactobacillus microbes maintain a stable population, which keeps competing bacteria out. Just by living and metabolizing these bacteria generate lactic acid and hydrogen peroxide, which act as disinfectants preventing less agreeable microbes from moving in.

Dr. Maria Mendes Soares of the Mayo Clinic refer to these bacteria as vaginal flora, or vaginal microbiota. The vaginal flora work to keep your vagina's pH at 4.5, or slightly acidic.

So in other words, our vaginas are self-cleaning and they naturally produce some discharge that helps this process.

Different factors will contribute to the odour of a healthy vagina. OB/gyne Dr. Lisaa Rankin and author of What’s up Down There? Questions you would only ask your Gynecologist if she were your Best Friend explains: When menstruating or after giving birth, it’ll have the “flinty, iron smell of blood”. Having unprotected heterosexual intercourse will even change the smell to “faintly bleach-like” as semen has its own special scent and pH. Heavier levels of sweating can produce a “strong, musky door” from contributions from the sweat glands.

Stress can alter the body's internal chemistry including hormones and healthy bacteria.

Certain foods that can change the smell of the urine can also affect the smell of the vagina. Some of these sources include asparagus, coffee, alcohol, onions, garlic, broccoli and some spices.

Don’t forget pheromones—the scent that the glands around the vagina secrete to attract a sexual partner. Variation in the major histocompatibility complex (MHC), an important set of immune system genes, imbues each of us with a unique "odorprint," like a fingerprint says Charles Wysocki, an olfactory neuroscientist at the Monell Chemical Senses Center.

To sum it up, Dr. Mendez Soares states: "Any smell you have is a combination of what the human metabolizes and what the bacteria metabolizes.”

Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine explains: “For the most part, don't mess with your vagina. It knows how to take care of itself. If you do see or smell something that doesn't seem right, have a health care professional (read physician) check it out.”