Washing your lady bits (vagina and vulva)… The facts.

19 November 2019.

The menstrual taboo, plus the sexualisation of the female body, means that most children, parents, and even some doctors, do not know enough about how to keep the vagina and vulva clean and healthy.

There are lots of myths and misconceptions out there… So, here is a menstrual matters’ independent and evidence-based guide:

1. Know the difference between the vagina and the vulva.

Diagram of the vulva

This may sound silly but many people use the word ‘vagina’ when they are actually talking about the ‘vulva’.

The vagina is only the inside bit (the warm, strong, and flexible tissue inside your body).

The vulva is the name given to most of the outside flesh- i.e. the parts shown on this diagram;

2. Do not wash the vagina: it is self-cleaning.

If you only remember one thing from this blog, this is it- DO NOT WASH YOUR VAGINA!

Despite the availability of ‘intimate’ products, and various traditional and modern practices of douching or steaming (using products or water to ‘cleanse’ the vagina), doing this is actually really BAD for your vaginal health [1].

Indeed, even so-called ‘intimate’ products state that they are for EXTERNAL use only (i.e. the vulva)- in the small print. Although, they do not mind implying that the vagina is dirty… because shame sells!

Why not?

The vagina is not dirty. It contains a wonderful ecosystem of mainly ‘good’ bacteria [2]. In order to keep everything in tip top shape, your vaginal and cervical secretions create an acidic environment to help this bacteria thrive (pH 3.8- 4.5) [2].

When water (or steam) (pH 7), soaps (pH 9-10), or even intimate products (pH 5.5) are put inside the vagina, it become less acidic; making conditions less suitable for the ‘good’ bacteria, and more suitable for ‘bad’ bacteria- potentially leading to a vaginal infection [1].

During menstruation and after unprotected heterosexual sex, the vaginal acidity level may also drop a little- which is what makes infections more likely at these times [3]. This is because menstrual fluid (pH 7) and semen (pH 7-8.2) are less acidic than the normal vaginal conditions [3].

TOP TIP! Swap to a plain, non-antibacterial hand soap to avoid transferring antibacterial chemicals as well as soap to the vagina during the insertion of menstrual products etc.

3. Even if you have an infection, DO NOT WASH YOUR VAGINA!

If you notice yellowy or creamy discharge (thrush) or an unpleasant fishy odour with watery discharge (BV- Bacterial Vaginosis)- please continue to resist the urge to wash your vagina. Again, adding water or soap to the vagina will only make the infections worse, by making the environment even less acidic [4]. Likewise, do not add any fragranced or antibacterial soap products to bath water, and definitely do not put them inside your vagina or near the vaginal opening.

A good solution for BV is an acidic pH-balancing vaginal product such as Balance-activ. Note- UK doctors can still only prescribe antibiotics for BV [5], many of which strip the good as well as the bad bacteria from the vagina. This may partly explain why some people get recurrent vaginal infections, since their healthy bacterial population may never fully recover [6]. Using antibiotics on such a regular basis can also contribute to the major global antibiotic resistance crisis [7]!

A Song Thrush (with thrush)- Pixabay

It is therefore highly recommended that you first try an acidic pH-balancing product alone, or at least during and/or after using antibiotics, if this is what has been prescribed for you (for any health issue, if you are prone to vaginal infections).

Likewise, thrush (caused by an overgrowth of a common yeast called candida albicans) is effectively treated with Clotrimazole, used in thrush-specific anti-fungal creams or pessaries (medical capsules you insert into the vagina). These are available from most supermarkets and pharmacies.

4. Do wash parts of your vulva- but avoid antibacterial or highly alkaline soaps

We all get sweaty when hot, and dead skin is shed from our bodies every day. Since the vulva includes the urethra (where urine/ wee exits the body) and is very close to the anus (where faeces/ poo exits the body), we do need to keep these external areas clean. During menstruation, it may also be necessary to rinse (water only) the vulva and surrounding area, i.e. if menstrual fluid gets onto the surrounding skin.

Image: Bruce Mars @ Pexels

Feel free to wash the outer sides of the labia (i.e.  the lips of your vulva). Just water is fine, but if you do choose to use a soap or body wash, make sure it is not antibacterial and ideally one that is low pH (more acid than alkaline).

Do not use soap between the labia, i.e. near the vaginal opening; simply rinse this area with clean water. If you prefer to have a bath, avoid adding any soap products to the water if you are prone to vaginal infections and never use any antibacterial products (e.g. Dettol).

5. Wipe, or wash, ‘front to back’ after going to the toilet

Most people already know this rule, but it is really important to always stick to it. After visiting the toilet for either a wee or a poo, take care to wipe (with toilet paper) or rinse (with water only) from the front part of the vulva towards the back, and in one direction only . This is because there are probably some bad bacteria near the anus (just behind the vulva). Wiping the wrong way could move the bad bacteria into the vaginal opening, or urethra (where wee comes out), leading to vaginal or bladder infections [8].

6. There are no exceptions to these rules… But there are some things that are safe to put inside the vagina

  • It is not healthy, and there is no need, to ‘wash out’ the vagina after sex (and it won’t help protect against pregnancy- that’s what contraceptive products are for- please see your local family planning doctor or nurse for more information). The vagina is usually able to return to perfectly clean and healthy conditions pretty soon after being exposed to semen, another person’s bacteria (from hands, or genitals) or sex-related products such as lubricant [2].
  • Most vaginal moisturisers, lubricants, medicated creams/ gels for thrush or BV, pelvic floor exercisers and any other medical device or product have been tested to ensure they do not significantly damage the vaginal bacterial ecosystem. Go ahead and use them if useful!
  • Menstrual management products- all fine to insert into the vagina- just rinse your clean hands first! Image: גביע האלופות @ wikimedia

    Internal menstrual management products such as medical grade silicone menstrual cups and high quality cotton-based tampons, will not significantly disrupt the vaginal bacterial ecosystem but do not leave them inside for longer than suggested- as this may result in TSS (Toxic Shock Syndrome) in those prone to this infection [9].

  • Also, make sure cups are rinsed well in clean water if you have used any soap on them (Note- simply boiling in water for 5 minutes between cycles is enough to keep cups clean- without the need for any soap).
  • Before inserting menstrual products, use non-antibacterial soap on your hands and make sure it is fully rinsed away before handing the menstrual product.
  • We do not recommend the use of sea sponges (or any other type of sponge) as menstrual products- partly because they are animals and deserve to be left to live their lives in peace, but also because their surface is mottled, which makes it difficult to keep free from bacteria [10].
  • Dildos, vibrators, and anything else that is made of a smooth (and washable) material and for the specific purpose of inserting into the vagina (avoid anything that isn’t!), should be fine so long as they are clean and any soap has been rinsed off before insertion.
  • Your fingers. So long as they are rinsed clean (i.e. washed with soap but then thoroughly rinsed to get all the soap off). Feel free to get to know your own body in this way- it’s a great way to combat any internalised shame or fear.
  • Lastly, please don’t buy ‘intimate’ products- these companies have literally made millions out of shaming people with vaginas, not to mention potentially damaging their customers’ vaginal health. Likewise, it is best to avoid vaginal steaming or douching practices; not only are they unnecessary and sometimes expensive, but they promote the idea that the vagina is dirty while making infections more likely… Fight the power!

References

[1] In fact, a review of studies found that: “Douching (washing the vagina with water or products) is associated with adverse reproductive and gynecologic outcomes including bacterial vaginosis, preterm birth, low-birth-weight infants, pelvic inflammatory disease, chlamydial infection, tubal pregnancy, higher rates of HIV transmission, and cervical cancer. Cultural beliefs and educational factors strongly influence douching practices“:

Cottrell, B. H. (2003). Vaginal douching. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN / NAACOG. https://doi.org/10.1177/0884217502239796

[2] Huang, B., Fettweis, J. M., Brooks, J. P., Jefferson, K. K., & Buck, G. A. (2014). The changing landscape of the vaginal microbiome. Clinics in Laboratory Medicine. W.B. Saunders. https://doi.org/10.1016/j.cll.2014.08.006

[3] Gajer, P., Brotman, R. M., Bai, G., Sakamoto, J., Schütte, U. M. E., Zhong, X., … Ravel, J. (2012). Temporal dynamics of the human vaginal microbiota. Science Translational Medicine, 4(132). https://doi.org/10.1126/scitranslmed.3003605

[4] In fact, people who previously washed their vaginas, no longer suffered from repeat BV infections after stopping this damaging practice! Brotman, R. M., Ghanem, K. G., Klebanoff, M. A., Taha, T. E., Scharfstein, D. O., & Zenilman, J. M. (2008). The effect of vaginal douching cessation on bacterial vaginosis: a pilot study. American Journal of Obstetrics and Gynecology, 198(6), 628.e1-628.e7. https://doi.org/10.1016/j.ajog.2007.11.043

[5] See https://www.nhs.uk/conditions/bacterial-vaginosis/ I have heard from several individuals (anecdotal evidence only) that Balance Activ is much better at resolving BV than antibiotic treatment- it certainly worked for me, when I had it!

[6] See: Mayer, B. T., Srinivasan, S., Fiedler, T. L., Marrazzo, J. M., Fredricks, D. N., & Schiffer, J. T. (2015). Rapid and profound shifts in the vaginal microbiota following antibiotic treatment for bacterial vaginosis. Journal of Infectious Diseases, 212(5), 793–802. https://doi.org/10.1093/infdis/jiv079

It is also known that some women who suffer from repeat BV, stop taking antibiotics due to the range of side-effects (and presumably then just cope with chronic BV symptoms, without treatment!) It’s probably time that the UK government funded some clinical trials of pH balancing products and compare their efficacy with antibiotic usage: Bilardi, J., Walker, S., McNair, R., Mooney-Somers, J., Temple-Smith, M., Bellhouse, C., … Bradshaw, C. (2016). Women’s management of recurrent bacterial vaginosis and experiences of clinical care: A qualitative study. PLoS ONE, 11(3). https://doi.org/10.1371/journal.pone.0151794

[7] Olesen, S. W., Barnett, M. L., MacFadden, D. R., Brownstein, J. S., Hernández-Díaz, S., Lipsitch, M., & Grad, Y. H. (2018). The distribution of antibiotic use and its association with antibiotic resistance. eLife7, e39435. doi:10.7554/eLife.39435

[8] Vyas, S., Sharma, P., Srivastava, K., Nautiyal, V., & Shrotriya, V. P. (2015). Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students. Journal of clinical and diagnostic research : JCDR9(9), LC15–LC18. doi:10.7860/JCDR/2015/10995.6547

[9] Vostral S. L. (2011). Rely and Toxic Shock Syndrome: a technological health crisis. The Yale journal of biology and medicine84(4), 447–459.

[10] I couldn’t find any recent research on the bacterial content of menstrual sponges! However, this old study found that the use of sponges resulted in relatively higher levels of ‘bad bacteria’ relating to TSS (Toxic Shock Syndrome) – than found in tampon/ pad use: Smith CB, Noble V, Bensch R, et al. (1982) Bacterial Flora of the Vagina During the Menstrual CycleFindings in Users of Tampons, Napkins, and Sea Sponges. Ann Intern Med. ;96:948–951. doi: 10.7326/0003-4819-96-6-948

 


Published In:AnatomyMyth busting

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