When it comes to the topic of vaginal hygiene, there is an abundance of questionable advice and products out there, and suggestions that special products are necessary for proper care. With the help of Dr. Michelle Lu-Ferguson, OB-GYN, we have done a deep-dive (*ahem*) to determine the best practices for maintaining vaginal hygiene.
Before discussing proper cleaning methods, it’s important to differentiate between the vagina and the vulva. The vulva refers to the external part of the genital area, including the labia, clitoris, and the vaginal and urethral openings. On the other hand, the vagina is the internal muscular tube that connects the vaginal opening to the cervix.
Vagina vs. Vulva
Basically, Vulva = outside; Vagina = inside.
- Do we need to clean the vagina?
“The most crucial point to remember is that your vagina is self-cleaning. Under no circumstances should you wash your vagina with anything,” advises Dr. Lu-Ferguson, emphatically. “Vaginal douching [washing inside the vagina with DIY or commercial cleansing products] is a common practice in many countries, so common that many girls grow up thinking that douching is necessary. The truth is that douching is not only entirely unnecessary, it’s potentially very damaging.”
As it turns out, your vagina has a natural care mechanism of regularly expelling discharge, which is not only completely normal, but brilliant. A healthy amount of discharge is the vagina’s way of cleaning itself, and this creates a perfectly balanced microbiome. Rather than creating a clean, “fresh”, environment, douches do the opposite by upsetting the natural bacterial balance of the vagina, leading to greater incidence of Bacterial Vaginosis. If that’s not bad enough, regular douching has also been linked to Pelvic Inflammatory Disease and increased complications from Gonococcal or Chlamydial infections.
Yeesh!
- Cleaning the Vulva: A Gentle Approach
While the vagina does not require cleaning, you can cleanse the vulva using plain water. Dr. Lu-Ferguson recommends avoiding the use of soap or any other products on the vulva, as they can cause sensitivity and irritation. She does however mention that a very mild soap can be used in any area around the vulva where pubic hair grows, as there can be more sweat and oil build-up there that can cause odor.
- What about those products marketed specifically for washing the vulva?
“It’s a big business (an estimated $150million a year in the US alone) and people tend to believe the hype and marketing. These products are often promoted as being of the same ‘unique pH-balance’ as the vagina or vulva. But using them doesn’t help to address pH imbalances at all,” Dr. Lu-Ferguson weighs in. “A mild, gentle soap around the vulva and groin and plain water on the vulva itself will do. Select the mildest option available without dyes or fragrances. If you experience any burning or sensitivity, stop using it and see if the symptoms go away”.
- What about other methods of “care down there”?
Dr. Leakhena points out that there are other products of concern, namely that panty-liners can be the scourge of the gynecology world.
“Very often we have women coming into the clinic, convinced they have bacterial or fungal infections. We test for everything that could be wrong, and nothing shows up. We try to convince them that the irritation could be caused by their panty liners but they don’t believe us. Finally, after getting multiple second and third opinions, and spending a lot of money on more tests and unnecessary creams, they stop using their liners and magically the problem resolves.”
She says that panty liners should only be used a few days a month, at most, if you need them for period care. They should not be used daily for discharge, as the constant contact with the vulva can damage the microbiome balance and cause serious skin irritation. “If you feel that your discharge is so heavy or bothersome that it requires panty liners, please come to see us so that we can check what might be going on.”
Steaming the vulva is a new concept, popularized by Gwyneth Paltrow. I will be bold and say outright that your vagina is not a Bāozi (包子), and steaming will have zero effect on it. However, there have been numerous accounts of women getting serious burns from steaming (ouch!), so it might be safer to skip it.
How about ‘Yoni Eggs’? These are polished egg-sized stones, worn in the vagina. Sellers claim they can help with toning the pelvic floor, improve “vaginal health” and increase libido. And while there is zero scientific proof that these claims are true, again there are numerous reports of damage. The most common issue is that these stone eggs are porous, which allows bacteria to be easily harbored on them, surviving routine cleaning. Indeed, yoni egg use has been associated with a clear increase in the incidence of Bacterial Vaginosis in users.
The bottom line is, if you are concerned about your vaginal health, see a gynecologist. If you are worried about your pelvic floor, see a physiotherapist specifically trained in this area. If you like Yoni Eggs, put them in a decorative bowl on your coffee table, but for heaven’s sake keep them away from your vagina.
- Recognize the marketing
Let’s talk about why women, for so many years, have misunderstood how to care for their own bodies. Firstly, it starts with not discussing our bodies with our children, friends, or partners. As the mystery around the vagina/vulva grows, so does the idea that this area must not be seen, smelled, or spoken of. Just like a microbiome imbalance, this silence creates the perfect breeding ground for mistruths, and it preys on the fear that you might not be ‘normal’.
Into this void walks the advertising of so called ‘feminine’ products (pads, panty liners, washes, etc.), which all have one thing in common: they are marketing the idea of “freshness”. The general concept is that you should use this pad/liner/wash and it will leave you feeling fresh… this word is thrown about with abandon. You may have never noticed it, but I guarantee your subconscious did.
Fresh is a euphemism for clean, implying the natural state is one of dirt and shame. But listen to this, my vagina-owning friends: your vagina is already clean. It is also supposed to have discharge (remember, that’s the self-cleaning system), and it is supposed to have a smell. Your vagina and vulva is not defined by being “fresh”, but subconsciously, it’s easy to fall into the trap of thinking that if I don’t use these products my vulva will be “dirty”.
- So, what’s the take-away point here, Dr Leakhena?
“Your vagina is well able to take care of itself, without any help from you. Leave it alone. Your vulva should be washed, but plain water will do that just as well, if not better, than anything else. Sometimes problems do arise, and if you’re not sure if your discharge or odor is normal, or you feel uncomfortable, please don’t start trying to correct it with DIY or over the counter products- you’ll likely just make it worse! Instead, come to see us, we can help.”