We don’t know about you, but until we started working with the women of WomanLab, NO ONE told us how to clean the genital area. Or really…how not to clean the genital area. Turns out, we were doing it all wrong.
In this post, we’ll talk about strategies to promote vulvovaginal (vulva and vagina) hygiene. As patient educators in the Program in Integrative Sexual Medicine, we have used these tips to educate hundreds of women on best practices for vulvovaginal health.
First, a brief venture into anatomy…
Genital? Vulvovaginal? “Down there?” What exactly are we talking about? When we say genital, we are referring to the internal (vagina) and external (vulva) sexual organs. Sometimes when people say vagina they are actually referring to the vulva, the external female genital area. In fact, many people would benefit from a refresher on the basics of female anatomy. So…briefly….the vagina is a muscular canal inside of the body that connects the vulva to the uterus. From the outside, you can only see the introitus (the opening to the vagina), and, to do this, you would likely need to separate the labia a bit. The vulva includes the mons pubis, labia majora (outer lips) and minora (inner lips), the clitoris and the urethra.
The following recommendations outline things you can start doing right now to promote your vulvovaginal health and to lay the foundation for more comfortable, pain-free, satisfying sexual experiences (no doctors or outside specialists required!).
No washing necessary
The vagina is a self-cleaning system – we often think of it as similar to the nasal passageway (it’s unexpected, we know). This means that, just as you don’t use products to clean the inside of your nose, you don’t need to use any products inside the vagina (say goodbye to douches….forever).
You also don’t need to use any products to clean the external genital area. Don’t be fooled or tempted by the “feminine hygiene” products with fun scents and colors.In fact, avoid using any scented or perfumed soaps, bubble baths, feminine hygiene products, douches, lotions and powders directly in the genital area. Using these products can cause irritation or infection (hello uncomfortable sexual activity) or more serious problems.
For menopausal women or women who have undergone treatment with chemotherapy, hormone therapy or radiation for cancer, products that previously were not irritating may become bothersome. The tissues of the vulva and vagina become thinner and more sensitive as the body produces less estrogen. Even shampoos, conditioners or body washes used elsewhere can run down the body and irritate the vulvar area. As much as possible, choose products with the fewest ingredients you can’t pronounce. And, always rinse the vulva (no scrubbing!) with water to ensure no residue from shampoo, conditioner, or body wash is left in the area and pat (don’t rub) dry.
Wipe front to back
Always wipe front to back after using the bathroom. Wiping in the opposite direction might transport bacteria from the rectum to the vulva and vagina. Avoid using packaged wipes or scented toilet paper- good old regular toilet paper is all you need.
Discharge? Don’t despair!
Vaginal discharge is normal and can vary throughout the menstrual cycle. Women in menopause also experience some normal discharge. Discharge is part of the vagina’s self-cleaning process and is typically clear or white without a strong odor. Talk to your health care provider if you notice a bothersome change in the color, odor or amount of discharge or if discharge is accompanied by irritation or itching or pain. Abnormal vaginal discharge can be the result of too much washing, but can also have other causes that should be diagnosed by a medical professional. As tempting as it may be, trying to get rid of discharge by washing with soaps can actually make the problem worse.
Nix the panty liners
Panty liners wick away moisture from the vulvovaginal area that is helpful for comfort and lubrication. If you’re menstruating, try to use tampons, pads and panty liners that are scent free or opt for an environmentally-friendly and cost-effective menstrual cup. (We’ve also heard good things about Thinx absorbent panties for your period, but based on one WomanLabber’s feedback, some women may find that they are not very breathable.)
If you’re experiencing excess discharge, instead of wearing panty liners try throwing a spare pair of undies in your bag to make a change if you need it. More laundry, but less irritation.
Speaking of underwear…
Cotton underwear is more breathable and therefore preferable to other materials, such as nylon, which can trap moisture. Sleeping with your underwear off at night also allows the area to breathe. If possible, change your workout clothes or swimsuit as soon as you’re done with the activity. A buildup of moisture in the groin area can promote yeast growth and other problems.
Consider switching to a scent-free laundry detergent to further minimize exposure to irritating fragrances and chemicals that can accumulate in underwear fabric. Most grocery stores and even larger drug stores carry scent free options or you can find them online (think Target and Walgreens.)
Keep some hair “down there”
Pubic hair grooming is an entirely personal choice, however there is no medical or hygienic reason why you should remove the hair “down there.” In fact, hair can help protect your skin from some of the irritants described above. Shaving and waxing can also irritate the skin (personally, we are more than happy to say goodbye to the hold your breath moments prior to the quick but excruciating pain of a bikini wax). If you do remove pubic hair, try to keep hair removal to the bikini line, preserving hair down the midline of the vulva. Just like the inside of your nose and your eyelashes, public hair is there for a reason.
Some women who have gone through cancer treatment experience thinning or loss of pubic hair – if this is the case, ask your doctor if you can expect that it will grow back and stick to the above recommendations to minimize exposure to possible irritants.
After sexual intercourse…
You’ve probably heard this one before: urinate soon after intercourse or any type of penetrative activity (like use of a vibrator or dilator). Urination helps to reduce the amount of bacteria in the bladder and prevent urinary tract infections. Despite what Hollywood would like us to think…in reality not many of us are practicing the post-coital roll-over best sleep of your life scenario. Again, avoid use of wipes, extra soaps or other products after sexual activity. If needed, rinse with water (shout out to the removable shower-heads and squirt bottles!)
These tips help to maintain vaginal moisture, avoid irritation and lay the foundation for pain-free, comfortable, and satisfying sexual activity. Weaning yourself away from using soaps and other products in the genital area can be difficult – for some words of wisdom and inspiration when you might most need it, we like this piece by Jen Gunter, MD.
The bottom line: less is more! Give your vagina the freedom to clean itself.
**Note: Names of specific products or places to buy products should not be considered an endorsement. We provide examples to help make this information easier to understand. WomanLab does not have funding or sponsorship from these products or places.
Edited by Lilly Lerer
Last updated 5.15.2018