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Feminine Hygiene: Cleaning Up “Down There”

By Dr. Marisa Weiss on January 25th, 2012 Categories: Uncategorized

Caution: “Below the Belt” content!

With me, no health topic can be off-limits. Especially when it comes to maintaining personal hygiene, feeling well, and being confident about our bodies during and after breast cancer. I’m tackling these delicate issues within Think Pink, Live Green, because the personal care products we use can be absorbed into our bodies and potentially affect how breast cells grow, function, and behave. So get ready, it’s time to talk vaginas!

Rather than make this a monologue — which would be rather dull, since I have only one vagina and it’s not particularly fascinating these days — I thought it would be better to kick up this how-to-take-care-of-your-vagina discussion as a Vagina Dialogue and make it a group conversation.

To start, any discussion about the vagina has to include the vulva, which frames and cushions the entrance to the vagina. Regardless of how happy your vagina may be, if your vulva is upset with itching or burning — you’re not going to be happy. Besides regular maintenance, you may have experienced extra changes during and after breast cancer treatment, which can significantly change your crotch conditions. Here are just two examples:

  • Chemotherapy: chemotherapy can act like a strong antibiotic, making you more likely to get a yeast infection
  • Anti-estrogen therapy: anti-estrogen therapy can make your vagina more delicate and less wet

When it comes to regular care of your vagina, the good news is, there’s not much to do. You may have heard it called a “self-cleaning oven.” And while that expression may seem a bit inappropriate, it’s true that the vagina is able to clean itself naturally. It makes mucous to keep the right balance of acid and base to protect against infection from unhealthy germs and foster a healthy mix of micro-organisms (healthy germs) that normally live “down there.” So if it’s that easy, why are so many women using personal cleansing products like douches, sprays, and powders? Of course it’s normal to want to be clean, fresh, and smell nice for ourselves and our partners, but are we going about it in the healthiest way?

Douching is a “don’t.”

A lot of women I know think douching is a good way to keep things clean and tidy down there.

Douching, which comes from the French word for “wash,” literally means to wash out the vagina. Douches often come as a prepackaged mix of fluids you can buy at drug and grocery stores. They come in a bottle and can be squirted into the vagina through a tube or nozzle. Douches may be described in simple terms such as “vinegar and water,” yet there are often other additives that may be unhealthy (such as preservatives and fragrances).

There are many different reasons why women douche — and most are based on misinformation. Women I’ve talked to say they do it routinely to either rinse away blood after their monthly period, to clean up before or after sex, or to get rid of an odor. And you might take this cleanup effort to whole different level if it’s a night that you expect to receive oral sex. A gynecologist colleague of mine regularly tells me about women who come to her office with swollen, red and painful vulvas and vaginas after using harsh douches, scrubbing their vulvas, and then spraying on a fragrance. Others douche because they think it can treat an infection, protect them against sexually transmitted diseases, or prevent an unwanted pregnancy. Unfortunately, these reasons couldn’t be farther from the truth. Douching does nothing to protect you, and in fact, it may cause real health issues.

Douching changes the natural acidic balance of your vagina. That balance is what keeps it healthy. Changes to this environment can leave you susceptible to harmful bacteria and infection. If you already have an infection, douching may make it worse by pushing the bacteria further up the vagina. Some research has linked ongoing douching to possible health conditions that can create problems with fertility, pregnancy, and even cervical cancer risk.

Another big concern of mine is the chemical ingredients used in douches and other personal cleansing products. Many of these products contain ingredients that can act as hormone disruptors. Hormone disruptors can affect how estrogen and other hormones act in the body, throwing off the body’s hormonal balance. Because long-term extra estrogen exposure may make hormone-receptor-positive breast cancer develop and grow, I suggest women limit their exposure to these chemicals whenever they can.

Is something fishy going on?

It’s normal for even healthy, clean vaginas to have a mild smell that varies from one woman to another. It’s just a natural part of being a woman. On the other hand, a strong, foul odor usually means something is wrong. It may be the sign of an infection. If you have greenish or yellowish discharge with itching or a fishy odor, don’t try to treat it on your own or cover it up with feminine powders or sprays. The same is true for cottage-cheese like thick white discharge on your underpants, in the little folds inside your vulva, and inside the vagina. Go see your doctor. While it can be embarrassing, doctors see funky stuff all the time. And, the only way to get rid of symptoms of an infection is with a prescription medication that treats the specific type of problem that you have rather than covering it up. Also, sweat alone, separate from vagina smells, can contribute to any odor that you detect. Everyone sweats and you’re most likely to sweat inside of deep skin folds, within belly rolls and between your crotch, belly, and thighs. Lots of bushy public hair can increase sweating, by causing heat and friction. The hair wicks the sweat out to the surface.

Rinse, wash, repeat

To help keep your vaginal area clean and healthy, follow these steps each time you bathe:

Step 1:

In the shower or bath, thoroughly rinse the vaginal area with warm water. Be sure to open up and rinse out all the skin folds, inside the lips of the vulva (labia) and around the hood of the clitoris.

Step 2:

Carefully wipe the inner labia and vulva area clean using a small amount of mild, diluted unscented soap. Unscented Dove is mild; however, Ivory, Irish Spring, and Dial tend to be too strong. Be sure to rinse again thoroughly. Any soap that is left on the vulva can cause irritation. A soft wash cloth can help make this job easier — but don’t scrub or put too much pressure on your delicate parts. This is a gentle but important job. My gynecologist friend says that many women with itching or soreness don’t know how to take care of all the nooks and crannies of the vulva and vagina. Either they don’t do enough (like getting into all the folds) or they over-scrub.

Step 3:

After your shower, pat the vagina and vulva area dry with a fresh towel. Re-using towels isn’t a good idea, since they can harbor bacteria. I keep a stack of soft washcloths in my bathroom — I buy them cheap by the pack and launder them at the same time as my underwear.

Some other tips to consider:

  • Be gentle. Avoid abrasive washcloths or scrubbing, which can irritate sensitive tissues.
  • Avoid harsh cleaning products. Strong soap can dry out the mucous membrane of the vulva and cause irritation. Soaps and washes also affect the natural pH of your vagina, and can disrupt its healthy balance. If you do use soap, be sure to find one that is mild, fragrance-free, and without other harmful chemical ingredients. Also, avoid cleansers or pre-wet wipes that contain these ingredients as well as alcohol. The skin around the vaginal area is extremely sensitive and delicate mucous membranes can allow harmful chemicals to be more easily absorbed. I always check the Environmental Working Group’s Skin Deep Cosmetics Database to make sure the products I use are rated low for hazardous ingredients.
  • Use pure powder: If you feel damp or sweaty in the folds of your pelvic area surrounding your crotch, then kitchen corn starch can help. You can sift it to remove the lumps and put into a jar that you keep in the bathroom. Apply with your hand, a washcloth, or a retired blush brush that you can wash after each use. Don’t use talc powder because it’s not safe to breathe in the dust.
  • Trim tall hedges. If you have a lot of bushy pubic hair and you think it may be making you sweat more than you’d like, consider a little hair cut. You can trim a little off by using blunt-tipped scissors VERY CAREFULLY. This can help to reduce sweat and lingering odor.
  • Wear cotton. Underwear made from cotton and other natural fibers is more breathable and can help you feel fresher.
  • Check ingredients. Whenever you can, avoid personal cleaning products made with synthetic ingredients. Some contain parabens and other chemicals that act as weak estrogens in the   body — potentially turning on the growth of hormone-receptor-positive breast cancers.

Potty talk: Minding your business

Keep in mind that the vagina and vulva have two very close neighbors. In front of the vagina is the urethra, the urine drainage pipe. And of course the anus leading to the rectum is in the backyard. What comes out of these holes can irritate the vulva and vagina, especially if these structures are already upset for one reason or another. Here are a few tips:

1)     Wipe right: After going to the bathroom make sure that you wipe properly. Wipe from front to back until the toilet paper shows no residue.

2)     Wet your wipe: Use water to wet your toilet paper before using it to help clean with less friction. Avoid use of the pre-packaged diaper wipes that can contain alcohol or other strong ingredients.

3)     Change your pad: Many of us dribblers have to wear a panty liner every day to deal with this issue. Having a damp pad with urine can irritate your delicate parts. Use the thinnest pad that works and make sure to change your pad a few times a day.

Stay tuned for the next Vagina Dialogue, in which where we’ll discuss lubricants and feminine moisturizers. In the meantime, post a comment and join the conversation!

Dr. Marisa Weiss

Marisa Weiss, M.D. is the founder, president and guiding force behind Breastcancer.org, the world's most trafficked online resource for medically reviewed breast health and breast cancer information, reaching over 8 million visitors per year. A breast cancer oncologist with over twenty years of active practice in the Philadelphia region, Dr. Weiss is regarded as a visionary advocate for her innovative and steadfast approach to informing, empowering, and treating patients with breast cancer.

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