Anatomy
The vagina is the tube that extends from the vulva to the cervix and is both elastic and muscular. The outer vaginal opening is normally partly covered by a membrane called the hymen while the upper end the cervix (neck of the womb) bulges into the vagina. The vagina allows for menstrual blood to flow out, sexual intercourse and childbirth. See image below.
The vagina is exposed to dryness, soreness, itching, excessive vaginal discharge, bleeding, cuts, lumps, pain, painful sex and several other symptoms. These can occur at any age or any stage of a woman’s life.
These symptoms may be a result of allergies or sensitivity to toiletries, underwear and sanitary ware, thrush, vaginal infections such as bacterial vaginosis, sexually transmitted infections such as chlamydia and gonorrhoea, vulval conditions such as eczema and lichen sclerosus that affects the skin of the inner or outer lips , childbirth, atrophic vaginitis in the menopause, lumps such as Bartholin’s cysts, vulval and vaginal pain known as vulvodynia, post radiation/ chemotherapy vaginal soreness and many other reasons.
Most of these are not dangerous for health but can be a nuisance and can severely affect quality of life. Stress, lack of sleep and other health conditions such as poorly controlled or undiagnosed diabetes can play a role in flare ups in sore vaginas.
Vaginal Health
Here are some tips that my patients find helpful.
- Some precautions can be helpful to reduce vaginal irritation such as avoiding soaps and perfumed toiletries, excessive washing, douching, harsh chemicals (avoid biological laundry detergents and fabric conditioners) and synthetic underclothes. Consider using an ecoegg.
- Use water and a gentle non soap-based wash
- Favour cotton underclothes, white or light underwear, white toilet paper and white towels as these contain the least chemicals so are less harsh on the skin. Dark underwear often has the highest amount of dyes which can irritate the vulval skin and vagina.
- Go knicker free when you can, especially at night to air the genital area, as increased heat, moisture and chafing are perfect settings for infections such as thrush to take hold.
- Change out of sweaty gym clothes and swimsuits as soon as you can as this may worsen vaginal soreness and discomfort.
- Using feminine wipes, most soaps, not washing the chlorine off after swimming and sweating on long walks can all worsen symptoms.
- Long courses of antibiotics can strip the vulval and vaginal barrier of healthy bacteria, so women need to be doubly strict about their genital hygiene in such situations.
- You should increase the intake of natural prebiotics (berries, apple cider vinegar, pickled vegetables) that encourage the growth of healthy vaginal bacteria in these situations.
- You should consider taking a prophylactic anti thrush medication if you know you are prone to thrush after a course of antibiotics.
- Use period pants or material pads, unbleached organic sanitary ware or the menstrual cup during periods to reduce vaginal sensitivity from commercial, often harsh chemical laden pads and tampons. This helps reduce plastic waste as well.
- Ensure you and your partner have an STI check before becoming sexually intimate.
- Consider the HPV cervical cancer vaccine that help prevent the majority of cervical cancers even if above the age 18. Talk to your doctor if unsure. You still need to have regular smear checks.
- Avoid sex while undergoing treatment for infections as you maybe sore. It is best to wait until the infection clears up. Use a condom to avoid passing it on.
- Eating a anti-inflammatory whole food plant based (WFPB) diet helps in improving the vaginal microbiome, aiding the growth of good bacteria.
- Eat a diet rich in fruits, vegetables, legumes, beans and whole grains and avoid foods such as fruit juices, oils, junk or ultra processed foods and animal products (dairy, eggs, fish, chicken, red meat). The closer one is to eating whole plants foods, the more benefits women will see in their general health and vaginal health.
- Not all bugs are bad. Prebiotics such as fruit and vegetables encourage the growth of healthy gut and vaginal bacteria and helps keep away candida (thrush) and other bacterial infections.
- Consider a high-quality probiotic if still getting infections despite taking all precautions.
- Sometimes it’s not vaginal thrush at all but other conditions so seek medical advice if symptoms don’t clear up.
- Consider non perfumed emollients and water based or non-silicone, pH-balanced lubricants during sex to prevent skin splitting and to keep the vagina moisturised.
- If using condoms, check the market as there are condoms available for sensitive skin
- Consider the use of vaginal dilators to maintain stretch and elasticity of the vaginal opening
- Consider local vaginal oestrogen in the menopause in the absence of contraindications to help with vaginal atrophy. You will need the advice of your doctor for this.
- Explore treatment options to improve vaginal elasticity (laser treatment). This may be particularly helpful for those who can’t use oral or vaginal oestrogens.
Dr Nitu Bajekal, FRCOG Dip IBLM
Consultant Gynaecologist and Women’s Health Expert
Updated January 2020
