How to care for your vagina in every decade – to avoid cancer, miscarriage and nasty infections
FOOD, flower, fanny… Forget whatever nickname you have for your vagina, because we’re about to get scientific about the passage that connects your uterus to the outside.
Not to be confused with the vulva – your external genitals – this vital organ is finally seeing scientists sit up and take notice.
It’s home to billions of bacteria that can leave you burning, itching or whiffy down there if the delicate balance is disrupted. Up to half of women will get a UTI in their lifetime*, 75% will experience thrush**, while bacterial vaginosis (BV) – which causes discharge with a fishy odour – is prevalent in almost a third of women, with some showing no symptoms.*
A new wave of products – from probiotics to specially formulated serums, lubes and period pants – aim to prevent these conditions (and the endless trips to the pharmacy) by helping to maintain the harmony of the vaginal microbiome.
“The scientific evidence relating to the importance of the vaginal microbiome is robust in many areas. However, there are still significant gaps, which ongoing research will hopefully continue to fill,” says Tracey Sainsbury, a fertility counsellor and ambassador for Femme Health.
While the vagina is complicated and fairly misunderstood (much like its owner), there are some hygiene basics all women should know…
Your vagina’s delicate microbiome
A normal vaginal pH is between 3.8 and 5 – moderately acidic to prevent overgrowth of unwanted bugs and fungi. “Your vagina has specific lactobacilli to lower the pH and keep it healthy,” says Dr Jo Bailey, an NHS gynaecologist.
When these micro-organisms become off kilter, symptoms of BV and thrush can occur. A UTI, on the other hand, is commonly caused by E.coli, which is present in the gut and travels to the urethra when shed in stools. “Women who have a healthy vaginal microbiome don’t get so many UTIs,” says Dr Bailey.
The suggestion is a healthy vaginal microbiome can help ward off nasty bugs. Simply put, there is a crossover between gut, vaginal and urinary health.
What are your hormones up to?
The hormonal changes that occur in puberty, pregnancy and menopause can impact the vaginal microbiome. “Oestrogen is really important for supporting vaginal health,” says Dr Bailey.
During menopause, however, oestrogen levels continuously decline. “These changes increase the risk of atrophic vaginitis (in which the lining of the vagina gets thinner and dryer), BV and genito-urinary symptoms in postmenopausal women,” says Dr Bailey. HRT and vaginal oestrogen may help.
An oestrogen change also occurs before a period. “For some women, that causes changes in their microbiome,” says Dr Bailey. “Some data suggests women on the Pill, who have less fluctuations in hormones, may have fewer problems.”
But the science is not conclusive. “For some, introducing the Pill can be a blessing, boosting the flora and fauna in the microbiome, while for others it can cause a significant imbalance,” says Tracey.
The complications
If the risk of nasty infections wasn’t bad enough, some evidence points to more sinister implications of an imbalanced vaginal microbiome.
Research has looked at the vaginal make-up of women with HPV – the cause of 99% of cervical cancer cases. “The HPV virus is very common – any woman who has had any kind of sexual contact would have been exposed to it,” says Dr Bailey.
But while the immune system flushes it out in most women, it lingers in others, risking cancerous changes. “What is it about those women who can’t get rid of it quickly?
The data in one study showed they were more likely to have an imbalance of the vaginal microbiome,” says Dr Bailey. “Meanwhile, BV is implicated in early miscarriage, infections after delivery and preterm labour. BV is also associated with a greater likelihood of acquiring infections that can cause pelvic inflammatory disease.”
Self-care know-how
“You need to look after your vulva skin and vagina by wearing cotton underwear instead of synthetics, and have good general hygiene – so avoiding spreading bacteria from your anus to your vagina by making sure you wipe from front to back when you go to the toilet,” says Dr Bailey. The best way to clean the vulva (including the labia) is with warm water and, at most, a fragrance-free mild soap.
To clean between the vulva and anus, use the same front-to-back motion. But do not wash the vagina – the inside canal – as this is the home of those important bugs. An itchy vulva doesn’t always mean thrush, but can be skin irritation.
“Washing with an emollient, such as Cetraben (and using it as a moisturiser afterwards) can be soothing,” says Dr Bailey. “If you find your symptoms get worse with sex, using a water-based lubricant can help. If you have a new partner, use condoms.” This prevents STIs and potentially BV.
Gynae gear
VJJ Perfect V, £26
These probiotics for your vagina, containing four active lactobacilli, reach the vagina via the gut to ward off BV and thrush.
Naydaya Victory Oil, £28
You moisturise your whole body, so why not your vulva, too? This serum prevents dryness and discomfort, and contains only natural oils, such as coconut and sweet almond.
Annahitah Period Pants
Skip the irritating pads and tampons and go for period pants that are more gentle on the vagina. This range has heavy-flow briefs (Shanti, £24) to light-flow thongs for the gym (Venus, £20) – both machine-washable.
Yes WB Water-Based Personal Lubricant, £11.99
Lubricants can prevent any friction on vaginal skin during sex, making irritation less likely. This one is pH-matched and free of potential flora-upsetting chemicals or perfumes.
Luna Daily The Everywhere Wash, £14
Designed to avoid irritation, this intimate wash is also pH-balanced, and contains vitamins C, E and F, plus prebiotics to soothe and balance the skin.