A gyno's guide to good vulva and vagina health

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If you go to your GP with a sore back, knee pain or a headache, you’ll probably feel quite comfortable telling them what’s going on.

But when the body part that’s causing you trouble is inside your underwear, it’s often a different story.

Women will ignore symptoms that involve their vulva or vagina because they feel embarrassed or ashamed. Some even fail to recognise when something’s gone awry in the first place.

“Women need to become comfortable with their own anatomy and looking at their own vulva,” said Dr Elizabeth Farrell AM, gynaecologist and medical director at the Jean Hailes for Women’s Health organisation.

Ignoring symptoms — such as changes in appearance, pain or irritation — can mean you might miss picking up on a skin condition, infection, or sexually transmitted disease.

You may also miss something more sinister. It’s estimated that more than 6,000 Australian women will be diagnosed with gynaecological cancer this year.

Speaking to the new ABC podcast Ladies, We Need To Talk, Dr Farrell shared some advice on how to practice good gynaecological healthcare.

Dr Farrell’s top tips

Dr Farrell’s top tips

  • Wear cotton underwear
  • Avoid G-string underwear. G-strings and close-fitting underwear — especially those made from synthetic fabrics — can encourage the transport of bacteria from the rectum into the vagina
  • Change out of wet swimwear as soon as you can, and avoid staying in tight sweaty leggings
  • Choose your period products carefully — where possible, go for 100 per cent cotton pads, tampons and liners
  • Change your pads, tampons and liners frequently
  • When going to the toilet, always wipe from front to back
  • Don’t use soaps, douches or other cleaning products on your vulva or vagina — warm water washing is enough

Source: Jean Hailes for Women’s Health

Know your vulva from your vagina

Most people use the term “vagina” when describing female genitalia. What they are actually referring to is the vulva.

The vulva is the general name given to the external parts of the female genitals. It includes the inner and outer lips (the labia), the clitoris, the urethral opening and the vaginal entrance.

The vagina is the tubular muscle that runs from the uterus to the external opening. It allows for sexual intercourse and childbirth, and is the passage for menstrual flow.

“Vagina is very often used instead of vulva, and we have to change that,” Dr Farrell said.

Vulvas, like other body parts, are unique. They come in all shapes, sizes and colours, and no two look the same.

Dr Farrell says it’s important for women to know what their vulva looks like, so they’re better able to detect abnormalities or changes in the skin.

“It’s about good health care and knowing what’s normal for you,” she said.

Stay away from soap

While washing your hands, feet and hair with soap or similar products is hygienic, it’s not a good idea to do the same with your vulva.

“You don’t clean your vagina, full stop. The vagina has its own environment and it cleans itself,” Dr Farrell said.

If you feel you need to wash your vulva, Dr Farrell suggests warm water and a soap substitute. Steer clear of soaps and perfumed bath products.

“The vulva should never be scrubbed, the skin is gentle … treat it how you treat a baby’s bottom,” she said.

To avoid upsetting the balance of good bacteria in your vagina, you should avoid douching.

The same goes for talcum powder: the advice from Ovarian Cancer Australia is that women should avoid using talc-based products.

As for Gwyneth Paltrow’s “vagina steaming” advice, that’s also a no go.

“No washing in the vagina, no steaming in the vagina — it doesn’t help at all,” Dr Farrell said.

“It causes an abnormal environment and therefore increases the risk of infection.”

Dr Farrell says it’s a good idea to wear cotton underwear, and to change out of wet swimwear and sweaty leggings as soon as you can.

Not all itching means thrush

Women often mistake any vulval symptoms for thrush — a yeast infection with symptoms that include itching, redness, swelling and a cottage cheese-like discharge.

But vulval irritation, including itching, burning or discomfort, can be caused by many things.

“It could be the soap you’re using, the underwear you’re wearing, the Lycra you’re wearing at the gym or even the pads or tampons you’re using during your period,” Dr Farrell said.

Vulval irritation is relatively common in women of all ages, and is often the result of a skin condition or infection.

While most cases improve with treatment, there are a few rare conditions that can become serious if left untreated.

“The important thing is to get your doctor to physically look at your vulva,” Dr Farrell said.

Common causes of vulval irritation

Common causes of vulval irritation

  • Sweating and/or vaginal secretions
  • Fungal, bacterial or viral infections such as thrush, trichomonas and genital herpes
  • Dermatitis / eczema
  • Allergies / adverse reactions to substances such as perspiration, soap and laundry detergent
  • Some medications and local anaesthetic
  • Piercings — these may cause infections or localised reactions
  • Ingrown hairs — gentle exfoliation may help prevent these

Source: Jean Hailes for Women’s Health

Discharge is normal

Most of time, vaginal discharge is perfectly normal — it serves as an important function of the reproductive system and helps to keep the vagina clean.

“There are some women who have vaginal secretions for the whole of their reproductive years and even after in the post menopause period,” Dr Farrell said.

While some women won’t have any discharge, others will have quite a bit, and this will vary depending on where they are in their menstrual cycle, or whether they are pregnant or breastfeeding.

Discharge can range in colour, from clear to milky white.

If the discharge, however, is accompanied by itchiness or burning, or the colour, smell or consistency seems unusual, it may be a sign of infection — and time for a visit to the GP.

Vaginal odour changes

Similar to the gut, the vagina has its own microbiome — an ecosystem of important bacterial communities — that helps to keep us healthy and protect us from infection.

A healthy vagina is rich in ‘good’ bacteria (mainly Lactobacilli) that help to keep the populations of the ‘bad’ microorganisms in check.

Vaginal odour is a reflection of whatever bacteria are living inside the vagina, and it varies according to our age, Dr Farrell says.

“The vagina smells differently at different times of a woman’s life,” she said.

“When you’re pre-pubertal, it will smell different and once your hormones kick in, it will have a particular smell, which is usually relatively pleasant.”

It may become particularly odorous or unpleasant if a woman has an infection, like bacterial vaginosis, she says.

“After menopause it definitely changes. It has another different odour because there is no oestrogen, so it a slightly more male-like odour,” she said.

Ageing vulvas

The onset of menopause means your periods end and your ovaries stop producing oestrogen.

According to Dr Farrell, there are two things that can happen: your vulval tissue either becomes more slack, or more tight.

“Other people will find it becomes more gaping. It really depends on what sort of tissue you have.”

If the skin surrounding the vaginal entrance loses elasticity, sex may become more painful.

While women are recommended to do pelvic floor exercises, those who experience vaginal dryness after menopause may find this can actually makes things worse.

“Having tight pelvic floor muscles is fine, the problem is if it’s dry and the intercourse is going to be painful, the muscles will get tighter,” Dr Farrell said.

“We must learn to relax our pelvic floor muscles at the same time as being able to strengthen them and contract them.”

What goes in must come out

It might surprise you to know that it is possible to lose something — like a tampon or condom — inside your vagina.

“Sometimes a tampon can be there and for some reason another is put in on top of it, and so that tampon gets pushed up the top … back behind the cervix,” Dr Farrell said.

“Usually after a period of time it does create a very unpleasant odour, and has to be fished out by a health professional.”

Rest assured that whatever goes in must eventually come back out.

Thanks to Dr Elizabeth Farrell AM and Jean Hailes for Women’s Health.



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