As a nurse practitioner working in women’s health, I talk with patients every day about many different things affecting their overall health, including open discussions about their vaginal health. What I’ve noticed is that many people are unclear on what’s normal and what symptoms might mean until it’s time to call their health care provider.
First of all, let’s get the most important thing out of the way. No, let’s not let get it out of the way. Let’s bring it front and center. There is no standard, run-of-the-mill vagina. Every vagina looks different from every other vagina. There is a very wide spectrum of normal – in terms of size, shape, color, texture – and your vagina is most likely not the exception. Please don’t buy into the cultural myth that if your vagina doesn’t look a certain way that something is wrong with it.
Here are some vaginal self-care suggestions:
For daily vaginal cleansing, less often means more. Your vagina is an incredible, self-cleaning organism that is amazingly well designed to keep itself healthy. While basic daily hygiene is important, most soaps and other cleansing products on the market that are aimed at keeping your vagina “so fresh and clean” can be more harmful than helpful. I recommend that my patients NOT douche and that they avoid all scented products in their nether regions. The ingredients in fragrances are quite often harmful to delicate vaginal tissues. The best way to wash your vagina is by using your hand (not a loofah or washcloth), with warm water and a very small amount of unscented soap. Be sure to rinse well with water until no soap remains. When it comes to underwear, cotton is best because it’s breathable. Avoid synthetic fibers like polyester. It’s also good to go without underwear at night.
Now let’s talk about discharge. Most women have some amount of vaginal discharge on a daily, weekly or monthly basis. This is normal. It’s important to know what your normal is and to call your health care provider with any changes you notice. Normal vaginal discharge changes throughout your menstrual cycle. Sometimes it’s clear and slightly mucous-y, other times it’s stringy like egg whites. However, foul smelling discharge or discharge that’s not clear (or slightly white in color) is not normal and warrants a visit to your health care provider. If you’re post-menopausal and you experience any vaginal bleeding or spotting, you need to be evaluated by your health care provider.
There are several reasons a person might have unusual vaginal discharge. Some of the most common causes are vaginal yeast infections, sexually transmitted infections and bacterial vaginosis. If you suspect you may have any of the above, please call your health care provider ASAP.
While there’s still more research needed, we do know that women can transmit some sexually transmitted infections between each other. It’s important to practice safe sex and to get screened for STIs if you are sexually active. Some of the more common sexually transmitted infections are gonorrhea, chlamydia, herpes, and trichomoniasis. (For more information on sexually transmitted diseases/infections, you can visit cdc.gov/std/default.htm).
Also important: getting regular pap smears. Human papilloma virus (HPV), the virus responsible for most cervical cancers, can be transmitted between women. Some health care providers still don’t know this, so if you are sexually active (even if with women only) please don’t let your health care provider convince you that you don’t need a pap smear. That just isn’t true. Get your pap!
Vaginal yeast infections are very common and can occasionally occur without explanation. However, a common cause of vaginal yeast infections are recent antibiotic use. Additionally, recurrent yeast infections can be a sign of diabetes or uncontrolled blood sugar. Usually vaginal yeast infections cause clumpy white discharge and significant vaginal itching. The treatment is an antifungal vaginal cream or an oral pill.
A healthy vagina flora has a balance of bacteria in it, keeping the pH at a healthy level. Bacterial vaginosis (BV) is an overgrowth of one kind of bacteria in the vagina as a result of a shift in the vagina’s pH. Many women can have BV but may not realize it, however, more commonly BV causes a foul, “fish-y” smelling vaginal discharge and sometimes vaginal itching, as well as generalized vaginal irritation. The vaginal discharge that accompanies BV is often gray or white in appearance. While not considered a sexually transmitted infection, BV can be transmitted between women.
While talking about vaginal health can sometimes feel embarrassing or scary for many women, we as health care providers are here to help. It’s important to work with a health care provider with whom you feel safe with to discuss vaginal health, and whom you can feel comfortable calling if you notice any new or unusual symptoms. Keeping up on your screening exams and notifying your provider in between visits about any new symptoms or issues are excellent ways to help keep yourself healthy.
Disclaimer: This blog post is not all inclusive and is not a substitute for medical attention. If you have any new or unusual symptoms, please contact your health care provider.
Nicole Flemmer, ARNP, FNP-C is a nurse practitioner in Seattle, Washington. She developed an interdisciplinary framework for helping professionals to create effective and meaningful partnerships with their patients called Empathetic Partnership. She is also the founder of The We Belong Project, an online resource for women of sexual minority and health care providers who care for them.