Women of all ages should be concerned about vaginal health. A healthy vagina is naturally acidic and contains abundant beneficial bacteria that help protect against infections and maintain a normal pH. A healthy vagina will also secrete small amounts of secretions. The amount and consistency varies because of hormones during different phases of the menstrual cycle and life. The vagina normally expels small amounts of discharge to keep itself clean. Interference with these normal processes and you may suffer vaginal irritation or infection. Likewise the vulva, or vaginal lips, are really the only area that may need to be gently cleansed.

Here’s how to keep your vagina & vulva healthy:

• Avoid using harsh soaps or cleansers on the vulva and definitely not inside the vagina, as these can affect a healthy pH balance. If desired you may douche (a vaginal rinse) but use only vinegar & water (same acidity as vagina), and not more often than once a week. If a strong fishy odor persists more than a week then you should be evaluated for Bacterial Vaginosis, which is an imbalance in the normal vaginal bacteria. A prescription for antibiotic can correct this quickly.
• Not everything that itches down there is a yeast infection. Yeast are a normal vaginal inhabitant in small numbers. Antibiotics, prolonged exposure to moist materials (eg. daily pad use or wet swimsuits) can increase risk for yeast overgrowth. Typically with a “yeast infection” there is also thick, white discharge, or a red vulvar rash. Over-the-counter anti-fungal medications (eg. Gyne-Lotrimin or Monistat) often work within 3-7 days.
• If it’s just a vulvar itch then over-the-counter 1% Hydrocortisone ointment 3-4 times a day is amazing at calming this annoying irritation.
• The skin needs to breath, and when it’s covered by a pad all day long that accumulates moisture the skin’s protective barrier function may break down (AKA “Diaper Rash”). If you feel you must wear a pad or panty liner try to limit use to daytime and uncover your vulva at night when sleeping (no pads or panties). Also consider placing a thin film of Vaseline on the skin before each pad application (works to improve skin barrier function).
• Vaginal dryness, experienced as friction during intercourse, is common especially if adequate time or the setting doesn’t allow foreplay to create arousal which stimulates vaginal secretion production. Vaginal lubricants (eg. Astroglide X Silicone) are a simple solution to help both partners enjoy intimacy.
• Women in menopause no longer produce estrogen which may lead to thinning of the vaginal lining and dryness. If lubricants fail to make sex comfortable, then a low dose topical estrogen prescription administered 2 nights a week in the vagina on a regular basis will “rejuvenate” the vagina so intimacy may once again be enjoyed. The estrogen is not absorbed so there are no side-effects.

If vulvar or vaginal problems persist then it’s wise to see your gynecologist to evaluate if a more serious medical problem exists.

Wishing you good health!

Scott Kramer MD, FACOG

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