When patients complain of chronic vaginal discomfort from bacterial or yeast infections, my first response is: “Describe your vaginal hygiene.”
A surprisingly large proportion of my patients tell me that they douche. Many report at the very least washing not only their labia, but also internally, with soap and water on a daily, if not more frequent, basis.
My first piece of advice to these women is to stop. Leave the vagina alone.
I always believed that douching was a practice of my mother’s generation. Upon further investigation, I found that many older women have been doing it since they started menstruating. Younger women often tell me that their mothers or grandmothers instructed them to keep clean with vaginal douching after sex or menses.
Certainly there are a variety of causes of vaginal infections: unprotected sex with multiple partners can be a culprit in bacterial vaginosis; antibiotic use or chronically elevated blood sugar can cause vaginal yeast infections. But in my practice, over-cleaning is frequently the cause of recurrent vaginal infections.
The vagina is similar to a healthy ecosystem that maintains itself with little attention. The more women use soap or chemicals designed to “clean” or “freshen,” the more we are affecting the pH and delicate balance of good bacteria and yeast that keeps the vagina healthy. Washing the vulva with an unscented plain bar soap is all that is necessary. To put it simply, the vagina is self-cleaning.
Women often complain that they have a daily discharge that makes them feel unclean. I have patients who wear pads all the time or make frequent office visits concerned that they have some sort of infection.
These patients need reassurance and education that vaginal discharge that changes in color and consistency throughout the month, but that has no foul odor and does not itch or burn is not only normal, but is a sign of a health and fertility. This is not anything that needs to be washed away.
Good vaginal hygiene requires little effort. Sleep without underwear. Avoid wearing pads, panty liners, or tampons on a daily basis. Wear cotton underwear and looser fitting pants when possible. Wipe from front to back, which also helps prevent urinary tract infections. Don’t take frequent bubble baths. Practice safe sex. Build the immune system by eating well, getting enough sleep and managing stressors. But most importantly, put down the soaps and the douche!