Feminine hygiene: How to clean and keep healthy down there

Women can conquer the world, break glass ceilings, have it all, especially if they have nothing to worry about in their vulva, vagina, their menstrual cycle, and the general, often-whispered subjects of sexual and reproductive health.

But it can get overwhelming, especially when they're on their period and period migraines and cramps decide to appear together and it feels like a cocktail of hormones is traversing their whole being.

So before we get ahead, let's go back to the basics: To the vulva and the vagina and how to keep these body parts clean and healthy. 

What is a vulva and what is the vagina?

Medically speaking, "the vulva is the external portion," says Dr. Jennifer Jose, a urogynecologist, pelvic reconstructive surgeon, and aesthetic gynecologist at Pelvic Health and Intimate Wellness Center at Medical Plaza Makati. 

On the other hand, the vagina refers to the passage or tube inside your body through which your menstruation passes or a baby is born.

According to Jose, "The vagina self cleans. You don't have to insert an examining finger in the vagina to clean it."

"Of course, externally, you should wash with a delicate soap — unscented, as much as possible — no fragrance," she continues, explaining less fragrance means less chemicals. "That will be better."

Fast facts

If you remember your Chemistry classes, then you'd remember the fascinating litmus tests and talk of pH balance. This is important to note because various body parts, like the vagina, have their own healthy pH balance.

Jose says the vagina's pH balance should be acidic, typically between 3.5 to 4.5 pH levels.

"If it is not acidic, there are different bacteria that will grow like, for instance, you can develop fungal infection. You can develop a lot of symptoms like irritation in the vagina. You can also have foul-smelling odor as well as a lot of unusual discharges," she says.

If the vagina's pH level is 4.5 and above, that is alkaline. "What happens is a different bacteria grows, which will cause an infection," said Dr. Jennifer.

If it is below 3.5 — or too acidic — then "you're going to have a lot of irritation. It's going to have redness. This will lead you to scratching, and if you scratch, then you're going to develop excoriations, which is also not good."

Excoriation is skin picking or repetitive scratching.

Tips for washing your vulva

Jose recommends to "wash every day" and "as often as you can, because you perspire."

"You also have some discharges, and you urinate, too. Ideally, when you have any activity there, wash," she continued.

She doesn't recommend douching, or cleaning the inside of the vagina (inner tube), "because that can change the pH of the vagina and you can develop a lot of irritation after."

Instead, Jose recommends using just soap and water — "the more gentle the soap is, the better," she said.

Between bar soaps and liquid soaps — like feminine washes — one isn't necessarily better than the other, Jose clarified.

Either will do, as long as it's unscented and has less chemicals.

"Whenever you wash, I always advise patients to wash from front to back," she said.

"Bacteria can grow and then when you poop, when you wash, it should not be from back to front," she reminded.

Referencing Dr. Sara Twogood, a board certified OB-GYN in Los Angeles and co-founder of Female Health Education, Newsweek reported that "wiping back-to-front may spread bacteria such as E Coli from the anus to the vagina and urethra that can lead to a urinary tract infection (UTI)."

So remember: Front to back. And please pat it dry. "Don't keep it moist," Jose said.

Recommended underwear 

Cotton underwear is the way to go, with the 90%-plus cotton underwear popular in the market still okay.

This way, "the vulva and the vagina can breathe and then, the discharge will not be trapped in the fibers of the underwear," Jose said.

She doesn't recommend wearing other materials like spandex because "the moisture will be trapped, and different bacteria may grow."

"It's also not advisable to wear thongs because it rubs in the urethra, the vagina, and the rectum," she said, adding that the bacteria in the rectum, particularly E. coli, may go to the vagina and then, to the urethra.

"It causes infection like urinary tract infection and vaginitis as well," she said.

During your menstruation

If you wear sanitary napkins during menstruation, Dr. Jose said, "It's good to change as often as you can — probably 4 to 6 times a day."

"If you're wearing tampons, you have to be more conscious in cleaning it and removing it every 2-3 hours because remember when you have a tampon there, the blood is actually going to the tampon, and then, it just stays there for a long time so the bacteria will stay longer so it's good to clean all the time," she said.

On hair removal

"There is actually purpose for the hair," Jose said.

In a 2019 interview, dermatologist Oscar S.D. Grino, Jr., said "it's primarily for protection against bacteria to enter the pubic region.”

Pubic hair can protect your vulva and vagina by "catching" bacteria, dirt, and other unwanted elements.

With pubic hair in place, "bacteria will not go to the vagina right away," Jose said.

"Number two, even for intercourse, it will cushion you from the irritation with intercourse as well," she continued.

Jose warns, "There is no muscle underneath. It's skin and also fat. So, if you keep waxing, with time, as you grow old, the vulva becomes very relaxed and then, it loses its shape."

"I would advise patients it's better to cut [their pubic hair] then," she continued.

Post exercise, after sex

Shower and/or wash your female parts immediately. And pee!

Post-work out, Jose recommends to shower immediately "because the outfit that you are wearing is not breathable so the moisture will be kept and because of that, you might develop a lot of infection," she said.

As for after sex, Jose says to "urinate right away and wash very well so that you can avoid having infections too."

If sex toys are in the agenda, do the "same thing, you need to clean [them immediately]," she said.

And as for masturbation, please wash your hands before touching your genitals.

Possible causes of foul odor or infection

According to Jose, foul odor signals infection. 

A vaginal infection will usually be accompanied by additional symptoms like a green-ish or yellow-ish colored discharge.

Sometimes, the infection and foul odor can be due to the soap you use, according to Jose.

For older women, she said, "when you reach perimenopause or menopause, the vulva becomes very dry or itchy."

She added that that is usually due to hormonal changes during menopause and perimenopause, which is the time period when women transition to menopause.

"You can can have lubricants or topical estrogens that may need to be applied in the vulva and in the vagina to address those problems," she said.

Tips for vaginal infections

According to Jose, the self-cleaning vagina can also heal minor infections, "especially if it's in the anterior portion of the vagina."

"If it's itchy, or if you feel there is an irritation, it doesn't mean you have an infection all the time," she said.

"If, after washing, cleansing, you feel the symptoms are getting more pronounced, then, we are looking at the possibility of infection already. That's the time you see your doctor."

She concluded, "I think what's very important is to clean as often as you want, use the proper cleaning material, keep your vagina acidic, and I think you're going to be okay." — LA, GMA Integrated News