By: Sigourney Cross
I love taking bubble baths. I use my scented body wash and a loofah down there. Sometimes I wipe so hard I bleed a little bit. I always use scented wet wipes to stay fresh. I wear thongs under my yoga pants. I use a daily scented panty liner just in case I have discharge or urine leakage.
The above statements are common responses I get when I ask my patients about the care of their vulva or the entrance to the vagina. All of the above statements have one thing in common. These are examples of poor hygienic habits. These poor habits don’t surprise me because women have been taught that the vagina is dirty and smelly. To learn more about how your vagina is supposed to smell, you can read one of our previous blogs here. Many women experience vulvar and vaginal discomfort from irritation and infection that can occur due to an overgrowth of bacteria, funguses or other organisms. These infectious organisms can be introduced into the vagina by improper hygiene. Below are some tips to follow to prevent vulvar discomfort, vaginal infections and to ensure a happy and healthy vulva and vagina.
Just use water!
Did you know the vagina is self-cleansing? This is because the vagina is naturally acidic with a normal pH range of 3.8-45. This acidity is due to good bacteria keeping bad bacteria away. When a women’s pH level is greater than 5 this is considered less acidic and more basic meaning bad bacteria have been given a chance to grow. An overgrowth of bad bacteria can result in vaginal yeast infections, bacterial vaginosis, trichomoniasis and atrophic vaginitis. Things that can change your pH level include antibiotics, intercourse, breastfeeding, menstruation, menopause and last but not least, SOAP! Yep, you heard me right. Those lovely scented body washes and soaps can raise your pH, causing an overgrowth of bacteria, ultimately causing you more harm than good. Gently wiping or rinsing the area with warm water is all you need. During that time of the month or when you’ve maybe had an extra sweaty workout session and you feel water isn’t enough, use an unscented and fragrance free soap without any other harsh chemicals. After washing gently pat dry or allow your vulva to air dry. Also stay away from scented wipes, douches, vaginal deodorants, perfumes, bubble baths and drugstore products labeled “feminine hygiene.”
Ditch the thongs and go commando
Thongs and tight clothing make a great breeding ground for yeast and other types of vaginal bacteria. It is important to always wear breathable cotton underwear for good ventilation. Avoid wearing nylon, acetate or other manmade fibers. Please ditch your thongs, especially during your workouts. When you are exercising, your thong will carry the bacteria from your anus up towards your vagina. The last thing we want is bacteria from where you evacuate your feces making it to your lady parts. Be sure to also remove damp clothing from sweating, swimming, or other strenuous activities to allow the area to dry. Sleep without underwear and loose fitted pajamas to further improve ventilation. Using fragrance free laundry detergent can also decrease risk of irritation.
Tampons not pads, toilet paper not wipes
Use tampons instead of sanitary pads to control menstrual bleeding. These are generally less irritating. Do not use deodorant tampons and be sure to change them every 4 hours to avoid toxic shock syndrome. If you are unable to use tampons be sure to use pads without chemical additives. When toileting, it is best to use plain white unscented toilet paper. Always wipe from the front to the back. Avoid using wet wipes that contain alcohol or other chemicals. At PHRC we use water wipes that are 99.9% water with a drop of fruit extract. When experiencing urinary incontinence be sure to use pads that promote dryness such as Poise and Depends. Do not use menstrual pads for incontinence. Daily use of panty liners can increase irritation around the vulva.
Estrogen can be your friend
Whether you’re going through menopause, breast feeding, or have a history of taking oral contraceptives, vulvar pain and dyspareunia can be potential side effects due to tissue changes. Applying a topical estrogen and/or estrogen and testosterone compound cream at the vulva can help with tissue sensitivity and pain as well as restore moisture and elasticity to the vulva. Topical hormone therapy in conjunction with pelvic floor physical therapy is the best course of treatment for most pain syndromes surrounding the vulva. Be sure to check with your doctor to see if your appropriate for hormone therapy as this is contraindicated with certain types of cancer. If topical hormones aren’t indicated, there are many over the counter vaginal moisturizers that mimic the effects of topical hormones that are good alternatives. Ask your pelvic floor physical therapist for some recommendations!
Considerations with sex
The pure mechanics of having sexual intercourse (bacteria moving in, out and around your genitals) can increase your risk of getting a urinary tract infection. Peeing before and after sex can help reduce your risk. Use of vaginal lubricants during coitus can decrease friction, allowing for increased ease and comfort. Vaginal lubricants unlike moisturizers are made to be used short term. For advice on the latest and greatest lubricants click here.
When it comes to taking care of your vulvar and vaginal tissue, less is more. Give these techniques a try and feel free to ask questions or comment below.
References
- Burrows, L. and Goldstein, A. (2013). The Treatment of Vestibulodynia with Topical Estradiol and Testosterone. Sexual Medicine, 1(1), pp.30-33.
- The International Society for the Study of Vulvovaginal Disease
https://www.issvd.org/handouts/Gen#eralVulvarCare.pdf
- The Cleveland Clinic. Department of Obstetrics and Gynecology. Vulvar Care.
https://my.clevelandclinic.org/health/articles/4976-vulvar-care
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.