Care for the intimate area, the 10 most frequent questions

Published: 14 May, 2023 - Updated: 26 October, 2023 | 8'

When we talk about the care of the intimate area, we're not just referring to a matter of hygiene, but to paying attention to women's vaginal health.

Improper vaginal hygiene affects the structure of the vaginal tissue, fertility, and even sexual desire and/or the ability to reach orgasm.

We wonder, what is vaginal health and how can we keep our intimate area in optimal condition? Doctor Joan Matas, integrative gynaecologist, resolves some of the most frequent doubts about the care of the vagina and the intimate area.

1. In general, how should I take care of my intimate area?

The starting point would be understanding the "vaginal structure". The vulva is the first line of defence to protect the genital tract from possible infections, while the vagina is the fibromuscular canal that extends to the cervix. The vulva and vagina configure an interdependent functional unit, so that an alteration in one affects the other.

The environment of this genital area is characterised by high humidity, mucous, an appropriate pH that ranges between 3.8-4.2, and its own bacterial flora. Some factors such as sweating, menstruation, sexual intercourse, hygiene, uro-faecal contamination, or cosmetic products, can "alter" the inner area of the vagina, in addition to other factors related to anatomy, age, hormonal fluctuations, etc.

Therefore, if we talk about what a proper hygiene of the area would be, we should start with a gentle cleaning of the vulva, a vital aspect of feminine intimate hygiene and vulvovaginal health in general. The daily vulva hygiene (external genitals), prevents the build-up of vaginal discharge, sweat, urine and faecal contamination, and is especially useful for women with smelly vaginal discharge. Moreover, the daily external washing, can reduce the risk of recurrence of bacterial vaginosis.

Some of the advice on caring for the female intimate area indicated by gynaecologists and obstetricians would be the following:

• Perform a wash of the external area once a day (which can be twice during menstruation), using a gentle hypoallergenic liquid soap with a pH of 4.2 to 5.6 and water. It's an area that prefers "soapy water", better than a large amount of soap even if it is appropriate.
• Avoid the use of sponges or towels. Wash the vulva area only with the hand and then gently dry with a towel.
• Avoid the use of inappropriate soap, shower gel, exfoliators, bubble baths, deodorants, baby wipes, or vaginal showers.
• Do not use talcum powder.
• Change tampons and pads frequently.
• Before and after intercourse, clean the vulva from front to back.
• Wear loose cotton underwear.

2. What happens if we excessively wash the intimate area?

It's recommended to wash the external area once a day (which, as we've mentioned, can be twice if necessary during menstruation), and always use gentle and hypoallergenic intimate soaps. This recommendation is because our vulvo-vaginal area must present optimal conditions of humidity, pH and bacterial flora to avoid the risk of suffering infections or alterations of our sexual life.

An excessive cleaning can aggravate vulvar symptoms (for example, contact dermatitis symptoms) or alter the natural conditions of the intimate area, especially pH and vaginal microbiota.

Due to the risks associated with internal washing, external female washes are considered more appropriate for female intimate health.

3. Are 'vaginal douches' advisable?

Vaginal douching is a method to wash the vagina consisting of using a solution, which usually comes in a bottle or bag, and introducing it into the vagina through a tube where the liquid is sprayed. The solutions can contain water, soap, vinegar, baking soda, among others, besides containing a fragrance.

These vaginal douches are not recommended as they can contribute to the occurrence of bacterial vaginosis, (which is the alteration of the vaginal microbiota), pelvic inflammatory disease, endometriosis and sexually transmitted infections. This is because vaginal douches can eliminate normal vaginal flora (as well as alter the pH), allowing the growth of other types of "non-natural vagina" bacteria and also, the pressurised fluid of liquid in the vagina facilitates the transport of microorganisms from the lower genital tract to the uterus, fallopian tubes, or abdominal cavity, possibly affecting the well-being of these structures.

There are clinical data, like the PEACH study (2001), which showed that women with endometritis or infection of the upper genital tract had been more likely to have undergone vaginal douching than women who had never undergone them.

4. Is it advisable to use intimate gels and other products when having urinary infections?

The recommendation when you have a urinary infection is still to maintain optimal hygiene of the intimate area, wash daily and gently the skin surrounding the vagina and the anus (externally), with products appropriate for this: hypoallergenic soap, with balanced pH, that does not contain perfume and that does not affect the natural bacterial flora. Using other types of products like intimate gels is not recommended.

Also, during a urinary infection, it is recommended, along with the treatment your doctor has indicated, to drink a lot of fluid (especially water), urinate frequently, and maintain proper anogenital cleaning.

5. Should the use of perfumed intimate hygiene products be avoided?

Yes. There are numerous associations of gynaecologists that recommend women to use a hypoallergenic cleaning agent (that does not contain perfume), with balanced pH for daily cleaning of the vulva, that does not affect the natural microbial flora and that has been clinically tested to ensure it is well tolerated.

Products such as deodorants, scented tampons or sanitary towels, perfumed intimate gels, etc. are not recommended for use in the intimate area.

It's important to underline that the intimate area, due to its structure, moisture and bacterial flora, has a distinctive smell, which should be monitored as if it changes could be a sign of alteration in the vaginal mucosa. In such cases, it is recommended to consult with a doctor or gynaecologist.

6. How to maintain the vaginal flora or vaginal microbiota?

Besides the recommendations provided by gynaecological societies, we've seen before, there are other good suggestions to maintain the balance of the vaginal microbiota, such as:

• Care for your diet. Diets rich in carbohydrates promote the growth of pathogenic bacteria in the intestinal and urinary tract, so it is recommended to moderate their consumption. Among the foods that are recommended to be regularly taken for vaginal microbiota are yoghurt or fermented products, nuts, fibre-rich foods and Omega fatty acids.
• Drink a good amount of liquids daily, at least 1.5 liters, which you can get from water, natural vegetable juices, infusions or broths. Hydration facilitates the balance of pH in the genital area, the conservation of cervical mucus and lubrication.
• Avoid wearing clothes that are too tight, as the intimate area is subjected to higher heat and sweat, especially if the clothes are synthetic.
• See a gynaecologist at least once a year, and in case of noticing any change in the genital area, seek immediate help from this specialist. The gynaecologist may recommend the intake of specific probiotics for the genital area.

7. If I have vaginal dryness, what should I do?

Vaginal dryness is a very common phenomenon, mainly associated with elderly women after menopause, although it can occur at younger ages. Usually, it is produced by hormonal changes, the intake of oral contraceptives, the use of synthetic underwear, stress or oncological treatments such as radiotherapy, among others.

The vagina is normally elastic with high moisture levels and, due to the factors mentioned before, there can be a decrease in mucus, less lubrication and hydration. This causes itching, pain or discomfort.

When these symptoms occur, it is advisable to seek the guidance of a health professional, who may appropriately suggest the use of lubricants, pH restoring gels or probiotics, vaginal moisturisers, such as local hyaluronic acid, or topical estrogens.

8. What are vaginal moisturisers and how to choose one?

A vaginal moisturiser is a lotion, cream, or gel that is applied both outside and inside the vagina, usually two or three times a week. The objective of these moisturisers is to balance the tissue moisture and restore the vaginal pH.

The continuous application of vaginal moisturisers improves the integrity of the mucus, humidifies the underlying tissue and allows the conservation of folds and rugosities, both of the vulva and the vagina. Moreover, vaginal moisturisers have shown high effectiveness in the treatment of local urogenital symptoms, such as dryness, vaginal itch, irritation and dyspareunia (pain during sexual intercourse).

One of these moisturisers is hyaluronic acid. It is a natural component of the skin and mucous membranes (including the vagina), whose properties are to maintain the hydration of the tissue and its firmness. Different studies^4,9 have shown that hyaluronic acid relieves irritation associated with dryness, itching, dyspareunia (pain during sex), in addition to balancing the pH of the tissue, at the same level as the use of a topical estrogen.

Internal and external use vaginal moisturiser

The vaginal moisturisers must meet three basic premises: they respect bacterial flora, balance the pH and restore the epithelial tissue of the vagina. Alongside this, they clinically prove their dermatological and gynaecological tolerability.

There is a wide variety of these moisturisers, among them those that contain a combination of hyaluronic acid and other natural agents in a water-based, are the closest to maintaining the "naturalness" of the vulvovaginal tissue.

They are also considered the safest, among moisturisers or products for the intimate area, as they are not irritating and do not cause latex deterioration, associated with lower condom breakage rates.

9. Are there exercises for vaginal health?

The vagina is covered by a muscle layer that, like any muscle, should be exercised. The good condition of this musculature, which is affected by the passage of time and with vaginal births, allows for better maintenance of the vaginal ecosystem and improves sexual relations, by enhancing the "dam effect" of the vagina on the male member.

The maintenance of this musculature can be improved with the known Kegel exercises, which practise the contraction of the vaginal muscles, as well as the pelvic floor.

10. When should I get a gynaecological check-up?

The routine, ordinary gynaecological check-up should be done annually. This frequency allows for effective early diagnosis of gynaecological cancer, breast cancer, ovarian, endometrial and cervical cancer. Also, it allows to express discomfort, doubts and resolve annoying benign pathologies that can be treated.

Every woman who starts having sexual relations should start these annual controls, whatever her age. In any case, from the age of 15 or 16, these controls should be started, or earlier if there is any discomfort that requires it. In these gynaecological controls, we can make early diagnosis of sexually transmitted diseases and effectively treat them.