All about vaginal health! In this episode, Dr. Lisa and Dr. Toni give you a crash course on: your anatomy “down there”; ways to optimize your vaginal pH and microbiome; how hormonal changes contribute to urinary tract infections, vaginal dryness and atrophy; and what to do about yeast infections and bacterial vaginosis.
Basic Genital Anatomy:
Your vulva is the outside of the genital tract, where your clothes touch your skin.
Your vagina is the inside of the genital tract and the transition zone from your vulva to your vagina is called the vestibule.
As you get closer to the vagina, your skin has fewer layers and less keratin, along with no hair follicles. This makes the area more vulnerable to trauma and irritation. The mucosal skin of your vestibule and vagina have cells filled with storage sugar called glycogen.
“There’s a lot of money in vaginal shame” Dr. Jen Gunter – Vagina Bible
- Each woman’s vaginal smell is unique and based on your changing hormonal balance and microbiome, which can be impacted by your diet and use of antibiotics.
- No douching (which is flushing the vagina with a medicated solution or even water) is needed.
- Any washing of your vagina can damage the protective mucus and Lactobacilli beneficial bacteria there.
- No vaginal cleansing products have been scientifically studied.
- Research has shown that washing your vagina with soap can increase the risk of HIV transmission by almost 4 times, while washing your vagina with only water can more than double the risk of HIV transmission.
Your Vaginal Microbiome:
This is your symbiotic relationship between bacteria and yeast along your vaginal tract and on the skin of your vulva.
You may always have some yeast or unfavourable bacteria present, but as long as your beneficial bacteria outnumbers your unfavourable micro-organisms, then you don’t have any issues or symptoms.
How Hormonal Changes Impact Vaginal Health:
As estrogen decreases in perimenopause and menopause, you can have less blood flow to your vagina and vulva which can cause:
- your vaginal and vulvar tissues to lose strength and elasticity, becoming more fragile and losing their ability to stretch
- your vaginal and vulvar skin to become more thin and feel more dry
- the amount of your vaginal and vulvar tissue to decrease, as your cells lose volume
- your microbiome balance to change, as your cells have less glycogen to feed Lactobacilli beneficial bacteria
- Lactobacillus bacteria produce lactic acid to keep our vaginas acidic with a pH between 3.8 and 4.5, while the pH of your vulvar skin is between 5.3 and 5.6
- This acidic pH allows for favourable microbes to thrive and unfavourable ones to not become a problem
- You can check your pH by parting your outer labia and applying pH paper with a narrow range as close as possible to inner vaginal wall, then hold a few seconds, compare colour to the key provided
- If above 4.5, a bacterial imbalance like bacterial vaginosis is possible
- Yeast or Candida doesn’t change your pH value
Possible Vaginal Imbalances:
An overgrowth of Candida albicans can irritate your vagina and your vulva resulting in symptoms like:
- thick, whitish or yellow discharge (but not always!)
- redness, itching and swelling of vulva
- pain after urination
What do you do if you think you have a yeast infection?
First, rule out allergic reactions, atrophic vaginitis, general irritation and dryness.
Over the counter antifungals (both oral and topical) may work in the short-term, but you need to change the terrain and treat the cause or they can keep coming back!
Addressing the root cause of yeast infections includes:
- Reducing or avoid your intake of sugar, simple carbohydrates, alcohol and cannabis
- One study on women who smoked or ate cannabis were 30% more likely to have yeast in their vaginal ecosystem, as well as their mouth
- Avoiding excessive and unnecessary use of antibiotics
- Studies show 23% of women develop a symptomatic yeast infection after antibiotics
- Using a probiotic supplement orally and vaginally
- Lactobacillus rhamnosus, reuteri and gasseri species have most evidence to support your vaginal microbiome balance
- Feed your beneficial bacteria with enough fibre in diet
- Chicory root, artichoke, green banana, onions, garlic
- Using oral garlic supplements, also using garlic bulb suppositories vaginally or suppositories garlic and probiotic
- Using boric acid suppositories, especially for yeast infections resistant to regular prescription or over the counter medications, for less than 2 weeks
- Avoid excessive wetness and heat
- Change right after your workout or swimming
- Wear cotton undies
- No undies to bed
Bacterial Vaginosis (BV):
This is one of the most common bacterial infections for women with symptoms including:
- has thin whitish/gray discharge
- foul fishy odour
- not usually associated with pain, itching or burning
- worse after menstruation or intercourse, since semen can change your vaginal pH); sugar, antibiotics, douching, wearing non-cotton undies, BCP?
- Gardnerella vaginalis most common cause
- If left untreated, it may lead to urinary tract infections, pelvic inflammatory disease, infertility, Candida overgrowth, increased risk of sexually transmitted infections
- Amsel criteria for diagnosis (3 of 4 needed):
- thin, white/gray milky discharge
- positive whiff test
- vaginal pH > 4.5
- clue cells on microscope
Studies show that women who have never partnered with men don’t get BV and women who partner with men who consistently use condoms (without spermicide) have healthier balance of vaginal bacteria.
Biofilms (protective coatings around bacteria and yeast) have been identified with both copper and hormonal IUDs and contraception rings.
Addressing the root cause of BV includes:
- avoiding sugar, simple carbohydrates and alcohol
- considering withdrawal before ejaculation of semen into vagina if having insertional sex
- using probiotic supplements containing Lactobacillus orally and vaginally (oral for 3-6 months)
- using boric acid suppositories (for less than 2 weeks at a time)
Genitourinary Syndrome of Menopause (GSM)
- Vaginal dryness and irritation
- change in discharge
- decreased lubrication
- pain with sex
- bleeding after sex
- burning on urination
- increased urgency and bladder infections
Vaginal Dryness: What can you do about it?
- Use personal lubricants during sex: consider water based vs. silicon-based
- Example: YES brand lubricants
- Use olive or coconut if not using condoms
- Coconut oil has been studied on skin of premature babies with no ill effects, performed better than mineral oil in preventing water loss from the skin
- Olive oil has studied with breast cancer survivors who could not use estrogen and was well tolerated
Vaginal Atrophy: What can you do about it?
- Hyaluronic acid suppositories
- Vaginal estriol or dehydroepiandrosterone (DHEA) cream
- Vitamin D – a small study suggested improvement in appearance of cells in menopausal women who took vitamin D supplementation
How to Have a Healthy Vagina:
- Use it or lose it?!
- Pelvic floor exercises (see Episode 34 on pelvic floor fitness) for more info
- Sleep in the nude or without underwear
- Switch to cotton undies
- Use gentle fragrance-free laundry soap to minimize potential irritation
- Only use water or a cleanser with a pH around 5.5 on your vulva
- Avoid commercial tampons or pads, especially fragranced ones
- Switch to a menstrual cup for your period
- Sanitize properly (consider alternating between 2 different menstrual cups)
- Limit or avoid your intake of sugar, simple carbs, alcohol, cannabis
- Consider prebiotic and probiotic supplementation – oral and vaginal
Today’s Mama Must Have:
Dr. Toni is a big fan of a new supplement that can be helpful for addressing yeast infections called Kolorex (containing the herb mountain horopito), as well as Genestra HMF Candigen probiotic cream for reducing vaginal irritation.
Thank you for joining us today!
Please tell your perimenopausal mama friends about us, too!
Stay safe everyone!