Do you really need to clean your vagina?
First of all, we need to understand that there is a difference between vagina and vulva.
Vulvar is skin, an external genital organ.
Vagina is the fibromuscular canal extending from its external opening in the vulva to the cervix, and it is an internal genital organ.
Vulva does not do self-cleaning, but vagina does.
Vulval cleaning
Since vulva is skin, just like other skin on the body, it needs to be washed!
Vulva is the first line of defense to protect the genital tract from infection. The microbial composition of the external vulvar area plays a major role in maintaining the overall vulvovaginal health. Harsh soaps may upset the vulvar skin as well as the mucous membranes, and further disrupt the microbial balance in the vulvar area, hence may provoke or exacerbate vulvar skin infection.
In fact, warm water is adequate to clean the vulva. However, if you insist on using a vulvar cleansing product, make sure you choose the right product.
Vaginal cleaning
How does vagina clean itself? By secreting vaginal discharge (without odour or tinge).
The normal vaginal pH would be around 3.8 - 4.4 (at reproductive age), anything that disrupt the pH balance might cause infections. One of the examples is by douching or washing the vagina.
Acidic pH in the vagina area, which is maintained by the ‘good’ bacteria, keeps the ‘bad’ bacteria from entering. Douching or washing the vagina might alter the normal vaginal flora and eventually lead to some bacterial or fungal infections. It has also been associated with an increased risk of pelvic inflammatory disease (may cause infertility) as the ‘bad’ bacteria are being pushed upward towards the upper genital organ. Besides, douching may also increase the risk of getting sexual transmitted disease and endometriosis, i.e. the condition where tissue similar to the lining of the womb starts to grow in other places inside the genital organ.
So, external wash or internal wash?
Due to the risks associated with douching, external feminine washes are considered more appropriate for intimate health, especially those containing lactic acid. With an acidic pH that supplements skin homeostasis and may serve as a helpful adjunct therapy in women with vaginal infections (which the pH balance is off) or taking antibiotics (where antibiotics kill a wide variety of bacteria, including those in the vulvovaginal). Vulvar cleansing may also be a useful adjunct for women with odorous vaginal discharge, and reduces the risk of recurrence of bacterial vaginosis.
It is recommended that using a pH-balanced hypoallergenic cleansing agent for daily vulvar cleansing. These external washes need to be carefully formulated for mild, gentle cleansing without impacting the natural flora. It is also important for intimate feminine hygiene products to be assessed clinically to ensure that they are well tolerated without negatively impacting the natural vulvovaginal microflora. Check the MOH approved products here.
All in all
The normal vaginal flora, acidic vaginal pH, and vaginal discharge are all parts of our body defense mechanisms that protect against vulvovaginal infections. Routine washing of the vulva is advisable to avoid accumulation of sweat, urine, vaginal discharge, and faecal contamination as to prevent offensive body odour. It is also important to note that vulvar cleansing products are not designed to treat infections, but they may be useful as an adjunct to a medical treatment. Products with features like hypoallergenic, soap-free, pH friendly, mild cleanser, no irritants, protection against dryness, and maintenance of balanced microflora, will not go wrong.
Remember to always ask for a professional opinion before purchasing any health-related products.
Medically reviewed by Ashwini Nair, MB BCh BAO.
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References:
1. Keeping your vagina clean and healthy. nhs.uk. Published October 3, 2018. Accessed February 20, 2022. https://www.nhs.uk/live-well/sexual-health/keeping-your-vagina-clean-and-healthy/
2. Chen Y, Bruning E, Rubino J, Eder SE. Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Womens Health. 2017;13(3):58-67. doi:10.1177/1745505717731011
