It seems like everything comes with an instruction manual. But, many of us were given minimal or absolutely no ‘care and use instructions’ for our bodies, especially those parts specific to female reproduction and sexuality.
From questions about menstruation to those regarding ‘normal’ vaginal discharge, to issues surrounding discomfort during intercourse or sexual activity, as a result of limited access or embarrassment or stigma, resources to learn facts about our own bodies can be hard to come by. As a consequence, people have been poorly informed or frankly misinformed about proper care of these parts of our bodies.
It is important to be sure that, when discussing anatomy, that we are talking about the same places. The Female Anatomy 101 blog post is a good way to get a sense for the anatomy lingo that you will come across most commonly in health related descriptions of specific parts of the female genitourinary tract.
To be clear, we are talking about the external female genitalia, aka the vulva. This includes: the opening of the vagina (also called the vestibule), the labia majora (outer lips of the vagina), the labia minora (inner lips of the vagina), and the clitoris. The opening of the urethra is also found in this portion of the vagina. Similar to any other portion of the body, such as an arm or a leg or a chest or a kidney, no two vulvas are precisely identical but care and maintenance recommendations for most people are generally pretty similar.
The vulva is a self-regulating system with its own intrinsic biology intimately related to its function throughout the lifespan of a woman, before, during and after her reproductive years. The vaginal tissue (epithelium) is also affected by external hormonal and environmental factors. After puberty, the vaginal epithelium thickens and, in response to estrogen, the levels of glycogen in the tissue increase. The outer layer of cells during this time, is believed to contribute to a vaginal microenvironment that optimizes vaginal health, promoting good bacteria and allowing immune cells to permeate and respond to bacterial and viral pathogens. These external cell layers are replaced frequently, as much as every 4 hours, and the sloughing acts as a natural mechanism to exfoliate harmful or irritative agents which might be present. This may account for a component of normal vaginal discharge.
General recommendations for routine vulvar health (absent infection or other issues) are to clean regularly with a mild soap between the labia but to avoid harsh chemicals or over exfoliating (scrubbing) the fragile cell layers. Spermicides and lubricants may affect normal cell function as can saliva and semen. While this is generally temporary, if you have ongoing or recurrent infections or discomfort, you should discuss these possible causes with your provider.
Some infections specifically impact the external vaginal tissue. These include yeast infections, bacterial vaginosis and certain STIs, such as Herpes (HSV). In women with reduced levels of estrogen in the vagina, for any number of reasons including certain oral medications (specific birth control and cancer related medications) as well as menopause (surgical or ‘natural), the vulvar tissues change significantly and many patients experience a condition called genitourinary syndrome of menopause. This is associated with symptoms of recurrent vaginal discomfort along with urinary symptoms and is often treated incorrectly as a UTI.
The vulva also includes the clitoris which is closely tied to orgasmic and sexual function and some of these can result in reduced or limited clitoral responsiveness. Clitoral phimosis is a condition in which the clitoris is covered by normally present tissue but is not able to expand or be exposed as it would typically in response to arousal. This can be treated easily with topical medications, although it may sometimes require a minor awake procedure in an office setting to correct. Treatment of clitoral phimosis is intended to result in de novo, restored or significant improvements in orgasmic function and sexual gratification.
The Dos and Don’ts of Vulvar Care
Wash with warm warm water and only a mild soap
Dry the area completely
Wear cotton underwear – avoid nylon or manmade fibers that can cause irritation
Use a vaginal moisturizer such a Replens or RepHreshe
Change into dry underwear/clothes after swimming or exercising
Consider lactobacillus and boric acid vaginal suppositories for recurrent vaginal discomfort or infections – See our OTC products
Wear nylon or synthetic fiber underwear
Wear tight panty hose or pelvic girdles
Use feminine deodorants, scented oils/sprays, bubble baths, scented sanitary pads
Use harsh soaps or douches
Shave or wax the vulva – pubic hair serves as a protective buffer against skin irritation and friction
Contact Snippa if you have vulvar and vaginal symptoms and would like to discuss solutions.
Written by Dr. Mara Holton and Kathleen Mackey, CRNP – founders of Snippa, a web-based telehealth company focusing on improving quality of life for women dealing with bothersome conditions including UTIs, Overactive Bladder, Incontinence, and Female Sexual Dysfunction. As active women and mothers themselves, Mara and Kathleen empathize with the burden these conditions cause and are passionate about empowering and educating women to take control of their symptoms and improve their quality of life. www.hellosnippa.com offers expert consultation with licensed specialty medical providers and a full range of products to treat these conditions.