It’s summer and the sun is shining and women are hanging out in their bathing suits all day so the vaginal infections abound. It reminds me of a patient that I had named Jennifer. Jennifer is an 18 year old high school student that has returned to my office numerous times for yeast infections.  She comes today with her mother, who is concerned about the recurrent problem. We have treated her successfully with medications in the past, yet the infection continues to occur. I begin to question her about the lifestyle changes that I have recommended.  When she states that she is still wearing her underwear at night, her mother scolds, “I told you, Jenny, you’ve got to let your monkey breathe!”  While I had never heard that expression, I certainly will never forget it.  I do believe that they are words to live by.

Dr. Deb’s Vaginal Maintenance Program (VMP)

The first thing women need to know to prevent such infections is the proper care and maintenance of the vagina. It’s not like we received a manual when our periods started. Many women get this information from their mother or their friends. Friends are often misinformed and mothers, as in Jennifer’s case, if they are right are often not believed. We are enticed by commercials and marketing that our vaginas are to be perfumed, powdered and suffocated which often leads to embarrassing and persistent infections. That “not so fresh feeling” may actually be an infection that requires an antibiotic instead of more perfume.

 

The following is my own personal recommendation about keeping your vagina healthy. It’s the basic “how to” of vaginal maintainence which consists of a lot of “don’ts” as there is very little that we actually need “to do” to prevent infection. The vagina is a self-cleaning organ. The only thing that you must do is “Let your Monkey BREATHE!” We are suffocating the poor things with tights jeans, thongs, bathing suits and even underwear, never giving her a chance breathe. Why does she need to breathe? Like a woman, she is far more complicated than a man and his penis because she is not covered in skin to protect her. Instead she depends on a delicate “bacterial flora” to protect her from infection. Let me simplify this bacterial flora thing. It consists of “good bacteria” like lactobacillus that fights infection. Estrogen also helps to maintain the vaginal flora. Women are more susceptible when they have low estrogen such as breast-feeding or at menopause. There are some other bacteria that are fine in small amounts such as yeast or garderella but if that lactobacillus gets wiped out, then those bacteria can overgrow causing an infection. Lactobacillus requires oxygen to live as it is an aerobic bacterium. Garderella is anaerobic meaning that is does not require oxygen. So you see by suffocating your vagina, you are really promoting anaerobic infections.

 

What does that mean? It means don’t wear your underwear at night. Now there are two camps of women in the world: Those that wear their underwear at night, and those that don’t.  No matter which camp you’re in, you feel pretty strongly about it.  Sometimes women choose based upon what their mother told them, but not always.  Now, if you are in the camp of nighttime underwear wearers, I know, the thought of not wearing your underwear is just a little bit frightening.  I promise, no bugs will crawl up in there. Isn’t that what you are really afraid of? That and, of course, the fear that your husband will see it as an open invitation to have sex all the time. You are going to greatly reduce the chance of having infection and irritation in your vulva and vagina by allowing some air to circulate. It feels very odd at first but once you get used to it you’ll find it much more comfortable so “Air it out!”

 

If you can get over not wearing underwear at night the next step is to stop the suffocation during the day. One of the biggest culprits is hanging out in a bathing suit all day just trapping all of that heat and moisture, practically inviting a bacterial party to come in. A lot of times it is just laziness but get out of that bathing suit when you are done swimming. This goes for a lot of the tight spandex uniforms in cheerleading, volleyball and track and field that I see my younger athletic patients wearing. It’s fine to do your physical activities in them if it is comfortable but get out of those things as soon as you’re done. You are just trapping heat and moisture that are huge instigators for infection.

Now we are down to the underwear. Call me Grandma but all white cotton underwear is the best if you are having any kind of pain or infection issues. Now they make some very cute styles and it doesn’t have to come up to your navel but a cotton panel does not count! Polyester and synthetic materials not only trap all of the air but can also rub against the delicate tissue causing painful sebaceous cysts. If you want to have your sexy weekend underwear, fine, but give your poor vagina a break the rest of the time. Next, there is the thong issue. I know some of you girls love it but it is hard for me to believe that a woman came up with this torture device. OK so you don’t want underwear lines but  I never could understand how a little crease under the buttock is worse than a big old V on top of someone’s crack. For the past 5 years at almost every wedding I have attended there is one woman in a very shear dress with a big old V on her backside. Is that attractive? Sexy? It looks gross. I call her the thonger. Thongers of America, if you wear a dress that sheer, don’t bother with the underwear so we don’t have to see the big V and so you won’t get an infection.

 

What about cleansers?  Remember, the vagina is a self-cleaning organ so you don’t need to put anything inside to clean her. Many women make the mistake of using perfumed products in their vaginal area. Douches, feminine sprays, body washes and scented powders that we think are masking odors are actually creating infections that cause odor. Not using these products may seem blasphemous to many women, but I’m telling you to get rid of the products, treat the infection and then you will finally be done with odor and irritation.  Even vinegar and water will disrupt the healthy bacteria in the vagina causing an overgrowth of other bacteria, which produce irritation, discharge and odor. If you don’t believe me try this little experiment at home.  Take a drop of vinegar and place it all in on a piece of meat. The vinegar will cause bubbling and the meat will turn gray. Yuck! Now think about doing that to your vagina and you’ll never reach for the vinegar again unless you are making a salad.

 

You mean I can’t use anything down there? For my very sensitive patients that are always battling irritation I tell them just to use water. That’s it. For most women I recommend a mild soap such as Olay of Olay or Camay. Some athletic women with oily skin that get a lot of those sebaceous cysts or basically pimples in their vulvar area I will recommend an antibacterial soap. Aloe Dial seems to provide the antibacterial protection without the harsh chemicals. Don’t use liquid soaps or fragrances.

 

What about when I am on my period?  The first thing is to change your protection frequently, about every 4 hours during the day. The same rule of no perfume applies which includes any “deodorant” product, such has deodorant tampons or panty liners. Even non-deodorant panty liners are not to be worn everyday. Some women get in the habit of wearing them all of the time if they have a little discharge. First, see your doctor to be sure that the discharge is normal. If it is physiologic discharge or normal female discharge then instead of a panty liner, bring along an extra pair of underwear to change into. That constant use of a panty liner is just acting as a garbage pail that you keep exposing to your delicate vulva. The friction plus moisture in the pad will result in irritation and infection. 

 

What else do I tell my patients to avoid? The primary thing is communal hot tubs. I don’t care if it is your clean freak sister’s hot tub, stay out of it. She doesn’t know what kids are sneaking in her tub when she is away. I have treated numerous monogamous married women that received and STI or Sexually Transmitted Infection from a hot tub. Trichomoniasis can live in moist warm environments. Hot tubs can also promote yeast infections in some women. I often wonder about how many infections are spread though the MTV’s Real World Hot tub that seems like a cesspool of infection with all of those kids having sex in it. This can likely be said for any college campus hot tub.  Your own Jacuzzi tub that is drained and cleaned after each use is fine but I have seen too many infections after hot tub use to recommend them at all.

That is about it when it comes to  general vaginal maintenance, not a lot really. So have fun in the sun today but let her breathe tonight!

Dr. Debb