What do we do as a society for the hygiene of the genital area? What do we pay attention to in this regard? What do we recommend as experts?
Are we exaggerating the hygiene of the genital area? In order to find the answers to all these questions, it is useful to first know what is in the anatomy, cell structure and natural structure of the genital area. Since these sections have been explained before, I will not mention them here.
Vagina and vulva are the two main parts of the genital system. It is useful to talk about vaginal care separately. Because the cell structure, tissue layers, moisture, flora and pH levels of each of them, which we call epithelium, are different from each other. As such, their cleaning and care are different. The vagina is a wet and moist organ. The vulva is dry and covered with hair covered with skin.
In some organs of our body there are areas of wet and mucous tissue. In order for these areas to function normally, they need to be nourished with secretions (saliva in the mouth, nasal secretion in the nose, tears in the eyes, etc.). Vaginal discharge, which we call vaginal secretion, starts in adolescence. It is present almost every day.
It is odorless, but sometimes it can mix with sweat during the day and smell, or it can turn yellow and smell if it stays in the panties too long. But it is odorless when it first flows. Its color is transparent-white. We call this physiological discharge.
Physiological discharge consists of the removal of the residues in the vaginal tissue, which renews itself with the cervical secretions and the presence of lactobacilli in the environment. It actually has an important function. The amount of this discharge is affected by the number of secretory cells in the cervix, the use of an intrauterine device and the blood level of the hormone estrogen in the woman. Sometimes physiologic discharge can be so abundant that it requires the use of pads.
Physiological discharge can be present every day of the menstrual cycle or only on certain days. During ovulation, a clear, rubbery liquid with the consistency of egg white is secreted from the cervix, and this liquid is often felt by the woman and described as "discharge".
The vagina is a wet and moist organ. The vagina has its own natural flora. The physiological discharge contains microorganisms (beneficial bacteria) in a certain ratio and balance. And these bacteria play a protective role. The vaginal flora contains hundreds of bacteria and a smaller number of fungi (candida).
About 20 species of bacteria have been identified. All women have a vaginal microbiota. However, the bacteria in the microbiota of each woman's vagina and their ratios are different from each other. In addition, changes occur in the microbiota of the same woman during young girlhood, pregnancy, adult womanhood and menopause.
The proportion of lactobacilli in the microbiota is lower in teenage and menopausal women. Lactobacillus rod bacteria are often found. For the curious, I am writing their names here. L. Crispatus L. Gasseri L. Rhamnosus L. Inners L. Jensenii Peptoniphilus spp.
Vaginal microbiota is a dynamic bacterial community depending on many factors such as ethnicity, sex hormones, birth control pills, sexual behaviors, vaginal douching, nutrition, smoking, social environment, genetic structure.
Vaginal pH, i.e. acidity value, is between 4-4.5. This value is formed by lactic acid, fatty acids and organic acids produced by lactobabacillus bacteria. Organic acids are formed in the vagina as a result of amino acid fermentation by bacteria we call anaerobic. Organic acids catabolize bacterial proteins. Glycogen in healthy vaginal mucosa cells is a food source for many types of bacteria, especially lactobacilli.
Changes in any one element in the vaginal ecosystem cause changes in the proportions of various species. For example, in menopause, the hormone Fsh increases and the hormone E2 decreases. This causes a decrease in glycogen in the vaginal epithelial cells and indirectly, the acidic characteristic of the vaginal pH deteriorates and increases to a value of 6-7.
Postmenopausal estrogen therapy is called Hrt: Hormone replacement therapy, i.e. replacement therapy, is given to treat the decreasing estrogen and progesterone hormones in the body. In women receiving this treatment, the density of lactobacilli, which protect the reproductive system like a barrier, increases.
If the vaginal ecosystem is in balance, you will not have complaints such as discharge, burning, stinging, itching and foul-smelling discharge.
Of course, during certain periods of the menstrual cycle, the amount, density and consistency of vaginal discharge may vary. There will be changes depending on hormonal levels. And it is normal. This discharge can be odorless, transparent or white in color, variable in consistency, sometimes like a watery yogurt, sometimes like uncooked egg white. And this is actually a physiological discharge that every woman has. As it stays in the panties, it starts to turn yellow and smell and this is a normal phenomenon. Whenever you do something that you should not do from the outside, vaginal douching, daily pad use, antibiotic use, immune system diseases, poor hygiene, etc.
The balance of the vaginal ecosystem will be disturbed and you will become more vulnerable to vaginal infections. Because the natural defense mechanisms of your vagina are hidden in the flora in this ecosystem.
It is the process of washing the inside of the vagina with water or products marketed for this purpose. Unfortunately, VD is common in cultures like ours that define the vagina as dirty after menstruation and sexual intercourse.
In Turkish culture, women describe menstruation and menstrual bleeding as dirty. The rate of VD in Turkey is between 43.9-64.5%. In other words, 6 out of every 10 women have VD. In a survey conducted by the Ministry of Health of the Republic of Turkey in 2014, 79.20% of women do vaginal douching citing reasons such as hygiene (96.26%),religious beliefs (52.86%) and pregnancy prevention (12.74%). There is no such contraceptive method as washing the vagina after sexual intercourse to remove sperm from the vagina.
Moreover, it is irrational. Even at the moment of intercourse, when the man ejaculates into the vagina, the ejaculate spills out of the penis into the vagina and even if you run to the bathroom and wash your vagina, the sperms have already reached the uterus through the cervix. In addition, in my professional life, I have witnessed many women diagnosed with vaginismus who could not have sexual intercourse with their husbands but became pregnant because their husbands ejaculated in front of the vagina. In other words, washing the vagina after intercourse is an unnecessary practice.
Why do women do vaginal douching? They report that it makes them feel clean, healthy and well, treats infections, helps them perform ablution, increases their interest in their partner and prevents pregnancy. In addition, women use vaginal douching for vaginal cleansing after sexual intercourse to protect themselves from diseases, to feel clean during menstrual periods, before sexual intercourse and gynecological examinations, to reduce unpleasant odors, to imitate those who do it, to be interested in new experiences, and for reasons such as curiosity.
The rate of douching in women over 50 years of age is 61%. The rate of VD in the 20-29 age group is 43%. 61% of employed women do not douche, while 56.8% of unemployed women douche. There is an inverse relationship between education level and the frequency of VD. Among vaginal douchers, 75% used only water and 18% soapy water.
Most women learn vaginal douching from their mothers. Many studies say that vaginal douching is harmful. It damages the vaginal ecosystem, the protective mucus layer, the pH.
Vaginal douches such as povidone iodine and vinegar water have both been shown to do more harm than good by increasing vaginal infection. In short, do not wash the vagina. Only the vulva, and then only with water after using the toilet and then drying it afterwards to remove excess moisture. Research shows that a vulva and vagina washed with soap increases the chances of HIV transmission by 4 times.
In one study, women showed that their partners encouraged them to use vaginal douching. The truth is that washing the vulva before sexual intercourse is sufficient. Water is enough to remove the moisture, sweat and odor that settles on it during the day. There is also no need to wash the inside of the vagina and vulva with soap.
The use of boric acid to support vaginal pH is very harmful. Boric acid is harmful to fungi and bacteria, not because it makes the vagina acidic, but it also damages vaginal cells. It should only be used in the treatment of drug-resistant fungal infections under the supervision of a physician to eliminate the biofilm formed in bacterial infections.
Some studies have shown the effect of VD on vaginal flora and the ascent of microorganisms into the upper genital tract. In the past, VD has been associated with bacterial vaginosis, human immunodeficiency virus (HIV) and chlamydial infections, pelvic inflammatory disease (PID),preterm birth, low birth weight babies, inability to have children, ectopic pregnancy, cervical cancer and AIDS.
Vaginal dryness, vaginal burning, genito-urinary infection and irritation have been reported in women who do frequent vaginal douching. In an older study, the rates of genital infection in douching and non-douching women were 53.5% and 33.8%, respectively. In other words, contrary to popular belief, the infection rate in douchers does not decrease but increases.
In 1990, Brinton et al. They found that the risk of cervical cancer and PID increased even more with the use of commercial products instead of water and soap solutions during showering.
In 2006, Akın et al. found that the rate of inability to have children (40.0%),miscarriage (47.3%),premature birth (40.0%) and low birth weight baby (57.1%) increased in women who do VD.
A study on the effect of douching on vaginal flora found that douching with saline or acetic acid once a day reduced the structure and number of vaginal bacteria within 10 minutes. In addition, douching with bactericidal agents such as povidone-iodine (trade name baticon) has been shown to promote overgrowth of pathogenic organisms that suppress Lactobacillus.
The World Health Organization also stated the negative effects of VD in 2012. Sunay et al. They showed that women who douche have about 4 times more risk of abnormal vaginal discharge than women who do not douche.
After all these, I think I have been able to express that VD should definitely not be done. Unfortunately, we cannot easily give up what we adopt, get used to and believe in as a cultural structure, I especially mentioned such extensive research so that we can understand the importance of the event together and know that the natural vaginal ecosystem is in a self-protecting and self-cleaning order.
We should know that our well-intentioned cleaning of it can harm it. I want to give an example right here, we have organs in our body that open to the outside and have their own ecosystem.
Like eyes, ears, nose. Like the mouth... Do we try to wash these organs with soap and water? Have you ever seen someone drop liquid soap into their eyes and wash them? Or rinse your mouth with soapy water, it's strange to imagine, isn't it? Then why do we do this cruelty to our vagina?
All of these organs have their own special defense barriers, cleaning and protective systems. Let's not interfere with the natural and learn how to protect it. This is actually the right thing.
The most basic mechanism of defense against harmful bacteria in our vagina is the bacteria themselves. These bacteria, called lactobacilli, which I mentioned above, can exist and multiply in an acid environment. The cells in the vaginal wall are epithelial cells and these cells contain glycogen (the storage form of glucose).
Glycogen is a food source for lactobacilli. They use the glycogen to form lactic acid. This is how they exist. They support both their own continuity and the maintenance of the vaginal pH level at an acidic level. When lactobacilli decrease for any reason (infection, VD, etc.),the acidic environment of the vagina deteriorates. The pH increases and the possibility of infection in the vagina increases.
If the acidic environment of the vagina decreases for any reason (such as inappropriate chemicals entering the vagina, decrease in glucogen stores due to decrease in estrogen such as menopause),lactobacilli decrease. And again, infection in the vagina becomes easier. In short, lactobacilli and lactic acid are two important vaginal protective barriers and lactobacilli produce lactic acid. When we talk about genital hygiene, I want you to think of this duo frequently and the rules of genital hygiene are aimed at protecting this duo.
The genital system, especially the vagina, is constantly at war with bacteria that enter during sexual intercourse. Apart from this, the vagina is in close proximity to the urinary tract and anus, so every woman should know the hygiene rules well.
During sexual intercourse, in the sexual response cycle, in the arousal phase, the clitoris fills with blood and rises, which allows the urethra to close, protecting us from bladder infections. Outside of intercourse, a sphincter (valve) mechanism in the urethra also provides protection against bladder infections. Urinating after sexual intercourse protects you from infections.
Beneficial bacteria living in the gut help to keep the vaginal flora healthy. It has been observed that the beneficial bacteria (probiotic bacteria) contained in the intestinal microbiota increase the success of treatment when they are added to the treatment for supportive purposes in capsule-shaped drug treatments produced to be taken orally, in recurrent resistant fungal vaginitis where they strengthen the vaginal flora.
In cases such as intestinal dysbiosis (flora disruption),we can see that the vaginal flora is negatively affected. Bacteria from the intestines can positively or negatively affect the vaginal flora. Therefore, the intestines are a natural source of lactobacillus in the vagina and contribute to the protection of the natural vaginal microbiota.
Vaginal microbiota changes throughout human life. Just as our body changes with age, our vaginal microbiota changes from childhood to adolescence, adulthood, pregnancy and menopause. The rhythm of our vaginal flora life is determined by hormonal changes in our body.
For example, vaginal flora changes during the menstrual cycle. Due to the proteins it contains, the existing bleeding is a food source for bacteria and creates a favorable environment for the proliferation of harmful bacteria. Therefore, vaginal infections occur most frequently during this period in women who do not pay attention to their hygiene. Therefore, it is extremely important for your health to follow the rules of genital hygiene.
Vaginal microbiota also plays an important role in childbirth. Physiological changes occur so that the body of pregnant women adapts to the baby and the body of the baby adapts to the mother. The vaginal flora of pregnant women is more stable, less diverse and less variable. This is due to elevated estrogen levels in the blood, which makes lactobacilli dominate and dominate the flora.
With menopause, estrogen levels in the blood begin to fall. The microbiota returns to another state of balance. The microbiota moves in parallel with hormones. Polymicrobial flora (a wide variety of bacteria) in pre-puberty period, Lactobacilli dominant flora in adulthood, polymicrobial flora during menstrual periods, lactobacilli dominant flora during pregnancy, polymicrobial flora during menopause.
They prevent pathogenic microorganisms from attaching and multiplying in the vagina. They do this by the following mechanisms.
Stress, Excessive hygiene, Vaginal douching, Medications (antibiotic treatment, etc.) Alcohol, Cigarettes and other tobacco products affect the composition of the microbiota and cause imbalance in the flora (Dysbiosis)
It occurs when Lactobacillus, the most important bacteria in the vaginal flora, lose their dominant status. And this opens the way for pathogenic and opportunistic organisms to colonize and invade the vagina. You can easily recognize that you have this condition. Here are the symptoms: An unusual vaginal discharge, vaginal itching, pain in the vulva, burning sensation or an unusual odor similar to fishy odor, and sometimes no symptoms at all.
When this kind of situation starts, that is, when the vaginal flora balance is disturbed, when the condition we call bacterial vaginosis starts, unfortunately, your chance of catching a disease such as Gonorrhea, Chlamydia, Trichomoniasis and HIV increases. So take good care of your flora. Clear! So we know what has a direct effect.
Good habits for daily intimate hygiene;
For daily cleaning, we recommend washing the vulva with water only on the outside. Moisture in this area prevents the accumulation of sweat discharge, urine and fecal contamination by washing with water.
They are live microorganisms that are alive and beneficial for the body. It helps to correct the imbalance in microbiota. It is naturally found in some foods. Vaginal or oral medication forms have been produced. They improve the symptoms of vaginal infection and reduce the chance of recurrence.
Probiotics are found in natural foods such as yogurt, kefir, pickles, vinegar, etc., which we consume daily. For this reason, it is important to eat a healthy and balanced diet and prefer homemade products.
They are indigestible fibers. Microorganisms in the flora selectively use fibers. Probiotics are added to some products. In products specially prepared for women, they help to correct vaginal acidity and support the proliferation of lactobacilli.
Prebiotics are complex carbohydrate compounds that cannot be digested in the upper gastrointestinal tract (stomach and small intestines) but are fermented by beneficial bacteria in the colon (large intestine). In fact, prebiotics are not a source of food and energy for the gut and body. They are essential substances, especially for the vaginal and intestinal flora.
Your diet is the only source of prebiotics. So by eating, you help protect your gut and vaginal health. We recommend a diet high in fiber, such as fresh fruit and vegetables. The following foods are sources of prebiotics.
Almost every woman has been advised at some point in her life to wear white cotton underwear (granny panties) to protect against vaginal infections and fungi. With this statement, it is as if the vagina is a vulnerable organ that can suffer an accident at any time.
Of course, the vagina and vulva have defense systems that can cope with blood, urine, feces and semen. Therefore, if it does not cause discomfort, a lace thong can be worn with different panties. There is a perception as if good girls wear white cotton and others wear lace.
If a panty disrupts the vaginal ecosystem, then it creates a problem. Anything that disturbs the pH balance of the skin, causes irritation and allergies, traps excess moisture and causes friction can cause problems. All these factors can create a microtrauma environment and then cause infection and fungus.
Panties cannot change the vaginal pH. Wet and moisturized panties under tight clothes for a long time can cause problems. For this reason, we recommend changing wet swimsuits that do not dry quickly after the sea pool. Quick-drying bikinis do not cause problems. If you are exposed to wetness for more than a few hours, a superficial skin injury called maceration occurs with the combination of moisture and friction.
Marathon runners apply Vaseline between their legs for this. If your underpants are suitable for your body, if they do not get between your legs every now and then and do not bother you, they are suitable for you. I recommend avoiding plastic products that create friction and microtrauma, trap moisture and make you sweat.
As for not wearing panties, many women do not wear panties because their vagina breathes. Contrary to popular belief, the vulva and vagina do not like oxygen. If it is not a problem for you to get your natural vaginal discharge on your legs, clothes, pants and pajamas, you may not use them. In this case, you will need to choose clothes that do not create moisture, do not cause microtrauma, and are not allergy-irritating.
If you are wondering how should I wash my panties, I recommend you to choose additive-free, dye-free liquid detergents, white soaps and I do not recommend using chemicals such as fabric softener. These can cause allergies.
Since urine and feces can damage the barrier of the skin called acid mantle in vulva cleaning, we consider it appropriate to clean with water only after each toilet. Glands called apocrine sweat glands in the vulvar skin are located at the base of the hair follicles.
They produce sebum, a thick, oily secretion that protects the skin. This is an important component of the acid mantle. We never recommend soap because it damages the acid mantle, dries the skin and causes infections.
The crotch, venus crest, outer lips, around the anus can be washed with water. However, we do not recommend washing the inner lips due to the vaginal opening and the mucosa structure inside the vagina.
We said no soap in washing, but can feminine shower products or special wet wipes produced for this area be used? You can use products that do not disrupt the vaginal pH, do not contain allergens, do not irritate, do not contain fragrances such as perfume, do not contain allergens and chemicals such as lanolin formaldehyde tea tree oil. But we can never be completely sure about these products. You will need to find the products by trial and error.
Because even if there is a product you like, they can change their ingredients in the next production. Dermatologically tested, gynecologist tested. Ph balanced product, light like a baby, etc. It is necessary not to be fooled by marketing terms. It is best to stay away from every product that bothers you.
Products with a pH value between 5.3-7 can be used, products between 5.3-5.6, which are at the pH level of the vulva, are much better. pH values of 7 and above damage the oil layer in the vulva. If you want to use soap, castile soap is well tolerated in studies.
A new market area in genital area cleaning has been wet wipes. This product is thought to be safe because it is used in babies. However, the truth is that the vulva is more likely to be irritated by these products.
They are 20 times more likely to contain allergens, fragrances and chemicals. They should never be inserted into the vagina. There is a lot of money hidden behind vaginas. The industry has set its eyes on women with a huge market share. Cleansing gels, solutions, intimate gels, soaps, cleansing suppositories, fragrances, deodorants...
Women, I've been seeing a lot of television commercials lately, there is an advertisement for an oven called a self-cleaning oven. Actually, that's exactly what your vaginas are like. It cleans itself.
Studies have been conducted to moisturize the vulva, coconut oil and olive oil reduce water loss, anti-inflammation effects and benefits, emollient and skin covering effects have been reported positively. You can use these products on the perineum (the area between the vagina and the anus) around the anus and vulva, never inside the vagina.
Avoid using products such as salicylic acid, retinol, decolorization products on the vulva. Finally, if we make a short summary;