Reducing Chemicals, Moisture, and Friction for a Healthy Vulva
The Vulva
The vulva is the gatekeeper to the vagina in more ways than its anatomical position. If you need a review of the anatomy, go back to the article You are more than a vagina. It has an important job to project itself, the vagina, and the urinary tract. External factors play a major role in the health of the vulva. This means what you put on or around the vulva including lubricants, clothing, soaps, and detergents can impact how it feels. These next few paragraphs will help explain why it is important to care for the vulvar skin.
Vulvar Skin is Different
The mons pubis and labia majora are made of keratinized, stratified squamous skin cells and contain sweat glands, oil glands, and hair follicles. This is similar to the skin on the rest of your body that grows hair. This skin on the vulva compared to your forearm has a higher hydration content, tolerance to friction, and occlusion which makes it more susceptible to irritation, inflammation, and reactivity to products applied to the vulva (1-3). Hair follicles in the vulvar region are larger than other hairy body part by comparison increasing the chances for microbes to get through the skin (4).
The vulvar vestibule is made of non-keratinized skin cells (1). These skin cells are similar to what you feel on the inside of your mouth, throat, and vagina. These skin cells may allow the vulvar vestibule to absorb anything applied to the vestibule more easily (1).
The vulva its own microflora and pH
The vulva has its own microflora that plays a key role in protecting the vaginal canal and urethra from pathogens which could lead to infections (5). It has its own pH which does the same. Both the microflora and the pH of the vulva fluctuate naturally with menstrual status, the anatomy of the vulvar folds, sweat and humidity, age, genetics, and contact with urine and feces. The vulva microflora and pH will also fluctuate with how you interact with the vulva: soap use, lubricant choices, clothing, laundry detergents, shaving (1). Appropriate microflora and pH are important to reduce risk infection, irritation, pain, and other vulvar skin issues (1).
How to Care for the Vulva
What is your vulvar self-care and hygiene routine? Has anyone taught you how to care for your vulva? Routine vulvar care education is often missed in the absence of a medical symptom. Advertisements and most commonly unnecessary products designed specifically for persons with a vulva make it increasingly confusing to innately understand how to care for yourself. Here are some tips to follow for a heathy vulva.
1. Wash with water only (and a clean towel)
The vulva with the vagina is a self-cleaning oven thanks to its pH, microflora, and other natural defenses (1,4). Products make this confusing with special “feminine” washes, douches, and deodorants which can disrupt the natural mechanisms of the vulva increasing the risk for bacterial vaginosis and other infections (4,6). If you would not put it in your mouth, it does not belong on the vulva (unless you are using a prescribed vulvar medication). Get a clean soft washcloth and use that to wash between the anatomical folds of your labia. It is not necessary to scrub, be gentle. Practice this daily, after intercourse, on your cycle, after exercising. Practice this always.
2. Use unscented and non-dyed laundry soap
Your underwear sit right on the vulva. The chemicals within the soap can be irritating to the vulvar skin. Dyes, scents, enzymes, whiteners, and brighteners in your laundry soap may not irritate your skin elsewhere but remember the vulva has increased ability to absorb and is often more sensitive. If you’re washing your underwear, skip on the fabric softeners and dryer sheets too.
3. Wear cotton brief underwear and take them off at night
Let the vulva breathe. Cotton underwear will help reduce excess moisture and sweat at the vulva to help reduce increased growth of bacteria. Wear briefs and not thongs. Think of a thong as a bacteria string that sits next to the anus. You could see how this could lead to increased risk for infection at the vulva. Friction can also irritate the vulva skin. Avoid underwear that are too tight or other clothing items that sit tight along the vulva to reduce friction. Finish off your day by taking your underwear off and letting the vulva breathe all night long.
4. Wash your sex toys
Wash your sex toys after every use. This includes toys used internally in the vagina and externally on the clitoris or other areas. Use soap and water or another alternate cleaner available on this website that is appropriate for the toy. This will help decrease build up of bacteria on the toy.
5. Keep the hair
Pubic hair is more than just hair. It has many functions including reducing friction against clothes and during sex, maintaining moisture levels, stopping microorganisms from reaching the vestibule, and releasing pheromones to attract others (7). Removal of the hair may lead to increased irritation through friction, changes of the microflora, changes of pH, and increase risk of infection (7).
6. Do vulvar skin checks once a month
Take out a mirror and look at your vulva once a month. Examine the shape, color, and your labia size. This will help you understand what your normal is but also if there is a change that may signify a medical symptom. In my practice as a pelvic health physical therapist, I often ask the question: is what your vulva looks like today normal for you? This could help clue me into skin conditions, hormonal changes, or other factors that may be impacting why the patient is seeing me. I too often get an ‘I don’t know’ as a response. This is of no fault to the patient but of the lack of education to do vulvar self checks in general healthcare visits. The vulva is a crucial part of your health, so if you haven’t been looking, start today!
As you make these changes, observe how your vulva feels and changes. Share with your friends and family so you’re surrounded by happy vulvas. This information is not common knowledge and you could be a part of the change to support education on vulvar health.
Cheers to a happy vulva,
Ariel
Sources:
1. Chen Y, Bruning E, Rubino J, Eder SE. Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Womens Health (Lond). 2017 Dec;13(3):58-67. doi: 10.1177/1745505717731011. Epub 2017 Sep 22. PMID: 28934912; PMCID: PMC7789027.
2. Elsner P, Wilhelm D, Maibach HI. Frictional properties of human forearm and vulvar skin: influence of age and correlation with transepidermal water loss and capacitance. Dermatologica. 1990;181(2):88-91. doi: 10.1159/000247892. PMID: 2242791.
3. Farage, M.A. Vulvar susceptibility to contact irritants and allergens: a review. Arch Gynecol Obstet 272, 167– 172 (2005). https://doi.org/10.1007/s00404-005-0732-4
4. Murino F, Graziottin, A, et al. Real-world practices and attitudes towards intimate self-care: results from an international women’s survey. Journal of gynecology obstetrics and human reproduction. 2021; 50(10). http:// doi.org/10.1016/j.jogoh.2021.102192
5. Brown CJ, Wong M, Davis CC, et al. Preliminary characterization of the normal microbiota of the human vulva using cultivation-independent methods. J Med Microbiol 2007; 56(Pt 2): 271–276
6. Sabo MC, Balkus JE, Richardson BA, Srinivasan S, Kimani J, Anzala O, Schwebke J, Feidler TL, Fredricks DN, McClelland RS. Association between vaginal washing and vaginal bacterial concentrations. PLoS One. 2019 Jan 24;14(1):e0210825. doi: 10.1371/journal.pone.0210825. PMID: 30677048; PMCID: PMC6345501.
7. Romero-Gamboa, Daniel & Diaz Martinez, Luis & Díaz-Galvis, Marta & González Blanco, Diana. (2019). Impact of genital hair removal on female skin microenvironment: barrier disruption and risk of infection, a literature review. Revista Médicas UIS. 32. 27-33. 10.18273/revmed.v32n3-2019004.
Artistic Vulvar Art: Shutterstock contributor Inna Marchenko, Stock Vector ID: 2314532473.
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