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Intimate care during pregnancy and post-childbirth

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eMediNexus    13 April 2018

The vaginal pH is ≤4.5 during the reproductive years.1 Several factors have been found to be associated with elevated vaginal pH during pregnancy. These may include bacterial vaginosis (BV), aerobic vaginitis and mixed aerobic vaginitis and bacterial vaginosis flora.2 BV is a common cause of malodorous vaginal discharge and the most common lower genital tract disorder among women of reproductive age group. The causative pathogenic organisms for BV include Gardnerella vaginalis, Mobiluncus species, Bacteroides and Prevotella species and Mycoplasma species.3 BV is a condition in which the lactobacilli-dominated vaginal flora is exchanged with a complex flora abundant in facultative anaerobic bacteria. It has been associated with significant obstetric complications such as preterm delivery, premature rupture of membranes (PROM), chorioamnionitis and postpartum endometritis.3 BV is often associated with fishy smelling vaginal discharge that is typically milky and bullous. Candida albicans causes infections of the vulva and vagina, causing intense itching and a white, lumpy, and odorless discharge.4 Pregnancy is a period that is associated with certain changes in the lower genital tract, including hypertrophy of the vaginal walls, increase in both blood flow and temperature, increase in non-specific immunity, and vaginal acidity. While these changes are protective to the uterus, pregnancy and fetus, they may potentially increase the likelihood of vaginal infection.4

Pregnancy and breast-feeding lead to fluctuations in the hormonal balance.5 Under the impact of estrogen, the vaginal epithelium becomes hypertrophic. The changing acid content prevents the vagina from bacterial invasion throughout pregnancy but makes it vulnerable to C. albicans invasion.6 Additionally, postpartum loss of estrogen hormone is associated with increased risk of atrophic vaginitis. Genital symptoms of atrophic vaginitis include dryness, burning, dyspareunia, loss of vaginal secretions, leucorrhea, vulvar pruritus, feeling of pressure, itching and yellow malodorous discharge.7

It is thus essential to maintain adequate intimate hygiene during pregnancy in order to prevent the development of such infections. Women, all across the globe, use several intimate hygiene products as part of their daily cleansing routine. Routine washing of the vulva helps prevent accumulation of vaginal discharge, sweat, urine, and fecal contamination. The Royal College of Obstetricians and Gynaecologists suggests that washing with water can cause dry skin and make itching worse.8 Of note, genital hygiene practices have been linked with reduced urinary tract infections (UTI) during pregnancy.9

The Indian beech, Pongam seed oil or Hongay seed oil, is known for its analgesic, and inflammatory activity. Karanjin is the principal agent responsible for the curative properties of the oil. The ethanol extract from Pongamia possesses analgesic, anti-inflammatory and wound-healing activity. Aqueous and alcoholic extracts from the stem bark of Pongamia pinnata have shown anti-inflammatory activity.10 In an evaluation of the antimicrobial activity of seed oil of Pongamia pinnata, the seed oil showed inhibition against tested fungal and bacterial cultures.11 The seed oil of Pongamia has antifungal and antibacterial activities against a variety of organisms.12 Methanol extract of karanja has shown moderate inhibitory action against C. albicans while methanol and chloroform extract have shown significant effect against C. tropicalis.13

Melaleuca alternifolia (tea tree) has long been used in aboriginal traditional medicine for wounds and cutaneous infections, and the essential oil has been in use to treat several conditions such as empyema, ringworm, paronychia, tonsillitis, stomatitis and vaginal infections. Tea tree oil has been noted to be effective in C. albicans clearance in vaginal infection in experimental models.14 Di Vito et al demonstrated the efficacy of tea tree oil in eradicating fungal colonization in vaginal candidiasis.15

Considering the antibacterial and antifungal potential of these two oils, it seems wise to use them as regular intimate hygiene products (wash, wipes, etc.) in order to prevent the development of vaginal infections during pregnancy and after childbirth.

References

  1. Panda S, Das A, Singh AS, Pala S. Vaginal pH: A marker for menopause. J Midlife Health. 2014 Jan-Mar; 5(1): 34–37.
  2. Zodzika J, Rezeberga D, Jermakova I, et al. Factors related to elevated vaginal pH in the first trimester of pregnancy. AOGS 2011;90(1):41-6.
  3. Rao JVN, Chandidni J. The association of bacterial vaginosis with adverse pregnancy outcomes. 2017; 4(50), 3040-3042.
  4. Lima TM, Teles LMR, de Oliveira AS, et al. Vaginal discharge in pregnant women: comparison between syndromic approach and examination of clinical nursing practice. Rev. esc. enferm. USP 2013;47(6).
  5. Bacterial vaginosis as a mixed infection. Hay PE (ed.). In: Polymicrobial Diseases. Brogden KA, Guthmiller JM(ed.). Washington (DC): ASM Press; 2002.
  6. In: Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Pillitteri A (ed.).
  7. Bachmann GA, Nevadunsky NS. Diagnosis and Treatment of Atrophic Vaginitis. Am Fam Physician. 2000 May 15;61(10):3090-3096.
  8. Chen Y, Bruning E, Rubino J, Eder SE. Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Women’s Health 2017;13(3):58–67.
  9. Badran YA, El-Kashef TA, Abdelaziz AS, Ali MM. Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy. Urol Ann. 2015 Oct-Dec; 7(4): 478–481.
  10. Pongamia pinnata (Linn.) Pierre and Inflammation. Badole SL, Patil KY (eds.). In: Polyphenols in Human Health and Disease. Watson RR, Preedy VR, Zibadi S (eds.). Academic Press; 2014.
  11. Kesari V, Das A, Rangan L. Physico-chemical characterization and antimicrobial activity from seed oil of Pongamia pinnata, a potential biofuel crop. Biomass and Bioenergy 2010;34(1):108-15.
  12. Bandivdekar AH, Moodbidri SB. Spermicidal activity of seed oil of Pongamia glabra. Archives of Andrology2002;48(1):9-13.
  13. Usha P. Antifungal activity of karanja (Pongamia glabra) on medically important clinical isolates of Candida fungi.IJAAR 2017;III(1):43-7.
  14. Mondello F, De Bernardis F, Girolamo A, et al. In vitro and in vivo activity of tea tree oil against azole-susceptible and -resistant human pathogenic yeasts. Journal of Antimicrobial Chemotherapy 2003;51:1223–9.
  15. Di Vito M, Fracchiolla G, Mattarelli P, et al. Probiotic and Tea Tree Oil Treatments Improve Therapy of Vaginal Candidiasis: A Preliminary Clinical Study. Med J Obstet Gynecol 2016;4(4): 1090.

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