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Intimate hygiene for vulvovaginal health

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eMediNexus    15 December 2018

Vulva acts as the first line of defense in protecting the genital tract against infections. Contaminants in the vulvar folds, increased moisture, sweating, menses, and hormonal changes affect vulvar microbial growth, leading to vulvovaginal infection and odor.1

The vaginal microbiota affects quality of life, protects against pathogens, and influences fertility and reproductive success. A disrupted balance of the microbial ecosystem gives way to extensive health consequences.2 Normal vulvar flora is composed of the vaginal, urethral, and colonic microbes besides microbes characteristic of intertriginous skin. The vulvar microbiome is diverse, and may include staphylococci, micrococci, diphtheroids, lactobacilli, streptococci, Gram-negative rods, yeasts, and species of fecal origin.1

Lactobacilli usually dominate a healthy vagina. These produce lactic acid, resulting in an acidic environment (pH 3–4) and prevent vaginal colonization by other bacteria. However, in some healthy women, Lactobacilli may be absent and replaced by other lactic acid-producing bacteria, such as Atopobium vaginae, Megasphaera spp., and/or Leptotrichia spp. In some asymptomatic women, the vagina may even be colonized by potentially pathogenic organisms.1

The composition of the vaginal microflora is known to fluctuate and is driven by internal factors such as age, hormonal shifts (during menarche, menses, and pregnancy), and infections, and external factors such as hygiene practices, sexual intercourse, antibiotics, and hormone replacement therapy.1,2 Normal vaginal flora, an acidic vaginal pH, and vaginal discharge constitute the defense mechanism and protect against vulvovaginal infections.1

Women have been shown to use diverse feminine hygiene products.1 The use of commercially manufactured as well as homemade products for vaginal/genital health and hygiene is quite common.2

A survey by Crann et al2 revealed that more than 95% of the survey respondents reported using at least one product in or around the vaginal area. Common products and practices included vaginal/genital moisturizers, anti-itch creams, feminine wipes, washes, suppositories, sprays, powders, and waxing and shaving pubic hair. Another study assessed vaginal practices in Indonesia, Mozambique, South Africa, and Thailand and noted that women used a variety of products, ranging from traditional herbal-type preparations to commercial products such as douches, soaps, and vaginal creams. Hygiene practices included external washing and intravaginal cleansing or douching and ingestion of substances.1,3

There are several factors that may contribute to feminine hygiene practices, including personal preference and cultural and societal influences. Vaginal douching is common among many women; however, it has been linked with an increased risk of pelvic inflammatory disease, endometriosis, and sexually transmitted infections. Routine washing of the vulva seems beneficial in preventing the accumulation of vaginal discharge, sweat, urine, and fecal contamination and prevents offensive odor.1

Of note, certain intimate hygiene products may disturb the pH in the vulvovaginal area, thus impacting the composition of the normal vulvovaginal microbiome. Daily cleansing of the vulva with a gentle hypoallergenic liquid wash has thus been recommended.1 It is known that poor vaginal hygiene is correlated with bacterial vaginosis. Thus, women should adopt safe and hygienic practices. Harsh soaps can irritate the vulvar skin and incite or aggravate vulvar dermatitis. It has been shown that using a lactic acid formulation for vulvar cleansing can help prevent bacterial vaginosis recurrence.1 The SOPHY project revealed that use of natural plant extracts for intimate hygiene had a positive clinical effect favoring the reduction of vaginal pH, improvement of symptoms and the quality of sexual activity in all age/conditions.4

It is thus clear that guidelines recommend a hypoallergenic liquid wash for intimate hygiene and evidence points to the potential role of natural plant extracts and a lactic acid formulation in achieving this aim. Therefore, for feminine intimate hygiene, preparations containing plant extracts with components having antimicrobial, antioxidant and anti-inflammatory action should be chosen. Additionally, the products should be formulated at acid pH.5

References

  1. 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.
  2. Crann SE, Cunningham S, Albert A, et al. Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey. BMC Womens Health. 2018; 18: 52.
  3. Martin Hilber A, Hull TH, Preston-Whyte E, et al. A cross cultural study of vaginal practices and sexuality: implications for sexual health. Soc Sci Med. 2010 Feb;70(3):392-400.
  4. Guaschino S, Benvenuti C; SOPHY Study Group. SOPHY project: an observational study of vaginal pH, lifestyle and correct intimate hygiene in women of different ages and in different physiopathological conditions. Part II. Minerva Ginecol. 2008 Oct;60(5):353-62.
  5. Guglielminetti ML, Benvenuti C. Antifungal activity of pH and plant extract active ingredients in feminine intimate cleansers. Glob J Microbiol Res. 2015;3(3):150-4.

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