Globally, women use a variety of intimate hygiene products as part of their daily cleansing routine. These practices are influenced by multiple factors, including personal preferences, cultural norms, religious practices, and recommendations from health professionals.
Despite the abundant literature on the vaginal environment, little is known about the vulvar area and how personal hygiene practices can affect its biological and physiological stability. More specifically, there is little information published in the medical literature on feminine intimate hygiene in relation to external topical washes and the role it plays in managing unpleasant symptoms and supporting overall intimate health.
This article describes vulvovaginal physiology and the relevance of transient and resident microbiota in relation to common vulvovaginal disorders. It also reviews global feminine hygiene practices and the potential benefits and risks of external vulvar washing for overall female intimate health.
Recently, there has been an increase in feminine intimate wash products on the market, making this topic timely and relevant to a wide range of women.
MICROFLORA
Although knowledge about the microbial composition of the external vulvar area is in its infancy, maintenance of microbiota ratio is anticipated to play a key role in overall vulvovaginal health. Data have shown that the normal flora in the vulva includes vaginal, urethral and colonic microbes, as well as microbes characteristic of intertriginous skin. Many studies in healthy women have shown that the vulvar microbiota is different, with no single species common to all women and includes staphylococci, micrococci, diphtheroids, lactobacilli, streptococci, gram-negative bacilli, yeasts and species of fecal origin. The type of flora on the vulva can also affect the proliferation of exogenous pathogens that cause vaginal and urinary tract infections.
The composition of the vaginal microflora is better understood. It was previously thought that a healthy vagina was dominated by Lactobacillus, non-sporulating gram-positive rods that produce lactic acid, resulting in an acidic environment (pH 3-4). These Lactobacillus prevent the colonization of other bacteria in the vagina (including pathogens) by competing for epithelial cell receptors and through inhibition of growth by generation of antimicrobial compounds in collaboration with the host’s innate defenses (e.g., the cycle periodic hormonal that promotes the release of glycogen and the constant shedding of epithelial cells containing bacteria) to maintain a healthy vaginal ecosystem.
However, the composition of healthy vaginal flora is more variable than initially thought, and in some healthy women, Lactobacilli are absent and replaced by other lactic acid-producing bacteria, such as Atopobium vaginae, Megasphaera spp. and/or Leptotrichia spp. In some cases, asymptomatic women of reproductive age are colonized by potentially pathogenic species (e.g., Gardnerella vaginalis, Staphylococcus aureus, Candida albicans), and therefore, the definition of a healthy versus an unhealthy vaginal microbiome is complex.
PH
The pH of the vulva might be expected to be between the values of the skin (estimated pH 4.7) and the vagina (average pH 3.5), with reports varying from 3.8 to 4.2 during the menstrual cycle. Several factors can affect the pH of the vulva including endogenous factors (for example, humidity, sweat, vaginal discharge, menstruation, contamination by urine and feces, anatomical folds, genetics and age) and exogenous factors (for example, soap, detergents, products cosmetics, lubricants and spermicides, occlusion with tight clothing or sanitary napkins, shaving and hair removal products).
Prolonged drying of the skin on the vulva has been shown to significantly reduce its pH. Vaginal pH correlates with total lactate concentration, since the vaginal mucosa is a rich source of lactic acid, a byproduct of anaerobic glucose metabolism regulated by estrogen. Lactobacillus bacteria and other species also metabolize extracellular glycogen into lactic acid. Therefore, vaginal pH is determined by the sum total of lactic acid production by the vaginal mucosa and microbial flora, but vaginal metabolism may have more influence than microbial metabolism.
GUIDES ON FEMALE HYGIENE
The topic of feminine intimate hygiene has not received enough attention in the medical literature, so education is a priority. According to the RCOG: Royal College of Obstetricians and Gynaecologists guidelines:
Women with vulvar disorders (e.g., contact dermatitis, vulvovaginitis) are advised on vulvar skin care and how to avoid contact irritants.
Washing with water can cause dry skin and worsen itching. It is recommended to use a small amount of soap and water substitute to clean the vulva.
It is preferable to shower rather than bath and clean the vulva only once a day. Excessive cleaning may aggravate symptoms (for example, contact dermatitis symptoms). The use of an emollient may be helpful.
It is suggested to avoid the use of sponges or cloths. Only use your hand and dry gently with a soft towel.
It is advisable to wear loose silk or cotton underwear. Tight clothing should be avoided. It is advisable to wear loose pants or skirts and replace tight stockings with socks.
It is recommended to sleep without underwear.
It is advisable not to use soap, shower gel, scrubs, bubble bath, deodorants, baby wipes or douches on the vulva.
Some over-the-counter creams, including baby or diaper creams, herbal creams (e.g., tea tree oil, aloe vero), and “thrush” treatments, may contain irritants.
It is recommended to avoid the regular use of panty liners or sanitary pads.
The use of antiseptics (as a cream or added to bath water) on the vulva area should be avoided.
It is advisable to wear white or light colored underwear. Dark textile dyes (black, navy) can cause allergies, but if new underwear is washed before wearing, it is less likely to cause a problem.
It is suggested to avoid using colored toilet paper.
It is recommended not to use nail polish on your fingernails if you have a tendency to scratch your skin.
Despite proper intimate hygiene, which not only serves daily cleanliness but also preserves the balance of the vaginal microflora, sometimes conditions such as bacterial vaginosis may arise, for which there are specific products on the market, such as GineCanesbalance.
In conclusion, caring for feminine intimate hygiene is a fundamental aspect of vulvovaginal health, requiring greater focus on education and dissemination of appropriate practices. Studies reveal the importance of maintaining a balance in the microbiota and pH in the vulva to prevent disorders and pathologies. The RCOG guidelines highlight the need to minimize exposure to irritants and the importance of adopting gentle cleaning practices, as well as choosing appropriate clothing to avoid irritation.