The Facts About Vaginal Health

While much is known about the vagina and its reproductive role, the organ may be one of the most misunderstood when it comes to daily hygiene issues and disease prevention.

Understanding how to care for your vagina is essential to preventing sexually transmitted infections (STIs), cancer, infection, rashes and irritation. It can also play a role in improving sexual health.

Understanding the vagina's anatomy and its functions are the first steps to maintaining vaginal health. Knowing the anatomy of both internal and external organs is key to preventing infections, maintaining proper hygiene and even enhancing sexual pleasure.

When most people think of the vagina, they think of the outer skin folds and the opening that leads to the internal cavity. However, these external areas are composed of the pubis and vulva. The vagina itself is the elastic channel that connects the outside of the body to the female reproductive organs. This channel contains a complex biome of microorganisms that is both delicate in its balance and robust in its ability to protect your body from pathogens.

In terms of external anatomy, the pubis refers to the front of the pelvis where most pubic hair grows. This section of the groin contains thicker skin and a cushion of fat to protect the pelvis and the high concentration of nerves in and around the vagina. Also external is the vulva, which is composed of the labia majora and labia minora. The labia majora is the outer set of skin flaps that surround the vaginal opening. This portion, covered with pubic hair, helps prevent friction during intercourse and protects the more sensitive inner lips (labia minora), the urethra opening and the clitoris.

The labia minora is often smaller in size than the labia majora, but every woman is different, and the size, shape, color and symmetry of the labia minora can vary. While many women have labia minora that are completely concealed beneath the labia majora, it is not uncommon for the labia minora to extend beyond the labia majora.

No matter the appearance of your labia minora, what is natural for your body is healthy for your vagina. The lips should be moist, free from inflammation and positioned on either side of the opening to the vaginal canal. The top point at which the two sides of the labia minora meet is called the clitoral hood, which covers and protects the clitoris.

The clitoris is seated at the top of the labia minora and above the urethral opening. This is an important distinction: Many women mistakenly believe that the urethra is inside the vaginal canal when in fact the urethral opening, where urine exits from the body, sits above the vaginal opening.

Internally, the vaginal canal begins at the vaginal opening and continues to the cervix, the entrance to the uterus. The vaginal canal is a closed canal inside the female body and is about 2 to 4 inches long. However, the vagina can elongate up to 8 inches when a woman is sexually aroused and also during intercourse. The vaginal canal can also increase in diameter before and during childbirth.

While the vagina is often thought of as a cavity, this muscular channel remains closed with the vaginal walls touching. It is only when something is inserted into the vagina that the organ will open to accommodate a foreign object.

The vagina is a highly elastic channel that is supported by the pelvic floor, a collection of muscles that serve as a foundation for the vagina, uterus, intestines and bladder. The pelvic floor can become weakened as a result of childbirth, surgery or abdominal muscle atrophy. Because of this, it is vital to bladder and digestive function to maintain a strong pelvic floor. Adding Kegels and other pelvic floor exercises into your daily exercise regimen can strengthen and maintain your pelvic floor and increase vaginal elasticity.

For optimal vaginal health, the natural microbial environment that supports the daily functions of the vagina must be maintained. This involves the physical state of both the vulva (exterior area) and vagina (interior organ), which are influenced by daily hygiene, as well as sexual and dietary habits.

When a vagina is healthy, the labia is elastic and free from excess yeast or discharge, which can build up and can cause irritation, itching and, potentially, infections of both the vagina and the urinary tract. A healthy vagina is actually a self-cleaning microbiome that produces its own lubrication, which acts as a cleansing agent to remove harmful bacteria, an overgrowth of which may lead to health complications.

Contrary to popular misconceptions, when functioning properly, the vagina needs little help to maintain its delicate microbial balance. In fact, the more we interfere with the natural cleaning cycle, the more likely it is that a pH imbalance will occur, possibly leading to infection. When the vaginal functions and microbial environment are balanced, vaginal health is optimal and enhances sexual performance by maintaining both proper lubrication and vaginal elasticity.

When vaginal health is compromised by infection, hormonal imbalance, pH imbalance, general irritation or injury, a woman's health and sexual performance can become compromised. Regular monitoring of your vagina and vulva can help you detect any unexpected changes—key in taking the first steps toward getting a proper diagnosis followed by treatment, if necessary.

While the vagina takes efficient care of itself, its delicate microbial balance can easily become compromised as a result of deficient or extreme hygiene, intercourse and monthly menstruation.

The natural pH of the vagina is slightly acidic, around 4.5. This level is just high enough that most harmful bacteria cannot survive. In fact, the higher the vaginal acidity, the less likely sperm will survive, which may be considered ideal for pregnancy prevention. However, this can create an additional obstacle for women who are trying to conceive. Regardless of your reproductive goals, note that naturally alkaline semen can actually impact the vagina's pH balance. This is why intercourse may create an imbalance of pH and increase the chances of vaginal infection.

Activities that can also throw off vaginal pH include washing your vulva or vagina with strong soap and using perfume, talcum powder and products labeled "feminine care products." These items all have the ability to negatively impact your vaginal health.

Normally, the vagina maintains its pH balance in part by creating vaginal discharge. This discharge contains a combination of natural vaginal lubricants, dead skin cells and any bacterial overgrowth that your vagina has cleaned from its tissues. Vaginal discharge is a sign of a healthy immune system. The average amount that a person produces varies, but as long as it remains consistent, your body is likely perfectly healthy. A change in quantity or color can signify ovulation or the start of menstruation.

If a change in discharge occurs that does not coincide with your monthly cycle, and you also experience redness, itching, generalized irritation or a foul odor emanating from the discharge, these may be symptoms of an infection. Some of the most common infections that can occur are yeast infections and vaginitis. A yeast infection, which is a type of vaginitis, is a fungal infection that causes irritation, discharge and intense itchiness of the vagina and the vulva. Some 3 out of 4 women will likely experience a yeast infection at some point in their lives. Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. If left untreated, these infections can spread to the cervix or develop into a urinary tract infection, requiring more urgent treatment.

The most common causes of infections stem from a bacterial imbalance. Common practices such as douching, taking a course of antibiotics, using tampons and even some forms of birth control may put you at a higher risk of recurrence.

Vaginal health begins with good hygiene practices, a healthy lifestyle and diet, and regular gynecological care.

Do not use perfumes, cleansers, douches, feminine wipes or anti-itch creams. These products will change the sensitive vaginal pH and may lead to a yeast infection. If you feel you need to freshen up during your period, look for wipes specially formulated to cleanse while promoting a healthy vaginal pH. Otherwise, you do not need to use products to get your genitals to look, smell or taste any specific way. This is a myth created by popular culture that can directly harm your health.

When you shower, only wash the pubis, labia majora and labia minora (exterior areas) with warm water, and do not ever put any soaps or washes inside your vagina. The only hygiene products that should touch your labia are pH-balanced, FDA-approved products that will not harm your natural flora balance. Lubricants and sex toys can also cause many health problems, so use care when choosing sex products.

In addition to hygiene, diet and lifestyle changes may improve vaginal health. A diet rich in fresh fruits and vegetables is a great way to maintain a healthy vaginal pH. Excess caffeine consumption and very acidic drinks may cause a high vaginal pH, which can lead to vaginal dryness and irritation. Eating a portion of fermented foods each day, such as sauerkraut, pickles and kimchi, and taking a probiotic supplement can help stabilize your natural pH level.

Regular exercise, too, can support vaginal health and may also improve your sexual performance, while preventing female sexual dysfunction. Exercises such as yoga can also improve sexual function by increasing the body's flexibility and stamina. Kegel exercises can strengthen the pelvic floor, which intensifies sexual pleasure and supports reproductive and urinary health.

Routine checkups and preventive care are essential for a woman's health regimen. Make your annual gynecological appointment a priority, including getting regular Pap smears, pelvic exams and other tests your physician advises.

Cervical cancer was once the leading cause of cancer death in women. But since the 1950s, incidence and mortality of cervical cancer has dropped by more than 70 percent as the Pap test and similar advances became more available. Preventive measures increase the chances of early detection and survival in the case of a cancer diagnosis.

You can help detect common infections and reproductive cancers early by documenting your monthly vaginal health, noting any changes that arise. As soon as you identify an abnormality, visit a professional for the appropriate care.

Get to know your body and talk with other women about their vaginal health experiences. The more we talk about the vagina, the better our chances are of overcoming stigmas that can prevent women from seeking early diagnosis and treatment for curable diseases and cancers.