Your Ultimate Guide To Vaginal Health

“Am I normal down there?,” you ask. Here is the ultimate guide to what’s normal, what’s not and what you can do to maintain your best vaginal health!

Let’s talk about it. The vagina is an important part of our anatomy, yet one we are often embarrassed to discuss. We shouldn’t be — after all, it is the source of both pleasure and life, and it is part of what defines us as women. We should embrace our vaginal health and not ignore any concerns we may have.

For all of us who have ever wondered, “Am I normal down there?,” here is the ultimate guide to what’s normal, what can go wrong and what can be done about it.

Appearance

Technically speaking, the vagina is the inner canal, and the visible area, including the labia (lips), is the vulva. Every woman’s genitalia is as unique as her fingerprints. The labia can be larger or smaller, smooth or slightly droopy. The labia are fat-filled sacs designed to protect the vagina and urethra (the urinary canal) as well as to make sex comfortable. And just like the rest of our skin, it changes with age. It also requires adequate nutrition, in particular good levels of protein to maintain collagen.

Between the labia, you might notice tiny, pimple-like bumps. These are normal sweat and oil glands which produce fluid to keep the vagina lubricated and prevent friction. The clitoris can also appear very different from woman to woman. An organ designed solely for pleasure, it extends back and can swell when aroused. Pubic hair too can vary greatly both in quantity and distribution, from just below the belly button to the top of the thighs.

Women are sometimes concerned about the appearance of their labia, even if they are perfectly normal in appearance and causing no pain or discomfort. Some women may even find themselves considering an operation called a labiaplasty. As with any operation, there are risks associated with the procedure, and the results do not always live up to patient expectations. It is important to discuss all aspects of this procedure with your health care professional. And unless deemed medically necessary, labiaplasty is not recommended for women under the age of 18, as the labia may continue to develop even into early adulthood.

Female genital mutilation is an illegal practice which can change the appearance of the vulva and narrow the vaginal opening, or introitus, resulting in both short- and long-term physical and psychological consequences. If you or or anyone you know is at risk, it is important to contact the authorities and health care professionals. For those who have undergone this procedure, surgery is available to re-widen the vaginal opening.

Types of discharge

Between puberty and menopause, a certain amount of vaginal discharge is perfectly normal and to be expected. The quantity can vary from person to person and throughout one’s cycle. The first few days of your cycle is your period; following this, the discharge can be white and creamy, or yellow, thick and sticky. When ovulation occurs, the discharge changes to clear, slippery, stretchy and wet. Following this, if you don’t fall pregnant, the discharge changes to thick, sticky and hostile to sperm.

Discharge becomes abnormal if other symptoms appear along with it, or if there are changes in color or odor, as these may be signs of infection, including sexually transmitted infections (STIs). As always, it is important to be sexually responsible. Both contraceptive hormones and a condition called cervical ectropion, in which the inner lining of the cervix protrudes outward, can result in copious amounts of discharge. Should you experience discharge that seems out of the ordinary, see your health care professional who can perform an examination of your cervix to ensure that it is healthy.

Just like the skin of our armpits, the skin around the labia has numerous sweat glands. The vagina also produces fluid to keep it healthy and maintain a pH balance at an acidic level. With exercise, it is normal to sweat more in these areas, so don’t be alarmed if the crotch of your gym wear is damp after a workout. Sweat is a good thing, as it prevents friction, chafing and overheating.

Irregular bleeding

Taking the combined contraceptive pill irregularly can cause bleeding or spotting in between periods. If the spotting persists even after you have been taking the pill regularly, then a visit to your doctor is warranted. Other forms of contraception such as the single-hormone mini-pill, contraceptive injections, implants and intrauterine devices can all cause your periods to be irregular. As long as there are no signs of infection and any tests come back normal, the issue will usually settle itself over time.

Bleeding after intercourse is also something you should discuss with your doctor, as it could be due to a polyp — a benign growth that is easily removed. Other causes could include changes to the cervix and cervical or (rarely) vaginal cancer. With these conditions, in addition to bleeding after intercourse, you may also experience copious amounts of discharge. (A one-time instance of mild bleeding after a particularly enthusiastic episode of intercourse is probably no cause for concern, however.)

Lumps and bumps

Bumps are most commonly due to ingrown hairs and are more common in those with elliptical hair shafts. Shaving and waxing can both contribute to ingrown hairs; to reduce the occurrence, try shaving in the same direction that the hair grows. Other hair-removal options are depilatories or professional laser hair removal. Be aware that depilatories can make the skin of the vulva dry and irritated, however.

Other types of lumps may be remnants of the hymen, which may become more obvious if the pelvic floor muscles are weak (keep up with your Kegels!) or the Bartholin glands. These mucus-producing glands, located on each side of the vaginal opening, can sometimes become infected, so it is important to see your doctor for treatment if they become swollen or painful.

The surface of the vaginal walls can also feel bumpy, as it is made up of a type of tissue that can retract and expand as needed. And just as with any other part of the body, the vulva is susceptible to sebaceous cysts (fluid-filled sacs that are not infected or painful), warts, boils and abscesses. A visit to the doctor is warranted should any of these conditions occur.

Painful sex

Some women experience vaginal pain during sex. One type of pain is defined as superficial dyspareunia, and usually occurs when the vagina is either too dry or inflamed, perhaps due to an infection. Foreplay and lubrication can often help with superficial dyspareunia, but if an infection is suspected, see you doctor.

In contrast, deep dyspareunia is pain that occurs in the lower abdomen or pelvis during sex, and can be due to several conditions, including endometriosis and fibroids. If you are experiencing deep dyspareunia, please see your healthcare professional for proper diagnosis and treatment.

Sex can also be painful because of a condition called vaginismus, in which the muscles around the vagina spasm on attempted penetration. In severe cases, this can happen even when inserting a tampon. It is important to discuss this condition with your doctor in order to determine the cause and the best course of treatment, which may include dilators to gradually desensitize the vagina.

Itching

The most common reason for vaginal itch is thrush, which is often accompanied by a chalky discharge. Thrush is easily treated with over-the-counter antifungal medication, but if this is a first-time occurrence or your current treatment isn’t helping, you should see your healthcare provider to rule out other causes.

Other conditions that can cause itchiness include eczema, lichen planus (itchy and sore white streaks or patches with discharge around the vulva and vagina) and vulvar dystrophy, or changes to the skin of the vulva. One type of vulvar dystrophy is lichen sclerosis, an itchy, sore area around the vulva that can result in pale, shrunken skin. These conditions can be treated by vulvar dermatologists who specialize in conditions affecting the skin around the vagina.

We can easily disrupt our normal vaginal flora and irritate the protective outer layer of skin by using scented products, douching and over-drying. This can lead to dermatitis, or inflamed skin.

Here are some basic tips for avoiding the itch:

• Refrain from douching (washing out the vagina)
• Wear cotton underwear or none at all
• Decrease the temperature of your bathwater
• Always wipe from front to back
• Don’t wear tight clothes, such as skinny jeans
• Change condoms if you practice anal and vaginal sex
• Wash with water only if possible, or only use unscented washes
• Switch laundry detergents if you suspect you are having a skin reaction

Odor

There are many possible reasons for vaginal odor, from the overgrowth of normal bacteria when the vaginal environment becomes less acidic (a condition called bacterial vaginosis) to a retained tampon or condom (which can easily be removed by your health care provider). In some women, bacterial vaginosis is triggered by their periods or intercourse. In these cases, regular use of a lactic acid vaginal gel can often prevent a recurrence by keeping the vaginal flora in balance. However, it is always advisable to have any new or worrisome symptoms checked out, especially if it is a first-time occurrence.

Numbness

The increased popularity of cycling has made numbness and pain a fairly common problem. The prolonged pressure of sitting on a bicycle seat can affect the skin and nerves in the area. Problems can usually can be prevented by wearing padded shorts and getting a firm, supportive seat that you won’t sink into. If you are experiencing more serious and persistent problems such as swelling, back pain, or urinary or bowel problems, a visit to your doctor is definitely in order. Cycling is a great way to increase your fitness level, but some preparation beforehand is essential to prevent problems down the line.

Urinary changes

When passing urine becomes painful, the most common reason is a urinary tract infection. This type of infection often appears after sex, and is best prevented by passing urine both before and after intercourse to flush out any bad bacteria that may be hanging around. Being well lubricated during intercourse can also be helpful in decreasing chafing or sores. Urinary incontinence can sometimes occur if the muscles are weak — be sure to see your doctor should this be of concern.

Dryness

Rigorous cleansing, the use of hormonal medications (especially those containing progesterone), low estrogen levels, breast feeding, aging and medications such as antihistamines and antidepressants can all contribute to vaginal dryness. Discussing contraceptive choices with your health care professional will help to ensure that you are on one without the side effect of vaginal dryness.

Vaginal dryness also increases as we get older and enter perimenopause and then menopause, but there are vaginal moisturisers, lubricants and hormonal treatments that can help. These products are available both over the counter and by prescription. Remember, it is important to always test vaginal products on a patch of skin, such as your inner thigh, before use to ensure that you are not allergic.

The vagina, like other parts of the body, needs to be kept healthy. Being aware of what’s normal and what isn’t, as well as when to seek medical advice, is vital because while most of what we notice and experience is normal, there are some signs and symptoms that are best treated rather than ignored.

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