It is important to maintain a healthy vulva, but few of us receive practical tips. The scientifically-based approach we recommend is outlined below.
Principle #1: Do No Harm.
In some ways, the vulva is no different than regular skin, while in other ways, it is very special. Generally, the protection mechanisms of the surface of the vulva is very similar to skin elsewhere on the body:
- barrier function keeps things from poking through the skin, and keeps moisture from seeping out
- healthy cell structure means that cells hold on to each other, and withstand friction without tearing apart,
- maintenance of good blood flow to the skin and sub-surface structures.
The vulva and vagina, in particular have:
- an acid-base balance (aka pH) which is in the acid range (usually 5.0-6.0) when the vulva is healthy, and
- a unique biological system (aka the vaginal microbiome) that helps keep the genital system healthy. Neither the vulva nor vagina are sterile, and they are not meant to be sterile. Aggressively treating or cleaning the vulva or vagina removes many of the protective systems that help keep it happy and comfortable. People who only occasionally clean their genitals generally have healthier genitals than those who clean/wash more than once per day.
Principle #2: Moderation in everything.
Think of the vulva as a healthy clean place already. Without intervention, the vulva can usually take care of itself pretty well with just basic care. Some of the problems that people encounter are based on an incorrect notion that “down there” is “very dirty”. This is a cultural/psychological belief, which is not based on anatomy or biology. You may believe that you’re not clean enough, which can lead to some serious–and damaging–scrubbing. Aggressive cleaning of the vulva can lead to damage of the natural protective mechanisms, accelerating a cascade of interrelated conditions that are more difficult to treat than they are to avoid in the first place.
Tips for cleaning the vulva
1. Wash the vulva no more than once per day. Less than once per day is fine.
- Showers are better than baths (since you avoid soaking the skin).
- Cool water is better than hot water (which can dissolve skin oils and break the skin-barrier surface).
- Hands washing the vulva are better than cloths or scrubbies (less friction is easier on the surface).
- Generally, an acid pH (6-7) is better than basic (higher pH) water, since the skin has a natural pH of 5.5. If you’re not having a problem with your vulva, then your usual shower water is probably fine. It isn’t easy to change the pH of your entire water system, and water softening will not necessarily help either. If you notice sensitivity with your shower water, consider rinsing your vulva after your shower with a small rinse bottle of distilled water acidified with a tablespoon or so of white vinegar. There is no need to rinse out the vagina, so don’t squirt water inside the vagina.
2. Soap is optional for the vulva, according to most skin care specialists.
- If you choose to use soap, dilute your soap in water and use the smallest possible amount, then rinse very well.
- If you choose to use soap, wash your genitals last. Do not cause a long exposure by “sudzings” up early in the shower.
- The choice of soap/cleaner is very important and a tad complicated. Generally, shampoo, liquid soap or shower gels are better choices than bar soaps. This is because the pH of most bar soaps is basic (8 or higher), while the above mentioned are acidic, so kinder to the skin. Bar soaps, even the “gentle-skin” variety, contain pore-clogging and skin irritating chemicals and oils. Beyond damaging your skin, oils can stay on the surface of skin and damage latex and stretchy-elastomer toys. Complexion soap is best left to the face.
- The terms hypoallergenic, natural, organic, sensitive-skin, or gentle mean nothing in terms of how safe they are to use on your vulva. Avoid liquid cleaners made with sodium lauryleth sulfate (SLS). SLS is a very effective detergent, and removes healthy oils from the inside the skin structure. Some people are also allergic to SLS.
- Be aware of possible allergens in your soap products. Beyond SLS , other highly allergenic ingredients are aloe vera, propylene glycol, dyes, and many fragrances including essential oils such as lavender, tea tree oil, citrus and peppermint. This is not a comprehensive list, as any individual can be sensitive or allergic to different ingredients.
- Do not use bleach, or skin-bleaching products. Your vulva is naturally a little darker than your hand skin tone. It’s only porn actors who decided genitals should be blanched in color. Using bleach seriously damages the skin, and may lead to a long-term darkening process over time. This means that your genital skin will be damaged and darker in color later than when you started bleaching.
- Disinfectant soaps (those that “kill germs”) are not recommended: Disinfectants kill healthy, beneficial bacteria, and disinfectants are often strong detergents, which remove oils and damage the surface layer of your skin. Remember, it isn’t that dirty down there.
3. Drying after washing is best done by blotting (dabbing till dry) the vulva with a clean soft towel.
- Most clothing has high residual levels of soap (we use too much in the wash), so rinse and dry a new undyed towel several times before use to remove the manufacturing chemicals. Then, dedicate this towel for blotting moisture off of the vulva. Hand-wash this towel away from other clothing using very little detergent, and air dry it for use again.
- Some with sensitive skin choose to dry their vulva with a gentle hair dryer set on cool air.
- Don’t wear underwear or pajama pants to bed. Some people seem unaware of what they have resting against their vulva most of the time. The skin on the vulva needs to air-out, and is easily damaged when kept wet/moist all day (and night) long.
To maintain vulvar health:
1. Wear underwear (if you wear underwear at all) made of undyed silk, cotton or modal fabric.
- Soft moisture-wicking fabric is particularly helpful, so cotton might not be the right choice for you.
- Find underwear which has fabric-covered latex elastic, rather than wearing elastic directly against the skin.
- Change your underwear promptly if it becomes wet for any reason, whether that’s from sweat (exercising, hot conditions), urine, sexual fluids (semen or vaginal secretions) or even menstrual blood.
- Change your underwear promptly if you’ve been exposed to cleaning chemicals, tobacco smoke and smoke from fires. The chemicals that you can smell with your nose dissolve in the sweat/oils of your vulvar skin, and can cause dermatitis (inflammation).
- Do not wear underwear during sleep. Your vulva needs that time to dry off.
- Careful if you go completely without undies, as the fabric of the clothing you wear may be harsh on your skin. However, some women find a great deal of comfort with a skirt/dress and no undies.
2. Avoid wearing anything tight against the vulva.
- Skin-tight jeans are a particularly common offender. Your blood circulation cannot overcome the constriction. Vulva binding is almost the same harm as foot binding.
- Careful about those long, long, long bike rides, too. The pressure from the bike saddle is keeping blood from circulating in your vulva. Stand up in the pedals and enjoy the breeze once in awhile. (And remember to change your shorts after your ride so that you don’t keep the sweat trapped against the skin.)
3. Do not use hair dye, makeup, or lotions on the vulva.
- Some moisturizing sexual lubricants are safe for all-day use on the vulva, but most cosmetic lotions and moisturizers are not. Particularly avoid desensitizing or pain-numbing gels, lotions or sprays. Although formulations differ, generally these compounds are very acidic and can irritate the skin long after the pain-numbing effect has worn off.
- Do not use benzocaine-based numbing products on the vulva. These medications commonly cause contact dermatitis, making whatever problem you had worse.
- Careful to choose OINTMENT over cream prescription preparations. Creams, by definition, have alcohol added to their bases which can irritate your skin as you are trying to heal it.
4. Do not, under any circumstance, use sticky-backed menstrual pad products.
- The pad adhesive is very irritating to the skin of the vulva. The adhesive seeps into the underwear itself, so that the next time you use your undies, you’re exposed to the adhesive directly against the skin. Washing is not very effective at removing all of the adhesive stuck in the undies, either.
- If you need some extra protection or cannot tolerate use of tampons, then use undyed organic cotton pads called Glad-Rags. These will catch blood, will not cause skin problems, and can be hand washed for multiple uses.
Regarding sexual practices:
- Choose your sexual lubricant carefully. One would think that sexual lubricants were developed to be safe on the vulva; unfortunately this generally is not true. It is also impossible to universally recommend any one product for every person, since each person’s skin is unique.
- Know the pH of your vagina and your sexual lubricant. Your health care provider can help with the first, and we list the pH of the lubricants sold in our Sexual Wellness Store. If you are pre-menopausal, your vaginal pH should be between 5.0 and 6.0; post-menopausal women between 5.5 and 6.5. Talk to us if you have questions about the type of sexual lubricant that might be right for you.
- Test a new lubricant elsewhere on your body before applying it to your vulva, particularly if you have sensitive skin. We prefer to use the inner elbow crease, because while the skin is relatively similar to your inner lips, it’s a lot easier to treat the inside of your elbow than it is to treat a negative reaction on your vulva.
- Apply a small dab of lubricant you are using for the first time in the inside of your elbow.
- Bend your elbow and watch TV or read a book for 1 hour.
- Observe the lubricated spot. Is it red? Does it itch at all? (If so, rinse well with cool water, and don’t use that product.)
- Observe the lubricated spot again in 24 hours. Is it red now when it wasn’t before (called delayed hypersensitivity)? If it is red, do not use this lube.
- The next test is to apply it to the outer lip, but don’t engage in sexual intimacy just yet. Observe it after 1 hr & 24 hrs again.
- If this is ok (no itching, redness or pain), then give it a sexual test-run. Remember that friction burns mimic problems with lubricants, so use enough lubricant to decrease friction. Consider using a condom during this test (male, or female nitrile is fine). If you have no pain, redness or itching, then you are likely safe to use this lubricant.
4. Sexual penetration should not hurt. Pain, although unwelcome, is also giving very important information that something is amiss and may lead to tissue trauma. Numbing the pain doesn’t mean that trauma isn’t occurring and you should continue. If you have redness or discomfort after sexual penetration, there are three main causes to consider:
- The mechanical friction of sex (causing skin burn and pain),
Mechanical friction often happens with partner-size-discrepancy, inappropriate fit of condom, lack of lubricant used on the shaft of a penis or dildo, or low arousal in a penetrated partner. All of these can be modified; ask us for help. Female condoms are particularly useful for partner-size discrepancy, for the female condom covers the sensitive vaginal layer, so that the friction is still felt on the penis, but not directly against the vaginal skin. Conversely, male condoms apply the friction against the vaginal wall directly.
- A chemical reaction or acid/base burning of the skin.
Semen has a basic pH (7.2 to 8.0), and includes prostatic enzymes which can break down the proteins in the vulva and vaginal skin. Wearing a well-fitting male or female condom can circumvent this completely. Silicone lubricants have a very acidic pH of 4.4 to 4.6, and may be just too acidic for you to use comfortably. Other people find the application of the lower pH lubes provide comfort, so you would have to experiment with this yourself.
- A true allergy to latex products.
Mechanical friction and chemical intolerance are more common than latex allergies. However, if you have a high occupational risk for allergy and know that you are allergic, carry your own non-latex barriers for your own comfort.
Some other problem. This post is not intended to diagnose or solve all pain with penetration problems. However, working your way through to this point gives you and your health care provider quite a bit of information on topics that don’t need to necessarily be investigated further.