Let’s talk openly about vaginas – no need to be embarrassed!
If you are experiencing burning, rashes, itching, soreness, strange-smelling discharge or regular urine infections, then your vagina may need some TLC.
In this blog, I’ll explain some facts about one of the most delicate parts of your body, and how to keep it healthy, strong and free from discomfort.
Did you know that the health of your vagina may be an indication of your overall health too?
Your body is a web-like connection of all body systems. Everything is connected. The centre of that connection is the gut. If the gut is compromised, then so may your vaginal and urinary health. I have been a specialist in digestive health nutrition since 2014 and a large proportion of my clients also suffer from vaginal & urinary issues (as I did and part of what lead me to study nutrition).
First, a little anatomy
Don’t worry, this isn’t a science lesson, but the little that we were taught in sex ed at school means that we tend to be left as adults with limited knowledge about vaginal health. And it’s so embarrassing to ask – it’s still such a taboo subject in our culture.
As a health practitioner, I wish to make it easier to talk about as it’s so important. For those of you who know me well, I also have the same feeling about talking openly about bowels & stools too!
It’s common not to know the difference between the vagina & the vulva
The vagina – an internal organ – is the tissue connecting the uterus (womb) to the external parts of the body. The cervix connects the top part of the vagina to the uterus.
The vulva – the external skin – comprises the labia which are two pairs of external skin folds that protect the vulva and urethra.
The vagina has muscular tissue and an outer lining that produces mucus and other viscous materials to provide lubrication and to protect against bacteria and irritants.
Did you know that you have a vaginal microbiome?
If you’ve heard the hype about the gut microbiome (and if you’re reading this, I imagine that you know that I have plenty of blogs about gut health), then it may not be so surprising that we also have a protective community of friendly bacteria covering the surface of the vagina & vulva.
We need specific types of bacteria to populate and defend this very delicate tissue. The barrier that keeps bad bacteria out is quite thin, so we rely on the beneficial bacteria to act like sentries and defend.
Communication between the gut and vagina
The bacteria lining the gut and vagina can communicate with each other, and bacteria can travel from the gut to the vagina too. So, when I ask about your gut and vaginal symptoms, I’m looking at your health as a complex interplay of your distinct microbiomes.
What helps to keep your vagina healthy?
The health of the vagina is reliant on three things:
Oestrogen is involved in the maturation of the vagina during puberty. It keep your vagina healthy through your child-bearing years. Then the subsequent drop in oestrogen that progressively occurs in perimenopause (age 35 onwards) and menopause (average age 51 years) can involve thinning of the vaginal walls. This vaginal atrophy can cause dryness, irritation, and inflammation.
- CONNECTIVE TISSUE
One of the layers of the lining of the vagina is made of mostly collagen and elastin (think ‘elastic’). At best this layer keeps everything in the right place and allows flexibility, but when elastin is in low supply, issues such as pelvic organ prolapse can occur. Low collagen can also cause this issue, which can be genetic or due to the reduction in collagen with age.
While your gut microbiome needs balance and diversity (a broad range of different types of bacteria), your vaginal microbiome needs a specific strain of bacteria called lactobacillus to be dominant.
These bacteria are critical to your health for fertility, better birth outcomes, lowering your risk of contracting a sexually transmitted disease, preventing vaginal atrophy, and protecting from urinary tract infections (UTIs).
Lactobacillus are key producers of lactic acid, which offers anti-bacterial & anti-viral protection. Lactic acid helps to maintain a slightly acidic pH around the vagina, preventing opportunistic bacteria from taking hold.
This is precisely why your vaginal microbiome needs nurturing at all stages of life, but especially from peri-menopause onwards.
However, bacteria from your gut can translocate to your vagina and urinary tract causing a downflow of symptoms, so ensuring your gut microbiome is in tip-top condition should be a priority.
When it all goes wrong
When the microbiome of the vagina becomes unbalanced, vaginal dysbiosis results. This common issue opens the floodgates for a myriad of problems. As well as affecting fertility and pregnancy those floodgates welcome bacterial and viral infections. Thinning vaginal walls can also make penetrative sex extremely uncomfortable, if not impossible.
UTIs are no joke
Women are more prone to UTIs than men because the tract (ureter) that runs between the vaginal opening (urethra) and the bladder is very short compared to male anatomy. This means that there is little distance between the delicate bladder walls and the outside environment. There is also a risk of introducing bacteria from your bowels to your bladder by wiping the wrong way when going to the toilet.
Women & girls of all ages can experience UTIs. For some, this can become a vicious cycle, especially when antibiotics are used to treat the infections. Sadly, for some, this can be a chronic condition (recurrent UTIs) which can be challenging to escape.
Why do UTIs and other vaginal infections develop?
Some conditions put women and girls at a higher risk of developing infections. Evidence continues to grow as more studies are done on the vaginal microbiome – we aren’t quite as far ahead as we are yet with the gut microbiome, but we now know that many factors can unbalance the bacteria protecting the vagina.
Vulva as art
As you can imagine I was delighted to see this amazing sofa called the ‘wombtomb’ with a vulva-like opening in the Stedelijk Museum in Amsterdam. This was designed in 1968 by Ferdi who wanted to create a liberating & playful environment in her design. We all need a sofa like this!
Some factors that may cause vaginal dysbiosis:
- Dietary, especially a limited diet lacking vital nutrients or high in sugar and/or alcohol
- Washing habits – douching, bidets, or using products that interfere with natural bacteria
- Tight-fitting underwear, especially many fabrics that do not breathe
- Antibiotics (oral and intravenous)
- Hormonal changes
- Frequency of intercourse
How to naturally support vaginal health
As a nutritional therapist, although diet is my focus, other lifestyle habits are important, especially where your intimate health is concerned. I often recommend the following practices as a first step:
- Avoid smoking
- Make sure period cups are washed correctly, use sanitary products with minimal toxins and change sanitary wear often when on your period
- Wear 100% cotton underwear and avoid wearing excessively tight trousers, shorts or tights
- There is no need to wash your vagina (the internal part), which is self-cleaning, and only use gentle products without harsh ingredients on your vulva.
- If possible avoid use of lubricants which may reduce lactobacilli around the vagina
How food can help
A blood sugar balancing approach is a great start – minimise sugar, limit carbohydrates and specifically use slow-release carbohydrate foods such as whole grains, whole fruit, and vegetables, rather than quick-release processed or white carbs. Fill your meals with many different plant-based foods with sufficient protein and healthy fats to make your diet nutrient-dense.
Eat a variety of vegetables, garlic, pulses, legumes, and whole grains especially, to provide prebiotics that feed your friendly bacteria. Many of these foods support hormone balance too because they contain phytoestrogens which are especially useful from peri-menopause onwards. Include flaxseed, sesame seeds, legumes, alfalfa sprouts, and organic whole-food or fermented soy.
Another way to promote friendly bacteria and a balanced microbiome is to include probiotic-rich and fermented foods. These offer fuel that encourages a variety of bacteria to thrive. Options include sauerkraut, kimchi, tempeh, kombucha, live yogurt, kefir, and mould-ripened cheeses. Introduce these slowly to let your gut microbiome adjust gradually.
You can find out more about eating to feed a healthy tummy with my 9 gut-friendly foods here.
Dealing with chronic bacterial vaginosis, vulvovaginal candidiasis (thrush), aerobic vaginitis, or UTIs
You may have bacterial vaginosis (BV) – if you have a white or grey discharge, often watery, odorous (smelling like fish – sometimes worse after sex) and there can be itching, pain, or burning, but most women who experience BV do not have any other obvious symptoms and can be asymptomatic. Still, any of these signs indicate a bacterial infection that needs addressing.
You may have vulvovaginal candidiasis (thrush) – if you have a white cottage cheese-like discharge with a yeasty-type smell, pain, itching vagina or vulva, or stinging when urinating.
You may have aerobic vaginitis – if you have yellow to green discharge, a rotten-type discharge or smell, pain, itching, or burning (often red & inflamed) where scratching can cause red marks.
You may have a UTI – if you have the need to urinate more often (often with great urgency and passing very little), have discomfort urinating, pain low down in your abdomen, cloudy or foul-smelling urine, blood in your urine, or feeling generally under par.
While it’s important to discuss any of the above with your GP, as a nutritional therapist there are many clinical tools at my disposal to help you to get these troubling issues under control.
Microbiome testing for the vagina & urinary tract
Using relatively new tests to assess the balance and health of your microbiome can be a key step in your recovery. This allows the use of targeted strategies to deal with the results. The vaginal test enables us to identify pH, inflammation, and levels of the desired lactobacillus populating this delicate ecosystem. It also assesses bacteria we don’t want in the vagina. The urinary test helps us look for the desired lactobacillus plus the known offending bacteria that cause UTIs. They are simple home tests requiring a vaginal swab and a urine sample.
You are the sum of all your body systems
Working with a registered nutritional therapist can be helpful to gain a holistic, full-body approach to your symptoms. Your female health hinges on the health of your digestive and immune systems, plus your hormones too. Working on symptoms alone in the localised area they affect will often mean that relief is short-lived unless you address the balance of multiple body systems.
Another tool a nutritional therapist can recommend is personalised and targeted supplements to help bring everything back into balance. We have some excellent supplements available to support all your microbiomes. There is no one-size fits all, so working 1:1 on a personalised programme is the first step to identifying what will help you as an individual.
If you like to learn more about the Ageing Vagina (how it gets affected from age 35 onwards, do watch this informative video here. This also gives more information on vaginal & urinary microbiome testing.
To understand which symptoms (within the digestive tract and outside) are common when your gut, immune system & hormones are out of sync, watch my FREE masterclass 3 Steps To Control Your Gut (And Still Eat Your Favourite Food).
Jane Barrett is a registered nutritionist and expert in digestive health helping women & children with digestive issues take control of their health through food. She offers support through meal plans, online courses & personalised 1:1 programmes on Zoom.