Staying Healthy Down Below

We’ll go through the common signs and symptoms you should look out for, suggest some possible causes and let you know what the evidence says about seeking support.

Staying Healthy Down Below

We’ll go through the common signs and symptoms you should look out for, suggest some possible causes and let you know what the evidence says about seeking support.

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Staying healthy down below.

Ever had problems with itching, discharge, bleeding or pain? Different things can bring these symptoms on.

Having sex with a new partner, getting pregnant, or entering perimenopause can cause you to feel not quite right down below. Learning about what to look for will help you to spot any issues quickly, understand your own triggers, and know when you should seek help for a particular problem.

In recent years, there has been a huge surge in the number of products marketed to treat vulva and vagina “issues”. Hormonally is here to address the mountains of misinformation and challenge that product promotion. We’ll go through the common signs and symptoms you should look out for, suggest some possible causes, and let you know what the evidence says about seeking support.

With this in mind, we have key tips for genital care and suggestions for your sex life that your vagina will thank you for!

Spotting when something's "off"

Some of the most common signs and symptoms that help to let us know things aren’t quite right are:

  • Changes to the amount, color, or smell of your vaginal discharge (beyond the cyclical changes you may experience each month – a good reason to get to know this part of your individual/personal health!)
  • Redness or itching around your vulva and/or vagina
  • Bleeding in between periods or after sex (or at any time, after you’ve been through menopause)
  • Pain during penetrative sex
  • A growth or bulge in your vagina

If you have any of these symptoms for the first time, it’s a good idea to make an appointment to speak to your healthcare provider. These changes may be nothing to worry about, but in some cases, they may indicate an underlying issue. Here are some of the common things that could be causing your symptoms.

A sexually transmitted infection (STI)

Various STIs can affect and cause vaginal symptoms, including:

  • chlamydia
  • gonorrhea
  • genital warts
  • syphilis
  • genital herpes

Most of these infections are very treatable, but you should seek support as soon as possible. Leaving an STI untreated could impact your future fertility, not to mention some can be quite uncomfortable.

Vaginitis

Vaginitis is an infection or change in the normal balance of yeast and bacteria in the vagina. Infection can cause the vagina to become inflamed and symptoms include:

  • increased discharge
  • a change of smell
  • itching
  • pain

Your doctor may tell you that you have bacterial vaginosis (BV), a yeast infection, or trichomoniasis.

Sex and relationships

Some vaginal concerns only become apparent during penetrative sex and most commonly, these involve experiencing physical pain.

Symptoms often include:

  • Persistent or recurring pain just before, during, or after sex (this is known as dyspareunia).
  • Involuntary spasms in the muscles of the vaginal wall (vaginismus), with the muscles in the pelvic floor becoming tense, causing pain during sex.
  • Not producing enough lubrication or feeling ‘dry’, when you have sex. This often happens at perimenopause and after menopause.  Although, even prior to these life changes, folks can still benefit from adding an external lubricant to the mix, especially during extended sexual play, which can also result in dryness.

Struggling to produce lubrication ‘naturally’ in your vagina can mean penetrative sex becomes uncomfortable and painful. This can lead to a difficult psychological cycle, in which you feel stressed about sex and the pain you may experience, which in turn, can lead to a lack of intimacy and frustration.

Pelvic floor weakness

Your pelvic floor is the name used to describe the muscles, ligaments and connective tissue that sit at the base of your pelvis and hold the bladder, bowel, uterus and vagina in place. Over time, the pelvic floor can weaken (especially after childbirth or menopause). You might notice this affects your bladder control. You may find you leak a little when you cough, sneeze, or take part in impactful exercise like running or jumping.  Sometimes even laughing hard can cause this leakage.

In more severe cases, pelvic floor weakness can cause the uterus, bladder, rectum or the vaginal walls to slip down, or prolapse, leading to a bulge in the vagina.

In rare cases, there could be growth of vaginal cysts or vaginal cancer. This might first appear as vaginal bleeding after sex, or any time after menopause.
See your healthcare provider if you think you may have any of these problems and haven’t yet been diagnosed.

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Further reading

What's Up Down Below?

Hormones and Your Sex Life

Help spread the knowledge

Vulvas of all shapes and sizes

Seeking solutions

If you’ve been diagnosed with a yeast infection or BV in the past, and you’re experiencing the same symptoms (such as irritation or changes to your discharge in consistency and smell), you don’t necessarily need to see your doctor every time you have symptoms.

You’ll usually learn from your healthcare provider what over-the-counter treatments and other measures work best for you to clear the infection.

A note on lumps

Finding a lump anywhere can be scary, but finding a lump down below may be extra worrying for some.

You should always have any lump you find checked out, but learning to recognize something called a Bartholin’s cyst is important. Near the entrance of your vagina, you have two glands called the Bartholin’s glands. These are responsible for producing lubrication in your vagina. Sometimes, these glands can get blocked, and when this happens they can swell and cause a lump to stick out at your vaginal opening. These cysts are very treatable and you should not be worried, but it’s a good idea to talk to your healthcare provider, especially if this is your first experience with this type of swelling.  It will give you the opportunity to confirm with your doctor that this is truly what is going on and not something else.  It will also give you more knowledge about your body, which is always a good thing!  In some cases you may need antibiotics if your cyst becomes infected.

What affects the health of your vulva and vagina?

Different things can affect your genital health. Factors that have an impact often relate to what’s going on in your life at the time – especially with your hormones.

Sexual intercourse

If you use barrier contraceptive methods (like condoms or diaphragms), your vagina may be sensitive to some of the materials they are made with.

If you have unprotected sex, it can result in a sexually transmitted infection that can cause symptoms.

You can get an STI even if you only have sex with women or those assigned female at birth. Infections pass via skin-to-skin contact (including through our mouths and through finger to genital contact), in our vaginal fluid, or via shared sex toys.

If penis-vagina sex or vaginal penetration through other means is forceful, it can lead to vaginal trauma and bruising to the surrounding tissues which can be painful.

Always ensure that the sex you are having is consensual and if you feel like you are experiencing pain, or are uncomfortable during sex, communicate this to your partner and ask them to stop. Healthy sex is also about healthy communication. Asking someone to slow down, change what they are doing, or take a break for a bit, is more than OK.  In fact, it is essential to your health as well as to the trust between you and your partner.  If someone ignores your request, especially after repeated attempts to make yourself heard, this is problematic.  At this point, do whatever you need to take care of yourself, even if that means removing yourself from the situation entirely.

Some of the health conditions that may cause sex to be more painful include:

  • endometriosis
  • pelvic inflammatory disease
  • scarring from pelvic surgery
  • complex trauma
  • certain cancer treatments.

Sexual trauma, anxiety and depression can all influence how aroused you are. A low level of arousal means your vagina will struggle to produce enough lubrication, resulting in discomfort and pain during sex.  However, everyone is different and some survivors  may be well lubricated, even when they were being assaulted, so don’t let that physiological response be the determining factor in how you view a sexual experience. Equally, if you find yourself feeling tense or stressed during sex, you may find your vagina struggles to ‘relax’ during penetration.

If you are experiencing or have experienced any kind of sexual violence there are useful resources and support available at Take Back The Night.

Pregnancy and childbirth

Pregnancy and childbirth changes your vagina. This may be a temporary or permanent change.

During pregnancy, vaginal discharge often increases, and it’s fairly common to experience vaginal tears during childbirth. In carrying a pregnancy to term and giving birth, the muscle tone in the vagina and pelvic floor may weaken and need extra strengthening exercises to help return it’s function.

If you’re worried about your pelvic floor talk to your healthcare provider about this. They will be able to give you support, and potentially refer you to a pelvic floor physical therapist.

Changes in your hormone levels also affect your vaginal health and comfort. When estrogen is in short supply (as it is during breastfeeding or at menopause), it can cause dryness and the vaginal lining to thin and become less stretchy, which may make sex uncomfortable or painful.

Keeping your vulva and vagina happy

Past experiences, health conditions or side effects from medications may be unavoidable, but there’s plenty you can do to look after your vulva and vagina and minimize the risk of soreness, irritation and infection.

Here’s our rundown of 6 tips to keep things happy and healthy down below:

Don’t douche!

In fact, stay clear of feminine hygiene products, altogether. Avoid intimate sprays, deodorants or washes. You don’t need them and they alter the natural balance of bacteria in your vagina, causing irritation and soreness. Wash your vulva (the outside parts) when you shower or bathe, using just water. If you feel you really need too, a mild (or preferably non fragranced) soap, shower gel or cleanser can be used.  NEVER wash your vagina – it is self cleansing and doesn’t need any extra help!

Wear breathable, cotton underwear and loose-fitting clothing

You don’t want to sit in sweaty or damp underwear. Too much moisture can lead to vaginal infections. Thongs are more likely to transfer bacteria toward your vulva and vagina, and can also cause infection. Sleeping naked or without underwear is another way to let things breathe!

Pubic hair has a purpose!

While hair removal is a big part of many people’s daily bathroom ‘routine’, your pubes are actually there to help keep extra bacteria away from your genitals. They reduce friction and also help with sweating, helping to protect this sensitive area.

Many forms of hair removal cause itching, soreness and ingrown hairs. Some evidence also suggests that having pubic hair can actually reduce your risk of contracting an STI too. With this in mind, maybe it’s time we can all start thinking about bringing back the bush?

Cut down on alcohol, smoking and other drugs

All of these substances impair our sexual function and arousal levels. They can also lead to many other physical and mental health problems too.

Keep up with your Kegels

These are exercises to strengthen your pelvic floor. Kegels involve tensing and relaxing the pelvic floor which helps you to control the bladder and therefore leaks of urine. It can also help to prevent prolapse (where the vaginal wall descends out of the vagina).

Know your meds

Some medications (particularly antidepressants) can cause side effects that affect your sex life. This can include reducing your arousal and ability to orgasm and increasing vaginal dryness.

Taking antibiotics can also impact our vaginal health as they can cause our vaginal microbiome to change. This can trigger a yeast infection.

If you’re having sex, no matter who it is with, do your best to incorporate the following 5:

  1. Use skin-kind lubricants and avoid lubricants that contain the ingredients glycerin, petroleum, parabens, scents, flavors or dyes.  If you’re using condoms (male or female), make sure the lubricant you choose is safe to use with them (generally water or silicone-based), otherwise it can damage the condom, making it ineffective. Lubricant can make a big difference in making sex more enjoyable, so give it a go!
  2. Pee after sex. The evidence as to whether this can reduce your chance of a urinary tract infection (UTI) is mixed, but many believe it can help and it certainly won’t hurt.
  3. Protect against STIs. This goes for any play involving genitals, orifices, fingers, mouths, or sharing sex toys too. Use condoms, gloves or dental dams. If you’re into anal play, it’s best to do this after any vaginal sex to reduce chances of infection.
  4. Get tested regularly for STIs and ensure you have routine checks such as your PAP and HPV screens.
  5. Use body safe sex toys that are kind to the skin, keep them clean and avoid sharing them.

The take home

So when it comes to keeping things healthy and happy down below, the main thing to remember is less is more and allow your body to do its thing.

Remember, your vagina is self-cleaning. You don’t need to use any scented products to keep things healthy or balanced. If you think something isn’t quite right, speak to your doctor and get it checked out. Most of the time it’s nothing to worry about, but being sensible and proactive in seeking support will help give you confidence in knowing your body and peace of mind.

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