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Steps of Internal and Intimate Hygiene, which keeps a woman healthy :Dr Sadhana Kala


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Healthy vagina, healthy woman

Vaginal infections are one of the most common reasons women see doctors. Lakhs of such visits take place every year, causing significant economic burden from lost productivity and treatment cost.  In the US, 29.2% of women ages 14–49 suffer from vaginal infections. And in high-income countries, the estimated economic burden is US $14·39 billion  (₹1,05,910.4 Crores) annually. Incidence in India is not known. But it is likely to be higher than in the US because awareness on how to avoid the infection is less in India. 
Vaginal infections can be reduced by better awareness of vaginal health and vaginal hygiene, and a few simple practices.  

Vaginal Health
Good general health leads to good vaginal health. Healthy diet and exercise – walk, run, Yoga, Kegel, and pelvic floor exercises – helps the pelvic floor to tone up and ensure good general health and good vaginal function. 
Bacteria in the vagina
Bacteria in the vagina provide for good vaginal health. Vagina contains more bacteria than anywhere else in the body after the bowel. These bacteria give “numerical dominance” – they outnumber the potential harmful bacteria that invade the vagina. And produce bacteriocins (naturally occurring antibiotics) which reduce or kill the invaders and prevents them from sticking to the vagina walls and thus invading the tissues.
For a healthy balance of bacteria in the vagina, the vaginal pH level should be slightly acidic, that is between 3.8 and 4.5. That is the normal vaginal pH level though it can vary depending on stage of life. 
High Vaginal pH 
Vaginal pH level above 4.5 allows the unhealthy bacteria to grow. Resulting in a higher risk of Bacterial vaginosis (BV),  Trichomoniasis (trich) and thrush.
BV causes a “fishy” odor, and/or an unusual grey, white, or yellow vaginal discharge, and may also cause  vaginal itchiness and burning during urination. BV puts the woman at increased the risk of more serious infections like human papillomavirus (HPV), herpes simplex virus, and HIV.
Trich is a sexually transmitted disease (STD). It is usually without symptoms, but it increases risk of other more serious STDs like HIV.
Low Vaginal pH (High Acidity)
An acidic vagina usually does not cause disease. But if the acidity rises too much, it might reduce  fertility. Because sperm thrive in an alkaline environment. The optimal pH for them to swim is between 7.0 and 8.5. During sex, the pH level inside the vagina temporarily rises. This protects the sperm and allows it to reach the egg. 
Maintain Normal pH
Vaginal health demands that vaginal pH remain normal (3.8 to 4.5). Otherwise, symptoms like vaginal irritation, itchiness and pain may appear. Some women are more sensitive to vaginal changes, particularly during pregnancy.
The pH can be altered by any foreign substance that is introduced into the vagina. Use of foreign substance can also have other adverse effects. For example, use of products such as talcum powder, or excessive wiping of the vagina, can make it very dry which can cause itchiness and vaginal dryness and pain during sex and make it prone to injury. Perineal use of talcum powder may increase the risk of endometrial cancer.

Do not shave pubic hair

Pubic hair protects the vulva (outer part of the female genitalia that surrounds the opening of the vagina) from bacterial infections. Non-electric shaving methods such as razors can cause genital injuries. If done at a parlour, the products used may have chemicals, and instruments may be unclean.
Do not ignore signs of vaginal infections
If vaginal discharge is stinky smell, or excessive or coloured, consult doctor immediately. Do not ignore an itchy vagina or pain in the vaginal region. It can be a sign of an underlying health condition.
Never try self-medication
Any infection or diseases of the genital areas such as ringworm infection, pubic lice infection, vaginal dryness, or itching, consult doctor.
Do not use home remedies like using baking soda solution to wash the vagina or applying some homemade paste to get rid of the odour, or over the counter (OTC) antifungal or antibacterial ointment or creams.
For yeast infections, eating yogurt may help. It contains lactobacillus acidophilus which helps create the acidic environment your vagina requires and combats the growth of yeast. However, do not put yogurt into your vagina. The sugar in yogurt can exacerbate the infection by encouraging the yeast to grow even more. Probiotics are a good source of lactobacillus as well and these can be taken daily and are available at your local pharmacy.

Vaginal Hygiene 

Vaginal hygiene focuses on the vagina and the  surrounding external area to ensure that the vaginal pH is maintained, and risk of infections is reduced.
Vagina keeps itself clean by natural secretions (discharge). The vaginal fluid or discharge is a part of a healthy vaginal environment. Healthy discharge is clear or white and does not have a strong smell or colour. If discharge smells or changes colour or itches, it indicates infection. Wetness may be uncomfortable but is not harmful.  Soreness around the vagina is abnormal. 
For good vaginal hygiene:

Keep the vaginal area clean.

Wash the area with warm water using toilet paper or clean, soft, cloth. Avoid soap. But if you must, then use plain soap. Do not use harsh soaps or scented soaps. These have harmful chemicals such as glycerol, perfumes, and antiseptics. These can affect the healthy balance of the bacteria in the vagina; can change the pH in the vaginal region, which can cause irritation and lead to the growth of unhealthy bacteria.

During period, wash vaginal area more than once a day. Also keep perineal area between the vagina and anus clean.

After intercourse, always clean the vagina with water because body fluids and particles from condoms can cause irritation and increased vulnerability to vaginal infections.

Clean the vagina from front to back (the vagina to the anus). If you do the other way, then the chances of dragging the harmful bacteria to the vagina are high. 

Do not Douche because it flushes up water into the vagina to clean vaginal secretions and involves the use of certain chemicals which can interfere with the vaginal pH and disrupt the normal vaginal bacteria. No evidence that douching protects against sexually transmitted infections or vaginal infections. It may even increase the risk.

Keep the Vaginal Area dry.
After urinating, always wipe the area using toilet paper or a soft cloth so your underwear is always dry. Not wiping the vagina can cause the panties to get wet causing bad odour and risk of vaginal infections.

Change sanitary pads after 4-6 hours. However, if flow during menstruation is heavy, then change the pads every 3-4 hour.

If using a tampon, change it every six hours. Also, clean the area every time you visit a washroom during menstruation.

Reusable cloth pads wash and dry properly before using it.

Change underwear twice a day if you have extra discharge to avoid sitting in damp underwear.

If sanitary napkins or tampons are not changed for a long time, it can cause skin rashes, bad odor, and risk of infections.

Avoid wearing tight clothes

Wearing tight clothes and inners made from synthetic fabrics cause sweating due to reduced air circulation. Excessive sweating and moisture can lead to the growth of bacteria and yeast, causing vaginal infection. Wear undergarments made from breathable fabrics like cotton.
Avoid using leather pants, tight spandex, and wet bathing suits for a long period of time.
Change clothes after working out or exercising or any activity which can be sweaty.

Do not use scented feminine hygiene products such as scented wipes, vaginal deodorants, or scrubs. These products can make you prone to infections and cause peeling of the skin thus increase risk of infections.

Practice safe sex
Sex is healthy and is not unhygienic. In fact, especially after menopause, sex helps prevent vaginal atrophy. Atrophy is when the vagina dries out and is more likely to tear and cause pain.
Urinate after sex to flush out bacteria and to avoid urinary tract infection. Shower or at least clean the vulva after sex with warm water and dry thoroughly.
Use protection such as condoms every time you have sex. First check if you are allergic to the material of the condom and pick the one that suits you.
Unprotected sex increases the risk of Sexually transmitted infections (STIs) such as chlamydia, gonorrhoea, herpes, warts, syphilis, and human immunodeficiency virus (HIV), of vaginal infections, and of unwanted pregnancies.
Avoid using lubes during sex. It can damage the vagina and increase risk of infections. Use of lubricants which contains glycerin can damage or irritate the vaginal cells, which in turn, ups the risk of STDs such as herpes and HIV. 
Abstain from sex if partner has any symptom of STD.
Harriet Beecher Stowe said, “A woman’s health is her capital.” And Maya Angelou said, “When women take care of their health, they become their best friend.” Be your best friend. Take care of your capital. Take care of your vaginal health because that way lies your good health. 

Author : Dr Sadhana Kala

Dr (Prof) Sadhana Kala is a USA-trained robotic & laparoscopic surgeon, Uppsala University, Sweden, trained fertility specialist


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