Episode 21: Vaginal Health

Dr. Sophia:
This episode of the Dr. Sophia Obgyn podcast is sponsored by Lactomedi; dedicated to providing the best scientifically supported premium feminine self-care products. Hello everyone. Welcome to the Dr. Sophia Obgyn podcast. I'm an Obgyn practicing for over 15 years in my native New York City, and I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Dr. Sophia Obgyn podcast. Today we get to speak on a topic that is near and dear to my heart, vaginal health. I am here with my good friend, Touseef Mirza.

Touseef Mirza:
Hello, everybody. So, yes, today we're talking about vaginal health, and what Sophia just said is absolutely true. She's so excited to talk about all things vaginal health, like especially vaginal-

Dr. Sophia:
Discharge!

Touseef Mirza:
She's been wanting to talk about this for so long, and so here we are. So we're just gonna talk about, in general, about all aspects of what is actually vaginal health and all the different aspects of it. Then, talk about all different areas where maybe you might have certain issues or problems that arriving with your vaginal health.

So first of all, Dr. Sophia, when we say vaginal health, I'm even wondering, was that even a term that was very prominent, even like, I don't know, 15, 20 years ago? Like, I don't remember hearing that that often. Do you?

Dr. Sophia:
I mean, I'm an Obgyn. So it's hard for me to say. To me, vaginal health has been on the top of my mind since the first day I decided I wanted to become an Obgyn. But I think women have become way more aware, right? Of the concept that they have vaginal health or how to keep their vaginas healthy. I'm so happy about that because we need to be completely open with ourselves, understanding our bodies, and that's a part of our body that we need to be very clear about how do we wash, how do we maintain a healthy, balanced vagina? So that's what we're talking about when we talk about vaginal health and how to prevent disease, how to prevent infection, how to always feel fresh, comfortable, how to maintain our pH balance.

Touseef Mirza:
So we're gonna go into all those details. But before we go into the nitty gritty, can we first start by just talking about, when we say the term, let's say healthy vagina, what does that mean?

Dr. Sophia:
To me, a healthy vagina is a vagina that has a normal balanced vaginal microbiome. That means it has all the good bacteria that is supposed to be there. That is part of what keeps it healthy. The bacteria in the vagina is actually what helps, keeps and maintains the pH balance of the vagina. The vagina likes a very acidic environment. So when I say that the vagina likes an acidic environment, it means that it likes to have a pH balance that's somewhere between 3.8 and 4.5. So we wanna make sure that we always have that good bacteria there.

Touseef Mirza:
So that level of pH enables that to happen then?

Dr. Sophia:
Exactly. An acidic environment is created by the good bacteria that lives in the vagina. When we have a disruption in that pH is when we allow other types of bacteria to overgrow. And there are many things that can disrupt that. But when we're just talking about a healthy vagina, so one, a good microbiome for the vagina. Two, maintaining a good pH balance of the vagina, three normal secretions of the vagina.

So discharge, discharge, more discharge. But normal discharge and understanding how our discharge changes over the course of our cycle, meaning a menstrual cycle for women who are of reproductive age, the discharge, understandably, is what helps to clean out. Remember, the vagina is a self-cleaning organ, and having discharge is a part of that self-cleaning process.

Touseef Mirza:
Okay. So there's a lot to unpack here. So number one, I just wanna go back and just say, when we talk about pH, the reason why we're saying it needs to be acidic is that if it's not acidic, then it can be more basic. That's what you don't want in your vagina. So that's sort of the key there. The second part is when we talk about discharge, we talk about secretions.

What we're basically saying is what you see on your underwear when you are, when you're looking at it. And sometimes it's a little translucent, sometimes it's a little spotty, but it's not blood. It's just some substance that is coming out of your vagina.

Dr. Sophia:
So, no, it shouldn't be bloody and it shouldn't be. I mean, it definitely should not be. I just wanna be clear what discharge means. So discharge is actually created from the sloughing off of some of the cells of your vagina, the cell wall, the walls of the vagina, sloughing off of the cells. Okay. That can happen. And also from the cervical mucus, these changes are happening over the course of your cycle. Do we expect a little something on our underwear every single day? The answer is yes.

Touseef Mirza:
Every single day?

Dr. Sophia:
Every day. As a matter of fact, probably the only time that you don't have any discharge is probably one or two days after you have finished your period, for example, because then the cycle starts again.

Touseef Mirza:
So that's so interesting because we have not had this conversation, that actually vaginal secretions are normal, are completely normal, and that the fact that you have them every single day is just part of the vaginal cycle.

Dr. Sophia:
Yes. Because the vagina also maintains its own moisture. And so that's also a part of the secretions, also a part of what creates the discharge. Is there a concept of too much discharge? Absolutely. Because discharge can also be a sign that something is wrong or off in terms of our pH balance or in terms of the health of the vagina. There's that sweet spot. There is normal discharge, and then there is abnormal discharge. But I want women to understand that discharge in and of itself does not mean something is wrong. For the most part, discharge is normal. We don't expect it to have a smell. We don't expect it to be irritating. We don't expect it to be itchy. We don't expect it to be smelly.

Touseef Mirza:
But a little smell. Like there is a smell of the vagina, or, you know like when you put your underwear to clean, there is a vagina smell.

Dr. Sophia:
So let's talk about the vagina smell. So yes, you have your own natural body odor, and the vagina can have its own, I hate to say the word odor, but then again, its own odor. The difference is, whether or not that odor is what we call foul smelling. Just like everybody has their own body odor, like how we associate even, let's say a baby's smell, right? Everybody knows what a baby smells like.

No one would think that a baby's smell is gross or obtuse. Right? Or like we don't like it. You know what I mean? And so similarly, in terms of a vaginal smell, first of all, it's influenced by many things such as what we're eating, medications that we may be taking, exercise, how we wash. All those things can affect vaginal odor. So when we say odor, I do want people to understand that yes, the vagina, like the rest of the body, has its own fragrant smell of some sort.

Touseef Mirza:
I like fragrant smell.

Dr. Sophia
It's a flower that is influenced by so many things, like our hormones. but it should not be pungent. It should not be foul smelling.

Touseef Mirza:
So it's a question of understanding what we smell like normally and to detect, oh, now it's smelling different. So we have a natural default smell of what our vagina is, for example. So now it's to just become aware if all of a sudden it smells completely different and maybe not completely different, but that all of a sudden it's much stronger, and so we notice it.

Dr. Sophia:
Yes. Understanding how the odor of the vagina can change even again, during the course of your cycle, partly because of the changes in your hormones. So I want women to understand that things can change even just over the course of the month, but still be completely normal. Your discharge changes over the course of the month and is completely normal. Like I said, the initial right after your period, you almost have very little secretions. There's very little smell. You know, it almost feels like you don't smell anything. And then again, as we get closer and closer towards, you know, a few days later, it starts to become this faint, pale, perhaps clear or white discharge. Definitely it becomes a more gel-like mucus, like egg white, like discharge as we approach and are actually ovulating.

Then after ovulation, it changes again and into this like almost a little bit milky. It gets a little thicker. I don't wanna say it's completely milky 'cause it's still thin and transparent for the most part, but just becomes a little thicker and a little thicker as we get closer and closer to our next period.

Touseef Mirza:
I just wanna pause here for a second and just take a moment again to reiterate that all of this is normal because nobody has told us this. Nobody has ever told me that before. And it's more like, okay, well I guess this is what just happening. I hope everything's fine down there. You know, this happens every month, but nobody actually said, oh no, this is actually, you know, it's like getting a period. You know how that's a normal part-

Dr. Sophia:
Of our life cycle, of our lives, of our bodies, and as women to experience that. Exactly. Your body is made perfectly to do the things that it's supposed to do. And that includes our periods. That includes how our vaginas maintain their health, you know, and understanding that. So, again the key factor here is knowing that the vagina likes a certain environment. Okay? And we're gonna call that environment the flora. And the flora is exactly the little bacteria, specifically it's lactobacillus. That's probably the most prominent.

Touseef Mirza:
Say that more slowly.

Dr. Sophia:
Lactobacillus or lactobacilli, the bacteria that really is in the vagina that likes to be in the vagina, that helps maintain the health of the vagina. But there are a number of other different bacterias that are all in the vagina and in truth, they're all keeping each other in check.

To me, I like to look at them as kind of little soldiers that are kind of constantly fighting each other and keeping all of their numbers where they should be. And it's when we change something in the environment of the vagina, that we allow one of those types of bacterias to overgrow. When we allow any of those bacterias to overgrow, that's when we can run into problems.

Touseef Mirza:
So the-

Dr. Sophia:
Lactobacillus.

Touseef Mirza:
The lactobacillus, that's the one that keeps everybody in check. So then the next question is then why is there an imbalance that even happens in the first place?

Dr. Sophia:
Imbalance can happen for so many different reasons. So for example, let's take a woman who has an overwhelming period. Like it's just not normal. She's bleeding all the time. She has her period for more than seven days. It's very heavy. Well, the problem is that blood is a great nutrient for bacteria. And when you're sitting in blood all the time-

Touseef Mirza:
There's too much blood.

Dr. Sophia:
There's too much of it. It's constant. It's just there. It's not passing through because it's just constantly sitting there, sitting there, sitting there all the time. You're just bleeding like crazy. So in those women, they may have a higher tendency of developing changes in the natural environment of their vagina. Again, because blood is a very nutritious thing to bacteria. It can allow the bacteria that we don't want to overgrow to overgrow.

That's just an example. Also, when we're on, you know, birth control or changes in our hormones, those changes can again allow different bacteria to overgrow in the vagina and disrupt the normal balance of the lactobacillus that's keeping everything in their pH balance low. We like an acidic environment, and can change it into what's called the basic environment or what have you, even semen. So sex with multiple partners, different partners can change your vaginal pH balance.

Touseef Mirza:
Wow okay. So having sex can actually affect the pH that can then enable the back bacteria to-

Dr. Sophia:
To overgrow more prominent, to be more prominent to overgrow. Yes. So I've had patients who've come in and they're saying that, listen, Dr. Lubin, I don't understand every single time I have sex with my partner, I end up with an infection. I feel like I feel weird, something else is happening. I just don't feel comfortable. And after investigating and investigating and investigating further, we just had to come to the conclusion that that particular partner, it could be in the way that something that he's eating, it could be something in his environment, in terms of how it creates his semen and his. But that is causing a disruption in that particular person's pH balance.

Now, obviously, that is not a majority of women and men and their intimacy. Otherwise, how the heck would we all be here? But it can happen because we have to take into account that our bodies are really that sensitive. And the things that we put into it can change what comes out of it. And if we understand that, then we can make certain changes. Whether it's increasing the amount of water that we drink, whether it's the type of vegetables and the type of foods that we're eating and clean, eating, clean and, you know, what kind of vitamins are we taking and supplements or, you know, it's just our bodies are very sensitive to what we put in it. And that doesn't matter whether we were a man or a woman.

Touseef Mirza:
So we talked about different causes where you have the microbiome that's not in balance, or the pH is not where it needs to be. Do most of these sorts of triggers occur within the vaginal area? Or it could be something that you eat, for example, that could have an effect on the way you're talking. So is that what you're saying, that you could also eat something or another stressor that could affect the vaginal area, even if it's not the initial place where it's affecting?

Dr. Sophia:
I will say that for example, we know that there's a link between, let's say, alcohol consumption and developing yeast infections, for example, or the chronic yeast infection type picture. Or just a lot of high processed carbohydrate rich foods, especially when they're over processed, et cetera. So not talking about just having a fruit, but rather having cakes and cookies and this and that, and how that can affect your vaginal health.

And another thing that lives naturally in the vaginal environment is yeast. We do have some yeast in our vaginas all the time. This is not some of the time, but rather all the time. But because all of the bacteria and all, and maintaining the right pH balance helps to maintain the normal pH balance. And so it keeps everybody in check, including the yeast. But when we have a change, then we can sometimes just kill off both good and bad bacteria. And then now all of a sudden we allow yeast to overgrow.

Touseef Mirza:
So you're saying that yeast is just part of the natural microbiome?

Dr. Sophia:
That is correct.

Touseef Mirza:
And when we say a yeast infection, it's because now the yeast is-

Dr. Sophia:
Allowed to overgrow. It's not being checked, it's not in check. So now we have the overgrowth of yeast, and that is when we have a yeast infection. And ooh, is that uncomfortable.

Touseef Mirza:
Yes, it is. Can a yeast infection resorb by itself, or do you need to get it treated?

Dr. Sophia:
The reality is that we need to get everything back into balance in order to treat a yeast infection. And oftentimes, yes, we do need to actually treat a yeast infection, meaning we need to kill off and bring back down the numbers of yeast that are in the vagina. And I just wanna go over even just the simplest parts of these things, BV or bacterial vaginosis and yeast. Bv, bacterial vaginosis, a change in the pH balance that allows certain bacteria to overgrow and cause the BV or bacterial vaginosis infection.

Touseef Mirza:
So that's more from a bacteria perspective.

Dr. Sophia:
That's a bacteria perspective. And then change in your pH balance, change in the normal bacteria, et cetera, that can lead to a yeast infection. Can they happen concomitantly? Absolutely. You can have both situations happening even at the same time where you have an overgrowth of yeast and an overgrowth of the bacteria that the vagina doesn't really like.

One thing I want to point out is that neither of those two things, when we are saying there's a change in the vaginal health, we're not saying that you now have an STD, I'm not saying that you now have a sexually transmitted infection or disease. I'm saying that you have a change in normal vaginal health that can lead to these types of infections, which are not sexually transmitted for our purposes here. And there are different symptoms that can happen with them and can affect what we normally think of as vaginal health. Remember, vaginal health encompasses your pH, your moisture, your smell, your comfort.

Touseef Mirza:
So could you have a yeast infection and not feel anything? I'm asking this because I remember there was one time I went for a pap smear and the Obgyn said, oh, you have a little yeast infection. And I said, oh, maybe there was a little bit of, I don't even remember if there was a little bit of uncomfort, but could it go under the radar where you're not really feeling uncomfortable, but you-

Dr. Sophia:
Or discomfort?

Touseef Mirza:
Yeah. You don't really feel it, but you do have a yeast infection.

Dr. Sophia:
Is it possible? Absolutely. It's totally possible that you may have a disruption in the normal and you don't really feel it because it's not overwhelmingly so there's still, I would consider it almost like saying a critical number that it has to necessarily get to.

And for all I know you don't know it, but you start eating more yogurt or having more fermented foods that you are now helping to treat your own vaginal microbiome. Naturally trying to increase the good bacteria. And in doing so, you then are already naturally keeping these other things at bay. And basically, I don't even know if I should say what the word is treating it really. Because I don't want people to come away with this thinking that, oh, if I have a yeast infection, I can just treat it naturally.
I'll just take a couple of yogurt and stuff like that, though, that is important in maintaining vaginal health, having good foods that are probiotic rich.

And quite frankly, if your obgyn says, hmm, it looks like you may have a little bit of a yeast infection, it doesn't necessarily mean that you have a true infection. You may have a slight overgrowth that she may notice, but you may not notice. Or it's just starting. And it may be something that if left completely untreated, meaning you haven't changed anything, you're maybe using, I don't know, some product that is promoting the change in the pH balance, that is then changing how the yeast is growing in your vagina.

Then it will eventually lead to the overgrowth that becomes uncomfortable, that leads to the typical signs and symptoms of a yeast infection. Heavy cottage cheese discharge, itchiness can actually even lead to that feeling of dryness. So yeast infections have a couple of different things that can be weird with them. It could feel dry or it could feel more moist because the yeast can cause a bit of a very watery kind of secretion or discharge at the same time that it's creating this clumpy curd, like heavy white discharge.

Touseef Mirza:
So what's interesting about what you're saying, when we talk about, you know, if you're eating yogurt or sauerkraut and probiotics, usually when we talk like that, we're really talking, most people think about their gut, you know? but we never really think about the microbiome of the vagina.

Dr. Sophia:
As related to the gut?

Touseef Mirza:
Not necessarily related, but just in general from just thinking about it, these are high probiotic foods that can, that is also for the vaginal health. We don't think that, we just think, oh, I'm doing that for my gut. You know, because that's where most of the education is when it comes to having a good and healthy microbiome.

Dr. Sophia:
So a good and healthy microbiome definitely comes from your gut. And it affects your vaginal health as well when you have good gut health. And that's why it's important that you eat well. That's the reason why the foods that we eat and what we take in have an effect on our vaginal health. Imagine a vaginal probiotic.The idea that we can have something that is just targeting specifically that yes, that's great. But overall it's about being healthy in the first place at the end of the day okay.

Touseef Mirza:
As a whole.

Dr. Sophia:
As a whole. It's about being healthy in the first place, addressing the fact that yes, our immunity comes from our gut. And that what's happening in our gut can affect our vaginal health, hands down. But if we're just gonna talk about the vagina itself, I want us to make sure that we understand how it's functioning, how it's working, what are the intricacies of that and that all comes back to our vaginal microbiome, our pH balance, our moisture, our discharge, and our smell. That all of those things are in a realm that is normal. And as a woman, it's so important to be very clear on what your normal is.

Touseef Mirza:
So, we talked a lot from a yeast infection perspective. So if we switch now more towards bv, what are certain differences? Or are there, I know that it's bacteria versus yeast, but in terms of potentially the causes or its symptoms, how does that differ from a yeast infection?

Dr. Sophia:
Okay. Yeast, we're talking about a fungus. Like I said, it can be naturally in the vagina. Bv bacterial vaginosis is a shift in the pH balance that causes an overgrowth of certain bacteria. One that comes to mind is a bacteria called gardnerella. It causes what we call the fishy smell. An odor that is what I would consider as foul smelling that women can typically identify and say, hmm, I feel like something's definitely off. I feel like something is off with how my vagina feels. And in my discharge it can be this thin, white, gray, frothy, even type of discharge. And I know that's funny.

Touseef Mirza:
Yes, like I said, she loves to talk about discharge, so please continue

Dr. Sophia:
It's just that we gotta know we're what we're talking about, what we're dealing with.

Touseef Mirza:
Cottage cheese-

Dr. Sophia:
You know, and, and it's funny, all doctors talk and try to explain things in ways that are like, you know, associated with food because it's like everybody can think about what does cottage cheese look like? You know what I'm saying? And frothy or fishy, that concept, right?

We can all relate to those things. And so that's part of the reason why we doctors typically use those as examples to try to explain ourselves. But at the end of the day, bv, bacterial vaginosis causes this type of discharge, and it can be thin, runny, you feel extra wet, you feel discomfort. It's not necessarily itchy. It's not necessarily pain.

Touseef Mirza:
Is it like a little burn?

Dr. Sophia:
Like a little burning. You can feel a little bit of a burning sensation. It can be a tingly sensation. It could just be like you're sitting down and you just don't feel comfortable and you don't know why. And you find yourself perhaps instead of just being in your underwear, feeling like you need to put on a liner because you have so much more extra secretions.

Certainly for some women, those secretions can definitely be smelly. Like I said, the one smell that I think comes to mind is the fishy odor, but it can have a different kind of a smell, even just just one that's not your normal smell that women can sometimes identify and be like, hmm, no, something is off. And very oftentimes that something is off means that they may have a BV infection.

Touseef Mirza:
So usually the yeast infection, I know you can have like over the counter type of treatments. Can you also have that for bv? And if so, how does a woman know which one to choose?

Dr. Sophia:
Bv? The things that I think because both BV and yeast can have very similar symptoms in that they can be uncomfortable, they can increase your discharge, they can make you feel dry or more wet. They can make you feel the burning sensation. The one thing I would say that's pretty different about them is that BV is typically associated with a smell, whereas yeast is typically not associated with a smell. So that's one major difference.

The second yeast is typically associated with a much heavier, thicker type discharge. Most of the time really, notorious for a very itchy, like an intense, you know, can be very itchy. Now granted, can you have yeast and not be itchy? Yes. That is pretty classic actually, in times of a woman's life, like let's say pregnancy, where women are very prone to having yeast infections, they may not know that they have a yeast infection because they don't get the typical itchiness that can be associated with yeast.

And also during pregnancy, in and of itself, pregnancy increases natural discharge period. So it's not yeast, it's not bv, it's just pregnancy. It's just more, but I would say that the most important difference between them is the smell that would give me a more of an inclination that it's bv, the heaviness of the discharge, the color, the thickness, the way it looks and feels that curd like cottage cheese, like et cetera, gives me a more of an idea of yeast. And then both of them can be uncomfortable when you have sex. And both of them can, like I said, either make you feel dry or make you feel more wet.

Touseef Mirza:
And so then for yeast, you can have it over the counter. And then for bv, what's usually the treatment for that?

Dr. Sophia:
So bv, the usual treatment, you really do need to come in and see your medical provider usually for the treatment, because we typically treat BV with an antibiotic. What's the caveat to that? Is that that antibiotic is not discriminatory. It's not gonna just kill that one bacteria that is causing the bv. It kills everything.

Touseef Mirza:
Is it usually an oral antibiotic?

Dr. Sophia:
It can be an oral antibiotic, it can be a vaginal antibiotic, meaning it's something that you insert just vaginally, which for some women is actually preferable. And to be honest with you, it is not a bad method in terms of managing vaginal infections. Just because you don't wanna also kill off all of your gut bacteria, when you take antibiotics, you are killing off bacteria in all parts of your body. So not just in the vagina.

So it is important that if you have to be on antibiotics to treat, let's say a vaginal infection such as bv, that you also back yourself up with a probiotic. You eat more probiotic rich foods in order to repopulate your gut with the good stuff that your gut needs. Also to repopulate your vagina with the stuff that it needs. In all honesty, there have been times when I've had patients call me, it's like late, they can't get to a pharmacy.

They are in a place where they have no access, or I have no access in order to give them a prescription for something that they may think they may be having, such as bv. And I'll say to them, listen, do you have a probiotic at home that you're using? Does it have lactobacillin? Does it have acidophilus, does it have some of the bacteria that we know is good bacteria for the vagina? Do you have any of this at home that we usually take orally? And I'll say, take two capsules and put that in-

Touseef Mirza:
In your vagina?

Dr. Sophia:
In your vagina, just to get you feeling better.

Touseef Mirza:
Yes. So maybe not addressing the root cause it-

Dr. Sophia:
It may not completely clear it, but it starts to help the repopulation of the good bacteria.

Touseef Mirza:
Wow okay.

Dr. Sophia:
So these are just little tricks that we have to use if we can't get to the thing in order to fix it completely. It buys us some time.

Touseef Mirza:
This is for bv?

Dr. Sophia:
Yeah, and it can be used even for yeast.

Touseef Mirza:
Oh, it's also for yeast okay.

Dr. Sophia:
Although women, listen, I'm not telling you to go now and put Activia or whatever probiotic yogurt into your vagina. I just want to be clear. I've heard of women. I've had patients who've come to me and they're like, oh, I was feeling a little weird, so I just put a ton of yogurt into my vagina. And though I'm very clear to say that I get it, because yogurt definitely has some probiotics, but I don't know what you're putting in. I don't know if you're putting the super sweet, whatever. Like there's all kinds. It can get crazy and messy.

So I just wanna make sure that it's not coming across in this podcast that Dr. Sophia is saying, oh, just put in some probiotic no matter how you get it. I'm not talking about just grabbing your latest and greatest type of whatever, like probiotic, probiotic, yogurt or kombucha or what have you though. No, that's not what I'm saying.

Touseef Mirza:
So really more, a tablet, and this is also just as a temporary measure.

Dr. Sophia:
Yes.

Touseef Mirza:
Okay. All right. Then for the yeast infection, usually that is something that you insert in the vagina. Usually they're like little capsules filled with lotion or something.

Dr. Sophia:
You can have a suppository, you can have a cream that comes with an applicator, and you can actually take pills in order to treat a yeast infection. So there are multiple ways of treating a yeast infection and it just depends on what you and your provider decide is gonna work for you.

Touseef Mirza:
But because it's over the counter, some people just take it upon themselves.

Dr. Sophia:
Yeah, sure. If you feel like you're having the typical symptoms of yeast infection, yes. An over the counter method can be effective. But for some women, it's not enough. The over-the-counter stuff works, but I have so many women who come in after they've tried over the counter products and still have some residual discomfort. So certainly if you're not getting better, come in and see your provider.

Touseef Mirza:
Okay. So it's a potentially good solution to try, but it might not work a hundred percent. And then you go to level two, an obgyn.

Dr. Sophia:
Level two, see a healthcare provider that can completely treat your symptoms and completely treat the infection.

Touseef Mirza:
When we talk about discomfort, we're also talking about irritation. You almost feel like it's irritating and you wanna scratch.

Dr. Sophia:
Sure it can be itchy, it can be just irritation that just makes you feel like you can't really sit, it can just feel raw, almost. It could be a little painful. It could feel like you have little cuts or heaviness, the swelling. So all of these things are possible in terms of what your vagina itself may be feeling like. When I say vagina, I also am encompassing the vulva. So the lips of the vagina, the clitoral region, you know, I'm talking about all those things as well as the actual vagina itself.

Touseef Mirza:
When it comes to vaginal dryness, what causes vaginal dryness? If we're not talking about perimenopause? Menopause, what can cause vaginal dryness in those situations?

Dr. Sophia:
The vaginal dryness that can happen sometimes, let's say with a yeast infection is because of the level of discharge that sticks to the vaginal walls and then therefore makes the vagina feel dry.

Touseef Mirza:
Okay. So the cause is-?

Dr. Sophia:
It's the actual yeast itself that can actually be sticking to the vaginal walls and then actually making the vagina feel dry. Then in terms of vaginal dryness, vaginal dryness can happen aside from just infections, definitely from hormones. So you may not be menopausal, but still may have changes in your hormones that can lead to some level of vaginal dryness.

So you don't have to be menopausal to experience it. Certainly when we do go through the menopause change, it changes the actual vaginal tissue. When there's no estrogen, it causes it to become very thin and those secreting glands to become smaller and just not secreting the way that they used to.

We also have to take into account our personal hygiene and how that affects our vaginal health in general. I like to say to women that they can use just water in a mild type of soap to wash with. But my thing is not changing. The biggest thing I find that women come into my office with bv or yeast infection is typically because something in their environment changed. And that something was like the soap that they decided to use because they used a different soap. They went and got the latest and the greatest thing on the shelf that says, oh, this is specifically for your vaginal health and this is specifically gonna make your vagina more fresh. So they go from the thing that they've been using their whole life to now feeling like, oh, I need something to make me more fresh.

Dr. Sophia:
Let me get that thing a week later, they're in my office. We don't realize that we really are that sensitive. So if there is something that you have been using that is working for you, makes you feel like everything is working in balance, don't change. Take that soap with you. Take that whatever it is that you're using with you when you go to your boyfriend's house, when you go to your mother's house, when you go on vacation, do not just go ahead and use whatever's in the hotel or whatever antibacterial thing, you know, because the word antibacterial in a soap should not be used in the vagina. It just should not, because literally the word antibacterial means it's against bacteria. And I just talked all this podcast about having good bacteria. And remember, these products are not discriminatory.

Dr. Sophia:
So they may be killing some bad stuff. Sure. But they are overwhelmingly killing the good stuff. In doing so, that's what causes the shift. Women don't realize we've been taught that somehow our vaginas are just so dirty and that we need to have something extra special.

You know, it's the reason why there was this big, I don't know even know if women still do this. I certainly hope they don't. But for things like douching, and for those of you who don't know what douching is, I remember being a kid and I didn't understand what douching was. I was like, what are they even, what is that word?

Dr. Sophia:
What is that? Anyway, douching meaning introducing, putting in some type of applicator that flushes quote unquote flushing out the vagina because it needs to be cleaned. I remember when I was a kid having family members who would after their periods because they needed to clean out their vagina after their period, which is totally unnecessary. All that did was clean out the good stuff and left room for the other bacteria to overgrow. That's why the first thing typically your obgyn will say is, are you douching? And please stop, don't do that. Not necessary. We do not have to do that.

Touseef Mirza:
You said at a certain point earlier in the podcast that the vagina is a self-cleaning organ. So do we even need soap?

Dr. Sophia:
No.

Touseef Mirza:
Right. Like, we don't-

Dr. Sophia:
We don't need soap.

Touseef Mirza:
We don't need soap. We just need to wash it with water.

Dr. Sophia:
With water you can use like a washcloth or just water. Yes, absolutely.

Touseef Mirza:
When we talk about the vagina here, we're talking about the vulva as well.

Dr. Sophia:
We're definitely talking about the vulva. I'm not saying to put things inside of the vagina because that's not necessary. We are talking here specifically about the vulva. When we say that, you know, like for some people, their secretions or their discharge, you know, they sit all day, they're at work all day. They don't get up and use the bathroom often. So those secretions can kind of sit in their underwear and then sit on the lips of their vagina. They may feel like it gets dry from that because the secretion is dry and then it becomes a little harder to clean off.

So maybe just using water for them feels like it's not enough per se. So I don't like to fully limit women's ability to feel clean, but it is important to understand that it's not necessary. That's for sure that you don't need to use some special soap or something like that, or soap at all. But rather that if you are going to use something, just use the thing that is going to work with your body and understand that every week we don't need to change to the next newest thing that's being promoted in terms of cleanliness. I think that's really what I want women to understand.

Touseef Mirza:
Well, I learned a lot today about the microbiome in the sense that when you were talking about all of this, it was almost like a movie of my vagina of different bacteria. Then you have the yeast and then the pH, like somebody needs to do like a visual of that. So we see it all happening and understand it even better.

Dr. Sophia:
See it in action.

Touseef Mirza:
Yeah. See it in action.

Dr. Sophia:
So for me, what I really want to take away here in terms of this podcast, talking about vaginal health, I want women to walk away with. Your vagina is a part of your body that needs to maintain and stay healthy. And a healthy vagina is one that has a good pH balance, that has a good microbiome, that has a normal smell, that has normal moisture, that has normal secretions. The best way for us to do that is to eat well, is to drink our water, is to have good, safe sex practices, is to go to our doctor, you know, have a regular visit with your obgyn or with your woman's health provider, whether that's an obgyn, midwife, a nurse practitioner. So that way there's an opportunity to have a check-in and make sure that whatever it is that you're doing in order to maintain your vaginal health is really working for you. So that we are avoiding the things that can disrupt the natural, you know, balance of the vagina.

Touseef Mirza:
Yes. And discharge is normal. So next time when you see discharge, you don't say, is something wrong? No, it's fabulous. It's working the way it's supposed to.

Dr. Sophia:
Your vagina's working the way it's supposed to if it's got a little discharge.

Touseef Mirza:
So say thank you.

Dr. Sophia:
Thank you, vagina.

Touseef Mirza:
Thank you vagina.

Dr. Sophia:
And thank you everyone here for listening to the Dr. Sophia Obgyn podcast. Until next time, bye!

Disclaimer, this is general medical information based on my professional opinion and experience. The content of this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Listeners should not delay in obtaining medical advice for any medical condition they may have and should refer to their physician.

This episode of the Dr. Sophia Obgyn podcast is sponsored by Lactomedi.