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November 7, 2022

Female Intimate Hygiene

Vaginal Microbiome

The vaginal microbiome influences quality of life, defends against pathogens, and influences fertility and reproductive success[i].
Shifts in the balance of the microbial system can result in profound health changes, and research in this area is focused on the determination of microorganisms that characterise a healthy microbiome to then correlate certain microbial profiles with adverse symptoms in gynecological and obstetrics[ii].
The composition of the vaginal microbiota can be affected by several health factors, from the use of antibiotics and contraceptive methods to sexual activity and the method of vaginal washing[iii].
As microbiome research advances, it is important to understand the impact of various vaginal hygiene practices on the microbiota and the associated health consequences.

Most common intimate hygiene practices and associated risk

Several studies that analyse intimate hygiene behaviours focus especially on vaginal irrigation, with indications that its use varies, with data from the US Centers for Disease Control and Prevention (CDC) reporting that about 20% of women aged between 15 and 44 use this method at least once a year[iv].
This practise is related to several negative obstetric and gynaecological effects, including pelvic inflammatory disease (DIP/PID[1]), decreased fertility, ectopic pregnancy, premature birth, cervical cancer, bacterial vaginosis (also called vaginitis or BV[2]) and an increased risk of sexually transmitted pathogen infection[v].
According to a survey with data from nearly 4,000 American women, women who have vaginal irrigation have more symptoms of bacterial vaginosis than those who do not. The same indicators also show that, despite this, there is no correlation between vaginal lavage and the incidence of BV. The data from this sample verifies the existence of a significant association between the prevalence of bacterial vaginitis and the use of intimate wipes[vi].
Research carried out on the vaginal hygiene practises of American women, in addition to irrigation, concluded that those who used irrigation techniques were more likely to use other vaginal wash products, such as sprays[3], wipes, powders, and washing solutions[vii].
Prevalence studies[4] in the US report that about 42 to 53% of women use sprays, 17 to 50% use intimate wipes, and 23 to 46% use antipruritic products[viii].
Although there is no clear justification for why the use of common intimate hygiene products is related to an increased incidence of infections and changes in vaginal health, it is clear that their use is correlated with an increased risk of these conditions, with the use of disinfectant wash solutions being associated with a greater risk of fungal infections and bacterial vaginosis, the use of intimate or baby wipes with a greater risk of UTIs, and the use of moisturizers/lubricants with an increased incidence of both alterations, at the same time that vaginal irrigations were associated with all the aforementioned alterations.

[1] Pelvic Inflammatory Disease

[2] Bacterial Vaginosis

[3] Usually called vaginal deodorant and of low use in Europe

[4] Also called transverse or vertical

[i] Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011 Mar 15;108 Suppl 1:4680-7. doi: 10.1073/pnas.1002611107.

Vaginal microbiome and epithelial gene array in post-menopausal women with moderate to severe dryness. PLoS One. 2011;6(11):e26602. doi: 10.1371/journal.pone.0026602. Epub 2011 Nov 2.

Probiotic strategies for the treatment and prevention of bacterial vaginosis. Expert Opin Pharmacother. 2010 Dec;11(18):2985-95. doi: 10.1517/14656566.2010.512004.

[ii] The Vaginal Microbiome: Current Understanding and Future Directions. J Infect Dis. 2016 Aug 15;214 Suppl 1:S36-41. doi: 10.1093/infdis/jiw184.

Characterization of the vaginal microbiota of healthy Canadian women through the menstrual cycle. Microbiome. 2014 Jul 4;2:23. doi: 10.1186/2049-2618-2-23.

Resolution and characterization of distinct cpn60-based subgroups of Gardnerella vaginalis in the vaginal microbiota. PLoS One. 2012;7(8):e43009. doi: 10.1371/journal.pone.0043009.

The microbiota of the vagina and its influence on women’s health and disease. Am J Med Sci. 2012 Jan;343(1):2-9.

[iii] The influence of behaviors and relationships on the vaginal microbiota of women and their female partners: the WOW Health Study. J Infect Dis. 2014 May 15;209(10):1562-72. doi: 10.1093/infdis/jit664.

Understanding vaginal microbiome complexity from an ecological perspective. Transl Res. 2012 Oct;160(4):267-82. doi: 10.1016/j.trsl.2012.02.008.

[iv] Centre for Disease Control and Prevention. Key statistics from the national survey of family growth. 2013.

[v] Vaginal douching and reduced fertility. Am J Public Health. 1996 Jun;86(6):844-50.

Vaginal douching and adverse health effects: a meta-analysis. Am J Public Health. 1997 Jul;87(7):1207-11.

Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health. 2001 Oct;91(10):1664-70.

Risk of preterm birth that is associated with vaginal douching. Am J Obstet Gynecol. 2002 Jun;186(6):1345-50.

A longitudinal study of vaginal douching and bacterial vaginosis – a marginal structural modeling analysis. Am J Epidemiol. 2008 Jul 15;168(2):188-96. doi: 10.1093/aje/kwn103.

Intravaginal practices, vaginal infections and HIV acquisition: systematic review and meta-analysis. PLoS One. 2010 Feb 9;5(2):e9119. doi: 10.1371/journal.pone.0009119.

[vi] The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007 Nov;34(11):864-9.

[vii] Vaginal douches and other feminine hygiene products: women’s practices and perceptions of product safety. Matern Child Health J. 2006 May;10(3):303-10. Epub 2006 Mar 23.

[viii] Adult feminine hygiene practices. Appl Nurs Res. 1996 Aug;9(3):123-9.

Beyond douching: use of feminine hygiene products and STI risk among young women. J Sex Med. 2009 May;6(5):1335-40. doi: 10.1111/j.1743-6109.2008.01152.x.

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