Vaginal Health is Usually Simple

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For hundreds of years, companies that sell "feminine hygiene products" have told women that the natural smells and fluids of their vaginas needed to be masked or perfumed. But never before today have women of all ages been bombarded with so many sales pitches for so many different vaginal health products and services.

"There are entire aisles in grocery stores and drugs stores that are devoted to so-called 'feminine hygiene products,'" says Dr. Kristin Rojas, a breast cancer surgeon and board-certified gynecologist at Sylvester Comprehensive Cancer Center. "Nearly all of these products are unnecessary and a waste of money."

Knowledge is power

When women learn how their vaginas work and how little help they need to stay healthy, they can ignore the marketing spin peddled by companies selling vaginal products, she says.

The vagina is a primarily internal part of a woman's anatomy. It's the elastic tube through which menstrual fluids leave the body, and through which a baby is born.

Your vulva includes those parts of your genitals that are easily seen with a mirror. These include the outer and inner folds (or "lips"), the clitoris, and the mons pubis, the mound upon which pubic hair grows.

Vaginal health all through life

The media has focused on mental and physical harms that young women may suffer by using vaginal products. "But it's not just young women who are prone to all the marketing tactics," says Dr. Rojas. These issues come up throughout a woman's lifespan, she says.

"Pop culture and even the pornography industry have perpetuated a certain aesthetic, a certain look for the vulva," says Dr. Rojas. "In reality, all vulvas and vaginas look different, just like faces do," she says.

The vagina usually recovers well after giving birth

Women who have given birth, perhaps to several children, are often targets of sales pitches for "mommy makeovers." The "makeovers" may include plastic surgery to change the shape of the vulva and vagina or reduce the size of the labia majora, the outer lips.

"The vagina is meant to be stretchy. That's how babies are born," says Dr. Rojas. It usually returns to its prepregnancy state with time. Although some things, such as certain autoimmune diseases, obesity, or smoking, can make this more challenging.

Injuries that occur during vaginal delivery may cause pain or the leaking of urine or stool. Such problems may need to be surgically repaired either at the time of birth or later on, she says.

"If you have issues with incontinence after delivery, such as leaking of urine with coughing or sneezing, you need medical attention," says Dr. Rojas. "Ask to be referred to a urologist or urogynecologist. They can determine the cause of the issue and develop a personalized treatment plan for you."

No one needs a "designer vagina"

vaginal healthIn recent years, famous people, such as reality stars and certain Kardashians, have been speaking openly about choosing to have procedures done so they can achieve a "designer vagina." This can make having these mostly unnecessary interventions seem normal, even glamorous.

Between 2013 and 2018, there was a 53% increase in labiaplasty procedures to alter the look of the vaginal lips, according to the American Society for Aesthetic Plastic Surgery.

Sometimes surgical procedures to alter the internal or external anatomy of the vagina are medically necessary. "But these procedures should be performed by surgeons specially-trained to do them," Dr. Rojas says.

Like any surgery, procedures on the vagina and labia involve certain risks.

Vaginal health surgeries can lead to the injury of surrounding organs, nerve damage, and chronic pain. At times, complications such as bleeding and infections occur.

"With labiaplasty, there's also some risk that a woman's nerves can be damaged, and she can lose sensation in the area," says Dr. Rojas. "This loss of sensation may be temporary or permanent."

While, typically, these operations are performed under local anesthesia, general anesthesia may be used. The risks of general anesthesia include strokes or blood clots in the legs, among others. These risks are higher for older women or those with chronic medical conditions.

Some companies promote 'vaginal rejuvenation' treatments that use lasers.

"Vaginal rejuvenation" is a marketing term, not a medical term," says Dr. Rojas. The promise is for a  better appearance, tightness, and relief from dryness without surgery by using lasers or radiofrequency wands placed inside the vagina.

"These lasers were FDA-approved for use on the face or body to reduce scars," Dr. Rojas explains. Companies that make these lasers have developed wands to treat the vagina. The lasers work by targeting water in the tissues. Then, causing tiny burns in the lining of the vagina. The idea is that these small injuries create a local increase in collagen.

The boost in collagen is meant to improve the stretchiness and lubrication of the vagina. The laser treatments are positioned as a cure for urinary incontinence or leaking of urine with coughing, sneezing, or urgency.

In 2019, the FDA issued a warning statement about "vaginal rejuvenation" products using lasers.

The FDA's statement says, "To date, we have not approved any energy-based devices [such as lasers] to treat symptoms or conditions related to menopause, urinary incontinence, or sexual function." Treatment of these symptoms or conditions with lasers may lead to severe problems, such as vaginal burns, scarring, pain during sex, and chronic pain.

"If you have experienced a complication from a vaginal laser, you can report your experience to the FDA, or read about other reports of complications through their website," says Dr. Rojas.

What if a woman is on anti-estrogen drugs?

Women who have had breast cancer may take medicines that block estrogen to lower their risk of the cancer coming back. Unfortunately, with less estrogen, their vaginal tissues become thinner, drier, and more fragile. This is called genitourinary syndrome of menopause (GSM).

"The most effective treatment for GSM caused by anti-estrogen drugs is estrogen creams placed in the vagina. But women who have had cancer are sometimes uncomfortable using them," says Dr. Rojas.

The creams can help in several ways. They improve elasticity and lubrication and help restore a healthy microbiome in the vagina, she says. The estrogen in the creams only enters the bloodstream in minimal amounts at the start of treatment compared to estrogen taken as pills or through a skin patch.

"Currently, there is no evidence that vaginal estrogen raises the risk of cancer recurrence in women with a history of estrogen receptor-positive breast cancer," Dr. Rojas says. But if you do have a history of estrogen-sensitive cancer, consult your medical oncologist before you start using any hormonal treatments, she adds.

Patients taking anti-estrogen drugs may wind up with issues after vaginal laser treatments. Low estrogen levels that breast cancer survivors have from the drugs may disrupt microscopic healing, she says. The disruption, in turn, may increase the risk of vaginal health complications, such as burns or chronic pain, from the lasers.

"At this point, I don't recommend vaginal laser treatments for these women," she says. "There just isn't enough evidence showing that laser treatments are safe for this population."

Many women feel insecure about their vaginal attractiveness and appeal.

With self-acceptance, you will find it easy to ignore misinformation in advertisements and embrace your true femininity.

Talk to your doctor before you buy these products. Your health care provider can dispel any myths about harmful products or services.

"Discussions about sex and sexual health need to become normal conversations," says Dr. Rojas. "When they do, it's so much easier for women to understand what are healthy habits and what are not."

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Milly Dawson is a contributing writer for UMiami Health News.


READ MORE

feminine hygiene
Learn more about vaginal health.

"Everybody is unique. It's important to get familiar with what's normal for you," says Dr. Kristin Rojas, a breast cancer surgeon and board-certified gynecologist at Sylvester. Your vagina is a mostly internal part of your body. Menstrual fluids pass through it. So does a baby during childbirth. Read more.