Introduction
Vulvovaginal health refers to maintaining the health of the vulva and the vagina. This is necessary to prevent infections and discomfort in the vulvovaginal region. As women age, the skin over the vagina and the vulva become drier and less elastic. This can also happen soon after cancer treatment or surgery, leading to vaginal atrophy (drying, thinning, and inflammation of the vaginal walls). This can be corrected by estrogen therapy, but it is not considered a safe choice. This article explains in detail vulvovaginal health and its maintenance.
What Is a Vulva?
The vulva is the external part of the female genitals. Each vulva is unique and different in size and appearance. The labia majora is the outer lips and is covered with pubic hair, and the labia minora is the inner lips and is hairless. The urethra and the vagina open into the labia minora. The tiny skene glands open on either side of the urethra opening. Also, Bartholin glands are present on either side of the vaginal opening. A clitoris extends deep inside the body and is at the top of the labia minora. The visible part of the clitoris is called the glans, and it is partially covered by a tissue fold called the clitoral hood.
What Is a Vagina?
The vagina is part of the female genitalia that connects the uterus to the outside part of the body. It begins from the opening, called the introitus (inner part of the labia), and ends at the uterus opening, called the cervix. It is an elastic, flexible, muscular canal with a soft lining that provides sensation and lubrication. The pH of the vagina is moderately acidic, and there are many ways in which this balance can be disrupted.
What Changes Happen to the Vulvovaginal Area During Pregnancy?
During pregnancy, the level of estrogen and progesterone (female sex hormones) increases. As there is increased estrogen and blood flow to the vaginal area, the vulva becomes more swollen. The vulvar skin color and the vaginal opening may become darker. As well as there will be an increase in normal vaginal discharge. There may even be changes in the balance of bacteria and yeast in the vagina because of changes in the hormone, so vaginal infections are more common during pregnancy. During pregnancy, some women may even develop varicose veins in the vulvar, vagina, and anus (usually known as hemorrhoids) area. This can cause discomfort but usually vanishes after pregnancy.
During childbirth, the perineum skin stretches to accommodate the head of the baby. This can sometimes cause the skin and tissues of the perineum to tear. Minor tears may heal without specific medical attention, but major tears may need surgical repair. The major problem after childbirth is vaginal dryness, especially in breastfeeding mothers. Vaginal dryness occurs mainly due to changes in hormone levels. Local estrogen therapy and lubricants can be used to prevent this problem.
What Changes Happen to the Vulvovaginal Area During Menopause?
Decreasing estrogen levels can affect the urinary tract and the vagina during menopause. Over time, the vaginal lining gets dryer, thinner, and less elastic. This is because of a decrease in the hormones estrogen and progesterone. It can also thin the lining of the urinary tract. Because of these changes, many women may experience the symptoms known as genitourinary syndrome of menopause (GSM).
What Are the Symptoms That Affect the Vulvovaginal Region?
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Irritation, itching, burning, chafing, or other discomforts.
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Light bleeding can happen because the vagina may get injured very often, and if any vaginal bleeding is present, it needs to be investigated.
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Inflammation can occur due to GSM leading to painful urination and infection.
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Dryness can occur from decreased vaginal secretions, which may lead to painful and uncomfortable sexual intercourse.
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Malodorous discharge, like rotten fish, can occur due to increased vaginal alkalinity, which can be mistaken for thrush.
How to Improve Vulvovaginal Health?
Vulvovaginal health can be improved by taking the following measures:
1) Vaginal and Vulvar Moisturizers - They help to increase the vagina and vulva moisture and improve tissue elasticity. Moisturizers are different from lubricants that are used only during sexual activity. But vagina and vulval moisturizers can be used more frequently, similar to how we would moisturize our face and body. Some examples of vaginal and vulvar moisturizers are:
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Hydrating Types - These moisturizers can be inserted into the vagina with a disposable applicator or put on the vulva. They reduce vaginal dryness and irritation.
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Natural Oils - Such as coconut oil or vitamin E can be used inside or outside the vagina. These can also be used to reduce vaginal dryness and irritation.
2) Vaginal Lubricants - They are short-term aids used in the lubrication of the vagina during sexual activity. The natural lubricant produced during sex will be less during cancer treatment, menopause, and aging. Lubricants make sexual activity more pleasurable by reducing discomfort and pain. There are many types of vaginal lubricants available in the market. They normally come in a liquid form and minimize pain and dryness during sexual activity and gynecological exams. Some types of lubricants available in the market are:
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Water-based lubricants.
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Silicone-based lubricants.
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Oil-based lubricants.
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Natural oil-based lubricants.
3) Vaginal Estrogen - This hormone-based medication is prescribed only by doctors as it does not suit everyone. This therapy is often advised to patients with cancer or undergoing cancer treatment. The candidate chosen for the vaginal therapy depends on their cancer type. Topical or estrogen therapy is the best way of treating the thinning of the vaginal wall skin for postmenopausal women in the general population.
4) Vaginal Dilators - They are typically prescribed to stretch the vaginal tissue and prevent vaginal atrophy after cancer treatment. Dilators are most effective in improving pelvic floor muscle control and vaginal comfort. It is necessary to get dilators that give the best possible chance of using it with comfort. Silicone dilators are flexible, warm, and more phallic-like than hard plastic ones.
Conclusion
Maintenance of vulvovaginal health is essential for all women, as it can cause infection, discomfort, and pain if proper care is not provided. Some natural phenomena like pregnancy, menopause, and aging can also cause changes in vulvovaginal health. So women should be aware of the changes that occur during these periods. If any discomfort or pain happens, it is necessary to consult a doctor and take proper treatment.
