Weekly Health Digest: Delta Surge, Moderna Booster, Cancer Screenings, Public Health Crisis, and PFAS
A summary of important health news from the past week. NPR poll: The delta surge…
Vulva. Labia. Clitoris. Vagina. Why are these words so difficult for Western cultures to embrace? While depictions of penises have historically been plastered on statues, paintings, and architecture, vaginas have been neglected. Even origin stories including the birth of a deity seldom depict birth in the graphic manner in which they would depict, for example, consensual intercourse or rape. As novelist and essayist Siri Hustvedt points out, “It is a stunning absence,” adding that the suppression of gestation and birth has to be “related to the suppression of women and the fear of women.” In contemporary pop culture, this absence of vaginal depictions has instead taken a new form stemming primarily from ignorance.
Often, women as a whole are ridiculed for vaginal odors or longer labias, also known as the vaginal lips. Both of these instances are common, but the cultural perception of vaginas has created a stigma surrounding vaginal health. This stigma is highly detrimental not only to women’s own perceptions of their bodies, but also how they take care of them. Afterall, those of us who have female genitalia have all been in a situation where we feel ashamed of our vaginas or unsure about how to best care for them. Are we supposed to douche? Is Summer’s Eve the best product for keeping our lady parts clean? Does pineapple really make it smell better? What does a “normal” vagina look like?
Let’s get one thing straight: there is no such thing as a “normal” vagina. Everyones’ is different depending on size, shape, color, discoloration, smell, labia length, and more. To know how to properly care for your vagina, it’s important to first learn the proper terminology and anatomy. While most people who have female genital refer to their entire genital region as their ‘vagina,’ this is anatomically inaccurate. The vagina is the narrow, elastic, muscular canal connecting the cervix to the outside of the body. It is what we use to have penetrative sex, menstruate, and give birth. The vulva is an encompassing term which refers to the external parts of female genitals including the labia (lips), the clitoris, the urethral and vaginal openings, the anus, and the mons pubis. Typically, most people are referring to their vulva when discussing issues down there.
Vaginas have specific upkeep systems in place to maintain a healthy bacterial balance and pH. Lactobacilli are the most prevalent and often numerically dominant microorganisms of vaginal fluid in healthy premenopausal women and are characteristic of a healthy vagina. Lactobacilli become the predominant inhabitants of the vagina at the time of puberty, presumably because of the effect of certain hormones on the cells lining the vagina. Diminishing numbers of lactobacilli, which may arise with the onset of menopause or antibiotic usage, result in a subsequent rise in vaginal pH due to a series of chemical reactions. High pH values promote growth of pathogenic bacteria which may result in infection.
The microorganisms that naturally inhabit the vaginal environment play a major role in preventing illnesses of the host, including bacterial vaginosis (BV), urinary tract infections (UTI), yeast vaginitis, and sexually transmitted diseases including human immunodeficiency virus (HIV). The role that the vaginal ecosystem plays in the maintenance of vaginal health is important in a functional equilibrium. This healthy equilibrium of microorganisms in the vaginal ecosystem provides protection against pathogenic organisms and imbalances of protective organisms. For example, the vaginal pH is exceptionally low (i.e., pH of 4.5 or less), serving as a protective barrier against bacterial infections.
The delicate balance of bacteria in the vaginal ecosystem can easily be disrupted. The species that occupy sites in the human body can change based on internal host factors such as age, hormone levels, immune responses, nutritional status, and illness. The vaginal ecosystem can also be altered by external factors such as environmental exposures to wet clothes or anything that fosters bacterial growth, microbial competition in the vagina, and hygiene behaviors. Any of these factors has the potential of causing a vaginal odor which is sometimes unpleasant. However, these odors can also be caused by sweat, unprotected sex, spermicide, antibiotic use, douching, pregnancy, menstruation, and plenty of other reasons.
Most health professionals agree that there is no “normal” vaginal scent as it may vary from person to person. Some people with vaginas describe their natural scent as earthy, ripe, pungent, or even slightly sour. The bottom line is that there is a normal scent for you, and it is important to be familiar with this scent to discern between a simple after gym odor or a vaginal infection.
Because the vaginal microbiota fluctuates so easily and frequently, most women have experience with a “not fresh” feminine odor. It is estimated that three out of four people with vaginas will get a yeast infection in their lives, many of which experience at least two episodes. While yeast infections and other common vaginal infections, such as BV, are easily treatable with prescribed medication, a veil of ignorance still persists where vaginal health is concerned, typically taking the form of shame.
Most packaging for vaginal hygiene products like gels, sprays, deodorants, wipes, douches are littered with words like “fresh” and “clean” – language that suggests the vagina should be odourless, hairless and unobtrusive. It’s a narrative that has been peddled since at least the 1930s when fragrances were added to menstrual pads to mask natural odors. But that doesn’t mean that the additives are necessarily safe. Scented products, especially scented tampons, can actually disrupt the delicate bacterial balance in the vagina. However, because the idea of the vagina as naturally “dirty” is so pervasive in Western culture, marketing schemes take advantage of women’s insecurities to sell these products promising to mask their “unwanted odors.” One study suggests that women are highly concerned with having the “perfect genitalia” fostered by unrealistic ideals of a hairless, odorless vulva.
“I got my first yeast infection freshmen year of college. I was so embarrassed that I hid it from my boyfriend. I went to my [gynecologist] and she prescribed me some medicine, but I suffered in silence.”– Anonymous Emory student
What’s more, the rise in usage of the word douchebag as a pejorative term reflects negative sentiments about vaginal health. According to the Merriam-Webster dictionary, douchebag when used as an insult means “an obnoxious, offensive, or disgusting person.” When used non-pejoratively, it refers to the rubber bag that is designed to catch the liquid inserted into a vagina for cleansing purposes. In other words, it contains all of the “dirty” and “nasty” contents of the vagina. Using this word as an insult reflects widespread disgust about what naturally occurs in the vagina, contributing to the stigma around feminine health. While the practice of douching has been largely discredited in the medical community, the idea of a container designed to hold the most “undesirable” remnants of a woman’s body fills the general public with disgust.
“My friend teased me about my yeast infection, insinuating that I was dirty.”– Anonymous Emory student
Encouraged by misinformation, stigmas around vaginal health have persisted for decades. Sometimes they appear in the form of “jokes” about vaginal odors or vulvar hair, often in the form of market shaming, but the impact they have on women’s relationships with their bodies can be detrimental. Accepting that everyone’s body is different and that vaginal odors are normal and treatable when necessary are imperative steps in removing shame and ignorance surrounding vaginal health.
References: Borges, S., Silva, J. & Teixeira, P. (2014). The Role of Lactobacilli and Probiotics in Maintaining Vaginal Health. Arch Gynecol Obstet, 289, 479–489. https://doi.org/10.1007/s00404-013-3064-9  Miller, E. A., Beasley, D. E., Dunn, R. R., & Archie, E. A. (2016). Lactobacilli Dominance and Vaginal pH: Why Is the Human Vaginal Microbiome Unique? Frontiers in Microbiology, (7)1936. https://doi.org/10.3389/fmicb.2016.01936  Cran, S. E., Cunningham, S., ALbert, A., Money, D. M., & O’Doherty, K. C. (2018). Vaginal Health and Hygiene Practices and Product Use in Canada: A National Cross-Sectional Survey. BMC Women’s Health, (18)52. https://doi.org/10.1186/s12905-018-0543-y