Your Perineal Hygiene Questions

We had some questions on proper perineal care, and our go-to gynecologist, Dr. Teri Benn, answered them all:

What is perineal hygiene, and when would I need to be most concerned with it?

Perineal hygiene is basically making sure that the vagina is clean and healthy. All women should be concerned about perineal hygiene just as they care for their armpits or any other part of their body. The general term “perineal hygiene” includes maintaining and caring for the perineum, vagina/introitus (opening of the vagina) and vulva (the labia majora and minora and mons pubis). These areas have normal bacteria which when not maintained can be killed off and bad bacteria or yeast can grow.

How can I care for this area and with what products?

Perineal hygiene tips:

• All soaps and detergents should be hypoallergenic, ie no perfumes in them. Perfumes can be harsh to the skin.
• Cotton underwear is the best fabric.
• Clothes should not be too tight so as to allow this area to “breath and circulate.”
• At night, sleep without any underwear on to all the vagina to breath.
• All products, such as lubricant, should be free of alcohol and should instead be water-based or silicone-based.
• When  you shower let soapy water run over the vagina and then pat it dry. Do not scrub the vagina and do not douche.
• When you are wet clothes or wet bathing suit or sweaty clothes, change out of them as soon as possible.
• If you feel that certain pads or tampons cause you to have symptoms (see below under reasons to call your OB/GYN), then you should change your brand or consider a brand of pad or tampon without chemicals and made of cotton.

What signs would indicate that I should I contact my OBGYN?

Call your OB/GYN if:

• If you have itching, discomfort, irritation, or swelling of the vulva, perineum or vagina.
• If you have change in the odor of the vaginal discharge, ie fishy odor.
• If you have a change in the color of the vaginal discharge, such as yellow or green vaginal discharge.
• If you have chunky or cottage cheese like vaginal discharge.
• If you have bleeding or spotting after sex or if you have pain with sex.

What would you say are the biggest misconceptions (if any) about perineal hygiene?

These are the myths I most commonly have to correct:

• Putting more perfume on it does not fix the problem.
• Scrubbing or douching can make the symptoms worse.
• Bacterial vaginosis and yeast infections are NOT sexually transmitted and treating your partner does not help your problem. You will not pass a yeast infection or bacterial vaginosis to your partner.
• Over the counter AZO does not make bacterial vaginosis or yeast infections go away.
• Your period does NOT cause you to have an infection. Certain things associated with your menses, such as using certain feminine products, can cause a change in the normal makeup of the vagina and put you at risk for infection.

**If a woman thinks that she has been exposed to a sexually transmitted infection or if she has symptoms that are not consistent with the above (see signs and symptoms to contact your OB/GYN), she should call her OB/GYN.

Can you give an example of a situation women have found themselves in from poor care and what the solution was?

A woman took an antibiotic. This antibiotic was helpful for whatever bacterial infection she had, like a sinus infection. She then felt like she had vaginal irritation and itching accompanied by a thick vaginal discharge. She came to the doctor and was found to have a yeast infection. The antibiotic, while helpful for one problem, killed off normal bacteria in the vagina (in addition to killing off the bacteria it was trying to affect) and allowed yeast to grow. She was treated with medication for a yeast infection and her symptoms improved.

A woman spent all weekend in a wet bathing suit at the beach. She then developed a green vaginal discharge with a fishy odor. She went to her doctor and was found to have a bacterial infection, bacterial vaginosis. She was treated with an antibiotic and her symptoms resolved.

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