A guide to your vaginal ecosystem ✿

Even as periods and womb health are becoming more popular and mainstream, “down there” care has made seemingly less progress.

Many of us are perfectly comfortable talking about our period blood, but an itchy vagina? Not so much.

Maybe because it’s more overtly related to sexuality, and because of that, it’s still cloaked in some mystery and hard-to-shake shame. A lot of us probably still wonder if what’s coming out of us is normal, how to tell the difference between bacterial vaginosis and an STI, or even how to best care for our vulvas.

But I know for myself, the more I've learned about my physiology, the more comfortable I got talking about everything from discharge (btw, I really think we need a better name for that….) to yeast infections to what “normal" labia looks like.

Body Literacy Basics 〰

Your vulva = The external genitalia, aka the part that's visible when you look in the mirror. Your vulva includes the Labia majora, the Labia minora, the clitoris, the vaginal opening, & the urethral opening.

Your vagina = The internal part of the genitalia. Your vagina is a canal that connects the vaginal opening to the cervix, providing a pathway to the uterus. 

Your vaginal microbiome —

You probably know about your gut microbiome and your skin microbiome, but did you know you also have a unique microbial environment in your vagina? The vaginal microbiome is a diverse ecosystem, teeming with vibrant life. Our overall health influences the health of our vaginal microbiome, and vice versa. 

Inside this dynamic ecosystem is a delicate balance of bacteria, most notably (for the majority of women) Lactobacillus.

Lactobacillus is a family of bacteria that produces lactic acid, which helps keep the pH balance low. It also promotes mucus production, which (among many other things) provides a layer of protection against bacteria, yeast and viruses like HIV.

Ideally, the pH of a vagina is somewhere around 4, which is quite acidic (have you ever noticed bleaching in your underwear? This is why!). We want the pH to be low, because that creates an environment that is inhospitable to yeasts, harmful bacteria, and other vagina-unfriendly organisms.

When our vaginal ecology gets thrown out of balance, through a disruption of pH or the introduction of unhealthy microbes, we become more susceptible to inflammation, irritation, and infection. 

A disruption is our vaginal ecology also increases our risks of developing endometriosis & other pelvic disorders, as well as chronic pelvic pain, vulva pain or discomfort (vulvodynia), vaginal pain (vaginismus), pain with sex, vaginal dryness, &/or general vaginal irritation. 

Bacterial vaginosis, a common condition caused by an overgrowth of bad bacteria, is specifically is linked to higher rates of preterm birth, as well as an increased susceptibility to STIs.

What influences your vaginal microbiome —

Our overall health – and especially our gut health – has a huge impact on our vaginal health. Chronic stress, trauma, hormonal imbalances, and poor gut health can all disrupt our vaginal flora.

Our diet in particular plays a big role. Nutritional deficiencies and an imbalanced blood sugar can both contribute to an imbalanced vaginal environment.

Many medications can disrupt our vaginal flora, from antibiotics and the birth control pill, to steroids and antifungals. So can spermicides, conventional lubes, conventional condoms, and conventional menstrual products. Emerging studies are also suggesting a link between IUDs are bacterial vaginosis.

And finally, stress. We are more susceptible to inflammation and infection when we are stressed. Acute, in-the-moment stressors – such as a move or a relationship issue – can cause serious disruptions. So can chronic stressors, like trauma, financial instability, or a chaotic work environment. 

But often overlooked are systemic stressors. The physiological outcomes of the systems we live within do not fall equally on all women. 

One study found that Black women experience higher rates of bacterial vaginosis than white women, even when controlling for all individual risk factors. That means that while the effects are physiological, the cause is very much social: the compounding stress of structural violence, disproportionate exposure to harmful toxins, generational trauma, and more (in other words, racism).

Several studies have looked at the rates of different vaginal infections in women experiencing homelessness, and found that homelessness and housing insecurity is a risk factor both for developing certain vaginal infections, as well as experiencing complications from those infections. This disparity is again due to social causes like lack of access to clean underwear and period products, and increased vulnerability to sexual violence. 

As Rupa Marya & Raj Patel write in Inflamed, “to wonder why some things settle in some bodies and not in others is to begin to ask questions about power, injustice, and inequity.”

Keeping your microbiome thriving —

• Because our gut and vaginal microbiomes are so closely linked, anything we do for our gut health also benefits our vagina. Probiotics, pre-biotics, a diversity of fruits & vegetables. 

• Keeping our blood sugar stable with fiber, adequate protein & regular meals. Avoiding alcohol and refined sugars is important especially if we're dealing with yeast infections, which thrive on too much sugar.

• Zinc, Vitamin A, Vitamin C, & Vitamin E are all important for vaginal health. Think citrus fruits, berries, dark chocolate, avocado, pumpkin seeds, leafy greens & red meat.

• Avoiding unnecessary antibiotics (according to Dr. Aviva Romm, 70 percent of the antibiotics prescribed in the US are unnecessary), and replenishing with a good probiotic if you do need them. If you're currently on the pill or using an IUD, potentially exploring switching birth control methods.

• Using nontoxic period products (here's a recent post on my favorite ones), nontoxic condoms (Lola & Here We Flo make great ones), & nontoxic lube (coconut or jojoba oil, or a nontoxic water-based one like Lola for a condom-safe option) is also super important. Which leads us to… 

Sex & your vaginal ecology —

Sexual health and vaginal health are intimately connected. 

Sex can have a big impact on your vaginal ecology. Whether it’s oral sex, finger sex, penis-in-vagina sex, skin-to-skin contact between vulvas, or sex involving toys, it can disrupt your vaginal ecology. 

Unprotected penis-in-vagina sex can potentially disrupt your microbiome in a couple ways. Each have their own unique set of bacterias, as well as very different pH levels— whenever they mix, it can throw things off balance. 

But here’s something interesting: our vagina can actually adapt to the bacteria of a familiar penis. However, this only seems to be the case when you are your partner are “physiologically compatible” — ie if your bacteria mesh well together. It’s similar to how women tend to prefer the smell of genetically dissimilar men.

Our vagina can also adapt to the microbiome of a familiar vagina. In fact, sex with a woman whose vaginal microbiome is healthy can actually stabilize your own vaginal microbiome and decrease your chances of developing BV (here's the study).

On the other hand, sex with an “incompatible” partner (of either sex) could potentially lead to ongoing discomfort or recurrent infections. Our partner's diet and overall health can play a big role in this as well – compatibility is not necessarily static. 

Things like yeast infections and bacterial vaginosis can also be passed sexually (though they're not STIs). 

It's actually a lot more common for infections to pass from vulva to vulva than it is for them to pass from vulva to penis. Though male partners generally don't need treatment when their partner has BV, the Mayo clinic recommends that female partners might, and should look out for signs of infection.

Unprotected sex with multiple new, unfamiliar partners can disrupt your ecology. This is absolutely not to say that casual sex is unhealthy — just that if it’s your thing, protection is extra important.

Oral sex, finger sex and sex toys can cause just as much potential disruption. Oral sex because the pH of the mouth and the pH of the vagina are so different, and because saliva has its own set of bacteria. Finger sex because, well, hands can be dirty (always wash hands with soap and hot water before sex)! And sex toys because, if not cleaned properly, can have a whole host of unfriendly bacteria (especially if you share them with a partner).

Okay, so how do we keep our vaginal happy, while still having good sex?

Practicing good “sex hygiene” (we'll talk more about this next time when we talk practical vulva care tips) is important, whether you're having penis-in-vagina sex, oral sex, or using a toy.

And perhaps most importantly, choosing to have sex with a partner(s) who you feel safe with. 

Sex with a partner who doesn't respect you, value your emotions, or care about your pleasure? Sex that, maybe, you feel like you “have” to have? Sex that you don’t even really get to enjoy that much?

Now, vaginal discomfort does not automatically mean anything about your partner(s). It's a complex ecosystem down there, with many factors at play. It's also not necessarily a definitive things – for example, you could experience a bout of discomfort or a flare-up of an infection during a difficult time in your relationship, that then clears up once the relationship issues are resolved.

But if you are dealing with an irritated vagina and resonate with any of the above questions? There might be something to consider.

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Cycles is a membership community dedicated to cyclical wellness for your body, spirit, heart, and shadow ꩜

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This post is for educational purposes only and is not medical advice. If you’re experiencing sudden or irregular menstrual concerns, or have any concerns about your reproductive health, it’s best to consult your doctor or a trusted healthcare professional.