Healthy Care for ‘Down There’


It’s Women’s Health Month in May and we thought we’d ask (quite frankly, in fact) … How much do you know about your vaginal health? There’s a lot to know! Check it out!


If you’re like many women, you breathed a sigh of relief when major health organizations such as the American College of Obstetricians and Gynecologists (ACOG) recently changed recommendations for frequency of pap tests (a test that checks for changes in cervical cells that may lead to cancer). These days, a woman who has had three consecutive normal yearly pap tests may be able to space out those tests to every three years – whew! Of course, we want to do what’s best for our health, but most women feel at least a little squeamish – if not acutely so – during a pelvic examination.

Not so fast, says Christopher Tarnay, MD, practicing gynecologist and Associate Professor of Obstetrics and Gynecology as well as Urology at the David Geffen School of Medicine at UCLA. You should still visit your doctor yearly, even if you don’t need a pap test. “An annual exam is more than just a pap smear,” he explains. “It’s the ideal time to survey your pelvic health, including checking for sexually transmitted diseases and ovarian problems and discussing reproductive health.”

Annual exams, according to Dr. Tarnay, should be done beginning when a woman becomes sexually active, or by age 21, whichever comes first. In addition to routine physical exams, you should always check with the doctor if you have a change in the color, odor or amount of your vaginal discharge, vaginal redness, itching or irritation, vaginal bleeding between periods, after sex or after menopause, or any lumps, sores or bulges in your vagina.

As far as squeamishness, especially when it comes to seeing a male doctor for your most intimate needs – “Women are less concerned about gender than they are about compassion,” says Dr. Tarnay, who models compassion with regular missions to Uganda, where he and his team offer medical services to pregnant women who lack prenatal care.

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Pretty much all of us have heard the gold standards of vaginal health, such as wiping from front to back and wearing cotton undies. But here are a few tips from the experts that will help you to maintain a healthy hoo hoo:

  1. “Don’t indiscriminately douche,” says Laurie Steelsmith, ND, LAc, naturopathic doctor and licensed acupuncturist of Honolulu, Hawaii, and author of Great Sex Naturally. While your doc may recommend a specific type of douche used to treat a problem, in general, “your body knows how to clean itself,” she says, adding that “douching can disrupt the friendly bacteria and promote overgrowth of yeast and bacterial infections.”
  2. Do remember that cleanliness is important prior to having sex, says Debra Wickman, MD, FACOG, Medical Director of SHE – Sexual Health Experts in Gilbert, Arizona. “You’d be surprised how many people pet the dog or cat and then have sex,” she says. To avoid infections, everyone should wash their hands.
  3. Do wash vibrators, personal massagers and other sex toys after using, says Dr. Wickman. “Otherwise they sit there growing germs, like a little petri dish.”
  4. Do get vaccinated, to protect yourself from diseases that can be spread through sexual contact, such as Human papillomavirus (HPV) and Hepatitis B.
  5. Do know yourself, says Dr. Wickman. “Take a mirror and a light out and know what you look like down there so you have a baseline in case something changes.”
  6. Don’t trap moisture in your genital area; let it breathe. Consider sleeping without undies to help maintain air circulation to your tissues and discourage yeast growth.
  7. “Don’t assume that your vaginal infection is a yeast infection,” says Dr. Steelsmith. Many conditions can cause similar symptoms, such as food allergies or intolerances, bacterial infections, dryness related to aging, and irritation from products such as toilet paper, deodorants or sprays. See your doctor for vaginal symptoms in order to get a proper diagnosis and treatment.


Many women find that after childbirth –  or upon reaching the big 4-0 –  things seem a little different down there. You may feel less sensation during sex, or a need for vaginal lubricant to combat dryness during lovemaking. You may notice a few spurts of urine leaking out when coughing or laughing, or during your daily run. What is going on here? These symptoms may be the result of pelvic floor muscle weakness, according to Debra Wickman, MD, FACOG, Medical Director of SHE – Sexual Health Experts in Gilbert, Arizona.

Pelvic floor muscles are the muscles that support your uterus, bladder, small intestines and rectum. Like any muscles, says Dr. Wickman, they can lose elasticity and become weak and difficult to control. This often occurs after childbirth or during perimenopause or menopause, when hormones diminish and cause decreased muscle tone. You can also put undue pressure on – and weaken –  your pelvic floor muscles if you’re overweight or if you have a chronic cough. And, says Dr. Wickman, a lack of using the pelvic muscles for sexual activity can cause them to become out of shape. “This is definitely a case of use it or lose it,” she says.

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When pelvic muscles are weak, you can experience symptoms ranging from less pleasurable sex and urinary leakage to a prolapse of your bladder and uterus, which is a condition where the organs slip down into the vagina – a problem that may require surgery.

Fortunately, you can strengthen your pelvic muscles just like you do your abs, with regular training. Most women know about – and have tried – Kegel exercises, which are done by tightening the vaginal muscles while drawing the pelvic floor up several times in a row; three sets of 10 Kegels each day are best. But while not so hard to do, they can be difficult to remember to fit into a busy day – and also boring. For that reason, Dr. Wickman suggests adding a new dimension to the standard Kegel routine with vaginal weights. “They’re a pocket-sized personal trainer for the pelvic floor,” she says. “They’ve revolutionized the concept of Kegel exercises.”

Dr. Wickman’s picks – the Laselle Kegel exerciser by Intimina, or Lelo’s Luna Beads, both of which can be purchased online or at your doctor’s office for under $50. Each exerciser is made of high quality, phthalate-free silicone, and is easy to use; you simply insert the weight and hold it inside. You can do it while you’re getting ready for work, and once you get proficient at it, even use it during your morning walk.

The best news? Hitting the vaginal weights just as you do the gym really pays off. “More than 75 percent of women with early pelvic floor weakness can be helped with exercise,” claims Dr. Wickman.


We all know that certain foods are better for the body, but did you know that certain foods promote – or work against – vaginal health? “In general terms, yes, there are foods that may be better choices for vaginal health,” says Michelle Collins, PhD, CNM, Associate Professor of Nursing and Director, Nurse-Midwifery Program at Vanderbilt University School of Nursing in Nashville, Tennessee.

First, she explains, the same well-balanced diet that you eat for optimum health – one full of fruits, veggies and whole grains, along with 6 to 8 glasses of water daily – will keep your immune system healthy and your vagina healthy, too. But beyond that, there’s the matter of maintaining good bacterial balance. The vagina, just like other areas of the body, says Collins, harbors a variety of “good” bacteria, the most common being Lactobacillus species. “The appropriate growth of good bacteria helps keep the overgrowth of harmful or infection-causing bacteria at bay,” she adds.

In other words, maintaining your vaginal “garden” with a dominance of Lactobacillus bacteria can help to keep problems like yeast infections or bacterial vaginosis, a common bacterial infection, away. How to promote the growth of good bacteria? Foods such as yogurt with live cultures, as well as foods rich in fiber and chlorophyll (think green leafy veggies like spinach and kale) can help beneficial bacteria thrive, says Collins.

If you’re prone to yeast infections, it also helps to avoid foods high in sugar and carbohydrates, she adds. “Yeast thrives on carbohydrates, so decreasing your intake of foods high in starch and sugars will help.”

Other foods/drinks to avoid, according to Collins: Refined foods with chemical additives, coffee and yeast-based or fermented foods like beer, wine, vinegar and tempeh.


Supplements can be beneficial in bolstering the immune system to protect vaginal health as well as treating certain symptoms, says Laurie Steelsmith, ND, LAc, naturopathic doctor and licensed acupuncturist of Honolulu, Hawaii, and author of Great Sex Naturally. Some of those she uses in her practice:

• Garlic extract, which has both antifungal and antibiotic properties, as well as beneficial immune activity. Garlic can have a blood-thinning effect, though, so talk to your doctor if you’re taking blood-thinning medications.

• Ginseng, taken by mouth, works to hydrate dry vaginal tissues.

• Vitamin E oil, applied topically, can also lubricate the vagina.

• Omega-3 fatty acids, such as fish oil, can help decrease inflammation and help with immunity.

• Vitamin C helps with immunity and protects the vaginal lining.

• Probiotics, especially containing 5-10 billion colony-forming units (CFUs) of acidophilus, can support the growth of healthy vaginal bacteria.