Vagina: What’s typical, what’s not

Vaginal health is vital to overall health. When the vagina is not healthy, it can affect the quality of sex and orgasms. It also may affect pregnancy. Vaginal health issues that go on for a long time can cause stress or relationship issues. Vaginal health issues also may affect how you feel about yourself. Know the symptoms of vaginal health concerns and what you can do to keep your vagina healthy.

The vagina is a closed muscular canal. It goes from the outside of the genitals, called the vulva, to the neck of the uterus, called the cervix.

Factors that can affect the health of the vagina include:

• Sexual activity. Having sex without protection can result in sexually transmitted infections. Forceful sex or an injury to the pelvic area can result in harm to the vagina.
• Certain health conditions and treatments. Some conditions that may affect the vagina can cause painful sex. These include a condition in which tissue that’s like the inner lining of the uterus grows outside the uterus, called endometriosis. Another condition that can affect the vagina and cause painful sex is an infection of the reproductive organs, called pelvic inflammatory disease. Scarring from pelvic surgery and certain cancer treatments also may cause painful sex. Use of some antibiotics raises the risk of a vaginal yeast infection.
• Birth control and hygiene products. Birth control that blocks sperm, called barrier contraceptives, can irritate the vagina. These include condoms, diaphragms, and the spermicide that goes with them. The use of sprays, deodorants, or douches also can irritate the vagina.
• Pregnancy and childbirth. Pregnancy often causes extra vaginal discharge. Vaginal tears can happen during childbirth. Sometimes, a cut needs to be made in the tissue of the vaginal opening during childbirth, called an episiotomy. A vaginal delivery may affect muscle tone in the vagina.
• Psychological issues. Worries and depression can lower sexual arousal. That may cause discomfort or pain during sex. Sexual abuse or a painful sexual experience also can lead to pain linked with sex.
• Hormone levels. Changes in hormone levels can affect the vagina. For example, there’s less estrogen in the body after menopause and during breastfeeding. Loss of estrogen can cause the vaginal lining to thin, called vaginal atrophy. This can lead to painful sex.

Conditions that can affect the vagina include:

• Sexual issues. These might include constant pain or pain that happens just before, during or after sex. Painful sex is called dyspareunia. Pain with penetration means that pain happens when something enters the vagina. This type of pain might be caused by muscle spasms of the vaginal wall, called vaginismus.

  The muscles in the pelvic floor can tense, causing ongoing pain and pain during sex. Vaginal dryness also can cause pain during sex. Vaginal dryness often happens as menopause nears, called perimenopause, or after menopause.

• Sexually transmitted infections. Sexually transmitted infections such as chlamydia, gonorrhea, genital warts, syphilis and genital herpes can affect the vagina. Symptoms might include vaginal discharge or genital sores.
• Vaginitis. An infection or change in the balance of vaginal yeast and bacteria can cause swelling and irritation of the vagina. Symptoms include vaginal discharge, odor, itching and pain. Common types of vaginitis include yeast infections and trichomoniasis.
• Bacterial vaginosis. This can happen when the vagina’s natural bacteria levels are out of balance. Having a period, douching or sex might lead to bacterial vaginosis. Symptoms may include vaginal discharge and odor.
• Pelvic floor relaxation. Ligaments and connective tissues hold the uterus and the vaginal walls in place. If these ligaments and tissues become weak, the uterus, bladder, rectum or the vaginal walls might slip down. This is called prolapse. Prolapse may cause a bulge in the vagina or leaking urine when coughing and sneezing.
• Other conditions. Vaginal cysts can cause pain during sex or make it hard to put in a tampon. Vaginal cancer, which might first show up as vaginal bleeding after menopause or sex, also is possible. But it’s rare.

Talk with a member of your healthcare team if you have:

• A change in the color, odor or amount of vaginal discharge.
• Changes in vaginal skin color or itching.
• Vaginal bleeding between periods, after sex or after menopause.
• A mass or bulge in the vagina.
• Pain during sex or trouble having sex.
• Problems putting in a tampon.

You might not need to see your healthcare professional every time you have vaginal irritation and discharge. If you’ve been diagnosed with a vaginal yeast infection in the past and you’re having the same symptoms, you can try the medicine you used before. If symptoms don’t go away after you use the medicine, talk with your healthcare professional.

You can take steps to protect your vaginal health and overall health. Try the following:

• Have safer sex. Use condoms. Or have sex with only one partner who has sex only with you and who has no sexually transmitted infections. If you use sex toys, clean them after every use.
• Get vaccinated. Vaccinations can protect you from HPV, the virus associated with cervical cancer. And you can get a vaccination to protect against hepatitis B. This is a serious liver infection that can spread through sex.
• Do Kegel exercises. Kegel exercises can help tone your pelvic floor muscles if your uterus and vaginal walls have slipped, called prolapse. Kegel exercises also can help with urine leakage or pelvic floor weakness.
• Know your medicines. Talk with your healthcare professional about the medicines you use. Know what side effects they can cause.
• Limit the amount of alcohol you drink, and don’t smoke. Alcohol misuse can harm your sex life. Nicotine might affect getting aroused. Substance misuse also might cause poor physical and mental health. Both can affect your sex life.
• Be gentle. Don’t wash inside your vagina. And don’t use products that can irritate the vagina. These include wipes, douches or harsh soaps. Don’t use scented products.

You can’t prevent all vaginal issues. But having regular checkups can help make sure that issues of the vagina are diagnosed as soon as possible. It’s important to talk openly with your healthcare professional about vaginal health.