Feminine Hygiene Products: Are They Safe for Treating Vaginal Odor?

The stigma of body odor and curation of 'hygiene norms' are the main focuses of industrial marketing centralized around female hygiene products. Aggressively promoted products promise better hygiene, which resonates with a healthy lifestyle. Should feminine hygiene products be a part of a healthy routine, or is there any reason to avoid some well-known practices and products? This article discusses potential effects one may observe with the use of female hygiene products.

What causes unpleasant vaginal odor?

An unpleasant vaginal odor might affect the quality of life, and sometimes may be associated with poor hygiene and changes in the vaginal microflora.

Vagina has its own microorganism environment, which is called vaginal microbiome. The most common microorganism is Lactobacilli, bacteria maintaining a moderately acidic environment in the vagina (pH 3.8–4.5). This environment plays an important role in protecting from sexually transmitted infections (STIs) and other infectious conditions appearing with lowered immunity and protection mechanisms.

Changes in the vaginal microbiome result in several types of vaginal inflammation (vaginitis), which may change the odor of the vaginal environment.

• Bacterial vaginosis. Occurs when the vaginal microbiome is overrun with anaerobic bacteria, such as Gardnerella vaginalis or Mycoplasma. Women experience a fishy-smelling, whitish, or gray watery vaginal discharge. This vaginitis increases the risk of gonorrhea, chlamydia, HIV, and herpes.
• Vulvovaginal candidiasis. A yeast (Candida spp.) infection characterized by an odorless, white, cheesy, curdy, or cotton-like vaginal discharge. The inflammation also causes itching and burning feeling.
• Trichomoniasis. A parasite (Trichomonas vaginalis) infection presenting with green or yellow discharge and a foul odor. This type of vaginitis causes painful intercourse, pain during urination, and vaginal soreness and increases risks for HIV and preterm births. Trichomoniasis is a sexually transmitted disease (STD).

Another type of vaginitis described in literature is aerobic vaginitis, which is characterized by an increase of aerobic and enteric bacteria in the vagina. Women suffer from foul or rotten smelling yellow to green thick vaginal discharge. Vaginitis presents with inflammation in the vaginal tissue, small erosions, or ulcerations.

Additionally, some other conditions may cause unpleasant odor:

• Forgotten tampon. Tampons soaked with menstrual blood and left for a long time in the vagina create an environment for pathogenic bacteria. If left for a prolonged time, in addition to unpleasant odor, it may have life-threatening consequences, such as toxic shock syndrome.
• Sex. Vaginal odor can change during and after sex due to contact with sweat, semen, and other bodily fluids mixing with vaginal fluid. In other cases, a fishy, off-putting order may signify a sexually transmitted infection (STI).
• Rectovaginal fistula. This condition occurs when holes develop between the vagina and rectum. This is a rare complication of a variety of causes, including childbirth and pelvic surgery. One symptom that can arise from having a rectovaginal fistula is foul-smelling vaginal odor and feces-mixed discharge.
• Cervical cancer. Degradation of a cancer tissue may present as a vaginal discharge and foul odor.

How does a healthy vagina smell?

Generally, our bodily smells differ from each other. Age, phase of the menstrual cycle, pregnancy, or menopausal state may affect the vaginal secretions and perceived smell. Also, hygiene methods and undergarment choices may have an impact on the perceived odor. Therefore, it would be difficult to describe a uniform odor type to define the 'normal' or 'healthy.'

Given the acidic environment, a slight sour smell could be sensed from the vagina. This smell is associated with the good bacteria — Lactobacilli — activity. Also, during menstruation, you may get a metallic smell. This is because of the iron content in the blood. During stress, overheating, or strenuous physical activity, you may get a sweaty smell from your undergarments. This is the result of your sweat glands’ work.

However, if you feel a distinctive change from the usual pattern, increased discharge in addition to the strong odor, this might be a sign of vaginitis. It is always recommended to discuss your concerns with your healthcare provider before starting self-cure methods, using a product you heard from others’ experiences.

Different types of products for vaginal odor

Vulvar and vaginal cleansing is a common practice among women. Women from different backgrounds use these methods before or after intercourse. Studies show that younger women aim to remove vaginal odor more often than older women.

The main concern linked to feminine hygiene products is about them altering the normal vaginal microbiome. When someone is washing their vulva improperly or uses any hygiene products in the vagina (the 'internal' part, where the tampon goes), the 'good' protective bacteria are cleansed out. As the balance in the microbiome is disturbed, potentially disease-causing microorganisms, which usually live in the vagina under normal conditions, overgrow rapidly. This may lead to inflammation of the vulva and vagina (vulvovaginitis) and a higher chance of urinary tract infections.

Surveys also show that regardless of the designation for external genital use, women use products in both vulvar and vaginal areas. The risk of adverse effects is much higher when such products are used internally.

Wipes

Feminine wipes are thin cleansing tissues used during menstruation or for daily hygiene. Although they are intended for external use, sometimes women use them internally for the cleansing of the vagina.

The tissue covering the vulva and vagina is different from the skin covering our body; it is nonkeratinized, meaning it is less protective from environmental factors. Therefore, the vagina and vulva are more prone to allergic reactions, as well as more sensitive to various irritants.

Wet wipes marketed for the genital area are promoted as 'for sensitive skin' or 'non-irritating.' However, the scientific evidence supporting these claims is scarce. A study analyzing the content of 34 unique hygienic wipe products sold in the U.S. found that each product contains at least one possible allergen. The authors of the study recommend checking the ingredients list of the product of interest for fragrance, oils, and other allergens.

Also, the components of the wipes may affect the vaginal environment and may lead to adverse effects. For example, in a Canadian survey, women using feminine wipes had double the odds of urinary infections (UTI), while baby wipes increased the UTI risk by 60%.

Considering potential adverse effects linked to the wipe use, it is recommended to avoid their use for routine genital cleaning, most importantly inside the vagina (which does not need to be cleansed at all).

Vaginal (vulvar) washes

Vaginal washing is most commonly referred to as a cleaning of the vulva and the skin surrounding it. However, the vulva refers to the area of the external female genitalia, which lies outside of the vaginal opening. The word 'vagina' in the name might be confusing with vaginal douching, which refers to the cleansing of the vagina, which is located inside the vaginal opening (aka the 'internal' part).

Study results show that the use of feminine washes and gels increases the risk of bacterial vaginosis by 3.5 and urinary infection by 2.5 times. Also, a study from Ghana has shown that the use of feminine washes may increase the risk of recurrent vulvovaginal candidiasis (a yeast infection) by nearly four-fold.

However, many women choose to wash their vulvas with cleansers. As clear evidence regarding optimal feminine hygiene is lacking, it's still questionable if their risks outnumber the benefits. However, if this is the preference, the cleanser should be formulated for the vulva, pH-balanced, clinically-tested, and contain no additives, such as fragrances or colorants. It should never be used to wash the vagina (the internal part).

Vaginal douching

Vaginal douching is a common hygiene practice in different cultures, although it has no confirmed health benefits and is known to be harmful. The method describes the process of washing the vagina, i.e., female genital organs inside from the vaginal opening, with water or commercial or homemade liquids. In addition to the liquid products, it is possible to stumble upon commercials of plastic tools with a container and nozzle to direct the solution to the vagina.

A study from Los Angeles showed that African American women use this method more than Latin women or Caucasians. Another study reported that 56% of studied middle-aged Korean women practiced vaginal douching; 13% of them used commercial products, while 6% preferred vinegar-mixed water solutions. In a study from a rural area in Turkey, more than 80% of women reported vaginal douching, and all of them had a history of recurring or treatment-resistant vulvovaginitis. However, in another Turkish study, only 26.5% of women reported vaginal douching practice, and 71.4% of them did so to decrease unpleasant vaginal odor.

Interestingly, in these studies, vaginal douching was more common among women and couples with lower educational and socioeconomic levels and who had unplanned pregnancies. Also, they mentioned that they started using the douching method because they heard from someone in the neighborhood about it.

Vaginal douching changes the bacterial environment in the vagina and increases the types of bacteria causing vaginitis. For example, detection of bacterial vaginosis-associated bacteria and Gardnerella vaginalis is more likely in the American women who practice vaginal douching.

Douching is also associated with an increased risk of STIs and pelvic inflammatory disease. Additionally, a study finds that if women use vaginal douche in the last 6 months, the risk of getting a vaginal yeast infection increases nearly by three times, bacterial vaginosis by seven times, and urinary infection by more than 2.5 times.

Soap

Soap is the most available cleansing product in almost every household and is commonly used for vaginal douching. However, soap is alkaline (pH 8–10) and, if used intravaginally, may alter the acidic environment characteristic of the vagina. For the same reason, bubble baths may irritate the vulvovaginal area.

Scented tampons and pads

A survey analysis shows that scented menstrual and intimate hygiene products are preferred by women of older age and less formal education. Analysis shows that scented tampons and menstrual pads contain more volatile organic compounds — such as terpene and aromatic compounds — than unscented products and are known to disrupt the vaginal microbiome and irritate the vulvar skin.

Are feminine hygiene products for vaginal odor safe?

Intravaginal cleansing practices are associated with several adverse effects. Various products may alter the vaginal microbiome. Women using vaginal douching report more vaginal infection history than those who do not douche. Also, the change in the vaginal flora may also increase the risk of urinary tract infections.

Ingredient analysis of different hygiene products revealed that most of them contain potential allergens and volatile organic compounds (VOCs). VOCs are easily vaporizing chemical products that are resistant to degradation. Long-term exposure to VOCs may lead to cancer development. In female hygiene products, VOCs are used as fragrances, moisture barriers, and adhesives. A study analyzing nearly 80 commercially available hygiene products found that vaginal washes, sprays, and powders have the highest concentration of VOCs. Also, the VOC content was not low in the items with labels such as 'organic' or “for sensitive skin.”

Given the potentially harmful components of feminine hygiene products and the adverse effects associated with the alterations in the vaginal flora, their use inside the vagina is not recommended.

What works to prevent vaginal odor?

Generally, the vaginal environment 'takes care' of itself — there is no need to wash the vagina even with water. Following proper vulvar hygiene rules and keeping the optimal pH of the vaginal environment is enough to avoid unpleasant odors.

Maintaining vulvar hygiene

Watching personal hygiene is the best way to deal with unpleasant bodily and vaginal smells. Please note that while it is recommended to wash the vulva (the external genitalia), washing practices of the vagina (the 'internal' part) are not recommended.

Here are some recommended practices for vulvar skin care:

• Vulvar washing with water is enough to remove a vaginal discharge, urinary or fecal contamination, and sweat.
• Avoid vulvar cleaning with bar soap, shower gel, deodorant, douches, antiseptic agents, baby wipes, or colored toilet papers.
• Once-a-day cleaning is enough. Overcleaning is not recommended.
• Showering is recommended over bubble bathing.
• Wash from the front to back but not otherwise. The reason is the high number of gut bacteria in the feces, which contaminate the anus. While these bacteria are normal flora for the gut, they are disease-causing agents for the vagina and urinary tract.
• Use your hand for washing. Don’t use sponges or other scrubbing methods.
• Tampons and sanitary pads should be changed frequently.
• Do not apply talcum powder or any perfumes to the genital area.

Wearing proper underwear

The wide selection of undergarments makes it tempting to use various models. However, white or light-colored underwear made of silk or cotton is recommended over other fashionable lingerie products. Also, avoid tight clothes, including trousers and leggings. Sleeping without underwear is also among the recommendations. Moreover, underwear should be changed frequently, and the regular use of sanitary pads should also be avoided.

Other than the choice of proper underwear, the proper care for them also may help reduce vaginal symptoms. Undergarments should be washed separately in a non-biological laundry detergent. Avoid biological powders and fabric conditioners. Lastly, washing the newly purchased underwear reduces the risk of allergy to textile dyes.

Dietary adjustments

Healthy lifestyle adjustments and a balanced diet are beneficial to reproductive health on different levels. The scientific evidence is limited to show a protective or beneficial effect of a certain food product on vaginal health and odor. However, a study questioning the dietary habits of participants showed that women following the 'unhealthy diet' pattern are more likely to develop bacterial vaginosis. Unhealthy diet patterns contain sugar, including desserts and sweet drinks, solid oils, red meat, fried potatoes, refined grains, and visceral meat. Similarly, another study showed that increased dietary fat intake increases the risk of bacterial vaginosis.

On the other hand, the ovo-vegetarian diet pattern may have a risk-reducing effect on bacterial vaginosis. The main components of the ovo-vegetarian diet are vegetables, including green, yellow, and starchy vegetables, beans, eggs, and whole grains. Also, some studies show that folic acid, vitamin E, and a higher calcium intake may reduce bacterial vaginosis risk.

In summary, maintaining proper vulvar hygiene and using condoms during intercourse to stay protected from STIs are crucial to avoiding unpleasant vaginal odor. Feminine hygiene products are not recommended to overcome the smell. On the contrary, they may alter the flora and disrupt the vaginal environment. If you sense changes in your vaginal health, including in the usual smell and discharge pattern, it is always advised to seek professional help to manage your complaints.