by Professor Lynn Basford
What is Personal Hygiene?
Discussing a women’s intimate parts has a sensitive ring, even more so when there is a need to discuss hygiene. Women generally are offended in that they assume, quite wrongly, that this implies that they are not clean.
Taking showers daily may be the norm, but it does not always ensure that the vulval area is clean and free from cross contamination and irritation. Particularly so if the woman has been bleeding, or has had a discharge for some considerable time, or the vaginal area is extremely tender and sore. Prior to hysterectomy it is important that extra hygienic care is taken so as to prevent infection in the urinary tract, vaginal/uterine area, or, post surgical wound infections.
Unfortunately, it is often assumed that everyone knows the anatomical positioning of the vulva, urethral oriface, the vaginal oriface, and the anus. In addition, what is meant by cross contamination in the perineum region?
So rather than make assumptions this article will cover :
(i) what is the vulval area?
(ii) the location of the urethra and anus
(iii) understanding the various Ph values in each of the threes bodily systems i.e. urine/vaginal/ rectum, and the normal bacterial flora contained within each of the separate systems.
(iv) the nature of cross contamination and how to prevent it.
(v) tips for how to care for your perineum region and any sensitivity you may have.
(i) What is the Vulva area?
The Vulva is a term used to embrace the female sex organs that lies outside of the vagina. these include the mounded area above the pubic bone known as the mons pubis; the labia major (labia meaning lip), which is the larger folds of sensitive tissue and the labia minor, the smaller set of sensitive tissue, the clitoris, that is a small round highly sensitive tissue, the vaginal orifice and the urethra.
(ii) The location of the Urethra and Anus with respect of the Vagina
- The urethral oriface is located just in front of the vaginal opening and below the clitoris. In some women, it may seem it forms part of the vagina as it is so close. WE ARE ALL DIFFERENT ANATOMICALLY, these positions are approximates. The function of the urethra is fundamentally to enable you to pass urine in a controlled manner. ( i.e no incontinence or dribbling). (see Figs. 1&2)
- The anus is located approximately one inch away from the vagina and functions to enable waste products from our digestive system to be eliminated. In between the vaginal opening and the anus, is the formation of the perineum. (see Figs. 1&2)
(iii) Understanding the pH values for each of the separate bodily systems.
First of all lets review what a pH value is and its importance for human health. pH is the acronym for “Potential Hydrogen”. It is measured in logarithmic scales from 0-14. lower numbers indicate an acidic medium ,while higher numbers are considered to be alkaline in nature. A neutral position is considered to be around the 7 point mark.
What does this mean in the body?
If your bodily secretions are more acidic there is less potential to absorb hydrogen ions, conversely, if they are more alkaline in nature there is greater potential to absorb hydrogen ions.
pH values in the human body control the speed of our biochemical reactions (enzyme production) that operate within a dynamic framework, i.e. they are always in operation mode and the speed of electricity that flows through our body.
All biochemical reactions in all aspects of living energy are under the control of pH. We know for instance that each of the systems under scrutiny have a different pH value. It is not surprising since they have distinct functions to undertake while functioning in unison with all the other systems to ensure the body maintains homeostasis (total balanced health in a dynamic framework).
For instance the vagina’s normal pH range is between 3.8 to 4.5 levels (an acidic medium). The anus and stool excreta is normally around 7-7.5 pH and the urethra and urine around 7.0. There is a difference between urine and faecal pH values and that of the vagina. Under normal conditions the problem starts to arise when the environment changes these pH values through various influences.
(iv) The influences of environmental changes and pH values
The chief question to be asked is what is meant by the environment and how does this change?
The environment within this context can be both internal and external to the vulval and anal regions.
As previously stated the pH values are maintained within the context of their own system and the normal functioning of the body as a whole. If one system is out of balance it can, and often does effect another.
For example, the vagina is influenced by the internal hormonal balance and the women’s monthly cycle and the stages of her reproductive life cycle. (menarche to menopause ).
The vagina itself hosts a variety of different kinds of bacteria, known as normal vaginal bacterial flora, namely, Lactobacillus group. Under normal circumstances this range of flora live symbiotically together to protect not only the vagina, but also the uterus and the reproductive organs as a whole – think sexually transmitted diseases and bacterial infections.
These bacteria flora love the acid pH medium of the vagina. Problems arise when this balance is disturbed often resulting in vaginal infections, due to harmful bacteria and broader systemic infections of the body.
Menarche – the beginning of womanhood and the menstrual cycle.
What appears is a sticky vaginal discharge prior to ovulation that can increase and become almost ‘runny’. Influenced by ovulation, discharge is at a peak. Following this peak is a decline in secretion. After ovulation, the discharge becomes thicker and the amount gradually decreases.
Changes can affect the pH acidity, which may allow harmful organisms to enter the vagina causing infections. These harmful organisms may be introduced through poor hygiene and unsafe sex. It is important that young women are educated not only in safe sex education, but the importance of good hygiene care that becomes a life time habit.
A woman’s reproductive cycle, once started, will continue throughout her reproductive lifetime some 35-40 years with temporary cessation due to pregnancy. The days when blood will flow normally lasts for 1-6 days. These are days when particular attention needs to be given to hygiene matters so as not to facilitate cross contamination. In addition, there is a need to change regularly so that the blood discharge does not allow for increased colonisation of harmful bacteria.
Pregnancy- when a women is pregnant there is a cessation of her menses.
Her body is adjusting to accommodate the growth of the baby and ensuing labour. There are clear hormonal influences going on that often changes the pH value of the vagina. It is important that vulval health is maintained during this period. As the pregnancy advances the weight of the baby may push down onto the bladder/urethra and the rectal area as a whole.
Menopause – the last major change to a woman’s reproductive system.
There is a natural change in the pH value of the vagina during and following menopause and this can invite over colonisation of harmful bacteria resulting in bacterial vaginosis. With this condition, the pH usually increases toward 5-8 i.e. moving from an acid base to a neutral, or, indeed alkaline. Whilst this is not the only time this condition may occur during a women’s reproductive life cycle, it is a significant point.
Other factors are known to produce over colonisation of bacteria such as stress, tight non organic clothing, poor diet and sleep patterns, new sexual partner or multiple partners, use of antibiotics, alcohol and drug abuse.
If you find yourself itching, have excessive discharge and / or painful urination it is likely that you may have a bacterial/yeast infection. Please Consult your doctor for appropriate treatment prior to your Hysterectomy.
(v) Tips to manage and prevent cross infection.
To begin with it is important to keep the vulval and perineum area clean and dry.
- To clean: thoroughly rinse the vulval area with warm, clean, unperformed water using either a handbasin, shower or bath. Ensure to open the folds (labia major and labia minor) and around the hood of the clitoris. Once rinsed carefully wipe the area with a specific clothe used for this purpose only. If you like, you can use a mild soap that is unscented. Rinse a second time if using soap as this can be an irritant on the skin. Remember this is a gentle procedure, your not scrubbing your knee!
- To dry thoroughly; once clean pat the area dry with a clean soft towel. Discard after each use to prevent cross contamination as towels harbour bacteria. Ideally cut up , or have some small soft wash clothes. If you are sore, or irritated in any way drying may be too painful. Some people have been known to use a hairdryer but with ultimate care and attention to heat, distance away from the body and not near any water.
NB avoid harsh soaps, cleansing products that contain chemicals, including those that are highly perfumed. Pre -wet wipes might seem an answer, but they often have chemicals impregnated in them.
Other general tips
- Trim tall hedges. Some women have a lot of hair around their pubic and perineum areas. if this is the case you might like to do some light trimming.
- Wear cotton. Underwear made from cotton and other natural fibres is more breathable and can help you feel fresher. they also absorb more sweat.
- Be conscious of your neighbours – it is important to remember that your vagina has anatomical neighbours whose ph value is different (the urethra and the anus). Therefore, wipe from front to the back when you have emptied your bowels. Keep wiping until the toilet paper has no remaining residue on it. You can wet your toilet paper to ease any irritation or aggravate any soreness you may have. If you are wearing panty liners then make a habit of changing each time.
- Avoid any products that are perfumed.
- Vaginal douches – are not advised.
- Hot Tubs and Swimming Pools- be mindful that hot tubs and swimming pools use chemicals to keep the waters free from harmful bacteria.
- Sexual practices – if you use a lubricant use a water soluble one that is free from added perfumes. Remember that contraceptive spermacides, mouses, foams, sponges and condoms can cause irritation. Be aware that these can create sensitivity and changes to your vaginal ph. In addition, if you use a diaphragm, vaginal dilators or any sex toys they must be scrupulously cleaned and dried after each use. If you engage in oral sex be mindful that saliva, beards, and moustaches may be a source of irritation. NB never have genital contact after anal contact, and after sexual intercourse empty your bladder and always wash and dry vulval area.
- If you have Incontinence – Incontinence may be urine /or faeces. Predominantly it is commonly referred to as urinary incontinence. This can be either stress incontinence i.e leakage during exercise, running, jumping etc. or of a chronic uncontrolled nature. The same principles apply keep the area clean and dry. Rinse, wash, rinse using proper front to back technique and change pads. If excessive you can use a barrier cream to prevent rash /irritation.
- Sitz baths – if you are able, a sitz bath adds comfort A sitz bath is a warm, shallow bath that cleanses the perineum (the space between the rectum and the vulva).
- Emptying your bladder – women by the nature of their anatomy usually sit on the toilet seat and urinate or defaecate. So often there is a tendency to sit towards the back of the spine, empty the bladder and when no more urine is coming out believe that the bladder is empty. This is not the case as the bladder holds a residual amount of urine in it which may be 2-4 ounces. If this remains this urine can become stagnant and there is a chance that bacteria can colonise and create urinary infection. Therefore it is advisable to bend forward slightly and remaining urine will be expelled out.