Sep 02 2011

Vulva Care – Keeping Everything Clean and Healthy

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Good care can prevent or minimize pain, itching, redness, or burning of your vulva. This is especially important if you have an STD, infection or are treated for cancer. The skin of the vulva can be very sensitive. Because it is moist and is frequently subjected to friction while sitting and moving, this area can be easily injured. There are various strategies that can be used to prevent irritation and allow the vulva to heal.

General

The strategy for vulvar care can be summed up as follows:

  • Avoid chemicals
  • Avoid humidity
  • Avoid heat
  • Avoid friction
  • Avoid allergies
  • Keep your hormones balanced
  • Stay clean

Depending on the severity of your symptoms and issues, you may want to follow more or less of these suggestions. Remember that you cannot wash your symptoms away. The biggest problems can lurk in the smallest details. Just because something did not cause a problem yesterday, does not mean it will be fine today. Be suspicious of everything when you have issues.

Clothing

  • Wear white cotton panties, or at the very least, underwear with a white cotton crotch. You may also choose not to wear panties at all. “Jockey for Her” and “Hanes Her Way” are two brands you may try.
  • Wear panties with full cotton crotches, like bikini, boy shorts or granny panties, not string underwear.
  • Avoid wearing pantyhose, tights, or other close‐fitting clothes. These synthetic materials holds both heat and moisture on the skin, conditions which encourage the development of secondary infections. Tight‐fitting clothes will also increase your symptoms and discomfort if you already have problems.
  • Wear thigh high or knee high hose instead of pantyhose. If you must wear pantyhose, try cutting out the center of the crotch.
  • Wear loose-fitting pants or skirts.
  • Remove wet bathing suits and exercise clothing promptly.
  • Sleep without panties when possible, to allow your vulva to dry and air out.
  • If you participate in a sport where nylon or spandex is needed, try to wear it for as short a period as possible. If you can practice with loose fitting clothes, do so.
  • Larger women may have problems with chronic dampness. Keeping dry is important. Use cotton fabrics when possible. Dry your body with a hairdryer on cool setting. Avoid tight fitting clothes.

Laundry

  • Use a mild, enzyme and fragrance free detergent such as those made for baby clothes to wash underwear with (Woolite Gentle Cycle, All Free and Clear, Arm & Hammer Essentials Free, Arm & Hammer Sensitive Skin, Sunlight Extra Sensitive Skin, etc.).
  • Double-rinse underwear and any other clothing and towels that comes into contact with the vulva. Make sure that there is at least one full rinse cycle at the end with just clean water.
  • Do not use fabric softener or dryer sheets on underwear.
  • Wash new underwear well before putting it on.
  • Use ⅓ to ½ of the suggested amount of detergent per load
  • If it is determined that your washing detergents are causing problems, baking soda can be used in its place
  • If you use a stain removal product on underwear and towels, soak and rinse it in clear water after that. Then wash using the regular washing cycle. This will help to remove as much of the stain remover as possible.

Hygiene

  • Use soft, white, unscented toilet paper. Pat the area dry with light pressure only.
  • Use lukewarm or cool baths (or Sitz bath) to relieve burning and irritation. Fill the bath with only an inch or two of water. Adding 4-5 tablespoons of baking soda, colloidal oatmeal such as Aveeno, or chamomile tea bags to the water may help reduce itching.
  • Do not use bubble bath, feminine douche, a deodorant spray, or any perfumed creams or soaps.
  • Use a soft cloth or your fingers to wash the vulva. Your fingers are actually the best way to clean there. Make sure you wash between the folds of your lips and under the clitoris hood. Wash the vulva with cool to lukewarm water only. Pat the area gently with a soft towel to dry. Do not rub it dry.
  • If you must use soap on your vulva, use an unscented and mild soap for sensitive skin. Unscented Dove, Neutrogena, Basis, Pears (made in England), and Conti Castile with olive oil are acceptable soaps. Pure clean water should however be the preferred way.
  • Avoid bath soaps, bubble baths, bath salts, scented oils, lotions, gels, etc. which contain perfumes that can be irritating. This includes many baby and feminine hygiene products marketed as “gentile” and “mild”. You may use neutral, unscented, non‐perfumed oils such as “Keri Oil” to damp skin after getting out of the bath. Do not apply directly to the vulva.
  • Rinse the vulva with water after urination. If you are not in Europe where bidets are common, use a small spray bottle filled with tap water. Pat yourself dry.
  • Urinate before your bladder is full.
  • Use 100% cotton menstrual pads and tampons. Two brand names are Natracare and Organic Essentials, but there may be others as well. These products may not be stocked in local drugstores. Both are available at multiple online drugstores. Use a search engine for cotton menstrual pads or tampons, or type in the brand name. Make sure you change your pad or tampon regularly to prevent it from soaking. Pads and tampons should never be scented.
  • Many women with vulvar pain experience a significant increase in irritation and pain every month when they use commercial paper pads or tampons. This monthly increase in pain can often be reduced by using 100% washable and reusable cotton menstrual pads. Some disposable cotton pads are available. Pure cotton tampons are also available
  • Sometimes a new top layer in an old and trusted menstrual pad brand can cause irritation and allergic reactions. Try a different brand if you suspect this.
  • Do not shave completely bald. If you want to groom pubic hair, use a hair trimmer, not scissors. Be very careful about the shaving products you use if you do decide to shave.
  • Always pat yourself dry, or use a hairdryer on cool.
  • Some women find warmed soaked tea bags to be soothing to the vulva. The tea bag may be placed on menstrual pads to hold them in place. Another method is to place the tea bags in warm water and use them in a sitz bath.
  • A compress of oiled Aveeno (a powdered oatmeal bath treatment) can be placed over the vulva three or four times a day. Put two tablespoons of Aveeno in one quart of water. Mix in a jar and refrigerate. Put it on a washcloth and place it over the vulva.
  • During intercourse use lubricants such as Crisco, Astroglide, Lubrin, Moisturel, Replens, PreSeed and KY Jelly to make intercourse more comfortable. Avoid extended intercourse and friction during intercourse.

Vaginal Stimulation or Penetration

  • Use a lubricant that is water soluble. K-Y and Astroglide are examples. A moisturizer such as Replens or a sperm friendly lubricant like Pre-Seed may also be used.
  • Pure vegetable oils like “Crisco” may help dryness with intercourse and lasts during sex and wash away with rinsing.
  • Do not use latex condoms as latex is often an irritant. Polyurethane condoms are available from the same brands as the latex condoms. Make sure you use a water based lubricant with it.
  • Use pull-out and prevent him from ejaculating inside you to prevent the wetness and possible allergic reaction to his semen.
  • A compress of oiled Aveeno (a powdered oatmeal bath treatment) can be placed over the vulva after intercourse when symptoms are flaring up. Put two tablespoons of Aveeno in one quart of water. Mix in a jar and refrigerate. Put it on a washcloth and place it over the vulva.
  • You can also apply ice or a frozen blue gel pack (lunch box size) wrapped in one layer of a hand towel to relieve burning after vaginal stimulation or penetration.
  • Urinate (to prevent infection) right after sex, do kegels to force his semen out if you did not use a condom, and rinse vulva with cool water (not inside your vagina, outside between your inner lips) after sexual intercourse. If you are trying to conceive, wait a few minutes after sex before doing this.
  • Do not use contraceptive creams, foam or spermicides.
  • Use smooth sex toys made from silicone, hard plastic, glass or metal. Make sure you use plenty of water based lubricant with it.
  • Never put anything that touched the anus in the vulva or vagina. Anal bacteria is bad for your reproductive system

Physical Activities

  • Avoid exercises that put direct pressure on the vulva such as bicycle riding and horseback riding.
  • Limit intense exercises that create a lot of friction in the vulvar area (try lower intensity exercises such as walking).
  • Use a frozen gel pack wrapped in a towel to relieve symptoms after exercise.
  • Enroll in an exercise class such as yoga to learn stretching and relaxation exercise.
  • Don’t swim in highly chlorinated pools. If you have to, rub Vaseline (petroleum jelly) on the outer lips to protect them.
  • Avoid the use of hot tubs.

Everyday Living

  • Drink plenty of fluids. This will help keep your urine dilute and make it less likely to sting or irritate the vulvar area.
  • Drink cranberry juice
  • Ask your doctor or nurse if it is advisable to use a foam rubber donut for long periods of sitting.
  • If you must sit all day at work, stand up for a few minutes as often as you can.

Itching

  • Don’t use antifungal creams or other over-the-counter medications.
  • Avoid perfumed moisturizers on the vulva.
  • Sorbolene cream may sting.
  • Try nappy rash cream, but ask your doctor and stick with what your doctor has recommended.
  • If itch is a problem and you as yet haven’t had any medical advice, you can apply 1% hydrocortisone ointment (not cream) available over the counter from your pharmacy/chemist. Be prepared for your pharmacist to caution you about the dangers of cortisone. Don’t be scared by such advice. Mild cortisones that are available over the counter are very safe. See your doctor as soon as you can for further advice.
  • Soak in lukewarm bath water with 4 ‐ 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 2 to 3 times a day for 10 to 15 minutes. This will also wash away any extra discharge and help with odor
  • Small amounts of “A & D” ointment may be applied to the vulva as often as needed to protect the skin. It may decrease skin irritation during the period and when you urinate.

Vulva Self Exam

  • Do a vulvar self exam once a month, just like you do a breast self exam.
  • Wash your hands carefully before you begin.
  • Lie or sit up in a comfortable position with good lighting and a hand mirror (a magnifying mirror may work best). It may help to prop up your back with pillows, or you can squat or kneel. Finding a comfortable position is important so you can clearly see the vulvar area, perineum, and anus.
  • First, just look and learn. Things may appear different from what you expect, and that does not necessarily mean they are abnormal.
  • Gently separate the outer lips of the vulva. Look for any redness, swelling, dark or light spots, blisters, bumps or other unusual colors.
  • Next, separate the inner lips and look carefully at the area between them for the same changes. Also, look at the entrance of the vagina.
  • Gently pull back the skin covering the clitoris and examine the area under the hood at the tip of the clitoris.
  • Be sure also to inspect the area around the urethra, the perineum, the anus, the outside of the labia majora and the mons pubis.
  • Feel for new bumps in your inner and outer lips.

Birth Control Options

  • The new low dose birth control pills do not significantly increase most women’s chances of yeast infections.
  • Contraceptive jellies, creams and sponges can cause burning and itching. A brand change sometimes helps. In general, these methods should however be avoided

Seeking Help

  • When seeking medical help, it might require a biopsy to diagnose your condition. If a biopsy is performed during your visit, after care is important. Keep the area clean and dry. Avoid application of creams or ointments to the biopsy site. Sitz baths twice a day for three or four days following the biopsy will aid in healing. If increase redness, severe pain, heavy discharge, or heavy bleeding occurs at the biopsy site, call for further instruction. Avoid intercourse until the biopsy site is healed.
  • Contact irritants may require low dose, short course topical steroids or topical anesthetics. If this is prescribed, use only as instructed.

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