Somewhere between Georgia O’Keeffe’s portrayal of the feminine genitalia as flowers, and models with flawless, photoshopped bikini lines, we are still perplexed by our bodies and feel ashamed of the normal physiology of our organs. In the last decade or so, there has been a significant increase in the number of feminine hygiene products on the market guaranteed to make your “nether regions” look, feel and smell “flowery fresh, and absolutely feminine.” However, what many women are forgetting is that we aren’t made that way, and that everything functions the way it does for a purpose. More and more women are going to meet their doctors with complaints of vaginal discharges and odours, but a significant amount of these complaints are normal biological processes in the body. In fact, lack of the same may actually be indicative of underlying issues which may warrant attention. So what constitutes normal discharge and when does one need to get professional help?
“The problem is that normal discharge itself is extremely perturbing to most women,” says Dr Aarthi Bharat, a consultant obstetrician and gynecologist with Motherhood Hospital in Bengaluru’s Banashankari neighbourhood, “Discharge that is white or even clear, isn’t foul smelling and doesn’t cause any itching or irritation is actually normal and hormone related, and is actually a good thing.”
She further explains how this normal vaginal discharge may vary at several points during the normal menstrual cycle. “There will be changes during the 30 day period, during ovulation a woman might present with thin, stringy discharge. But as long as it is white, clear and not smelly, it’s normal,” she states.
If discharge is normal, when should you see a doctor?
“If a woman is having any itching along with discharge, or if it has been persistent, or if she’s experiencing discharge and pain post sexual intercourse, it definitely warrants medical attention,” explains Dr Archana Sampath a Chennai-based consultant obstetrician and gynecologist, “Some discharge will be present during the normal cycle, for instance some clear discharge is expected during ovulation. But abnormal discharge appears thick, curdy white or even green and will be foul smelling.”
Several doctors agree that the best time for anyone experiencing such symptoms to see a doctor is between eight and 10 days after their last period.
“That way we can do whatever examination and lab tests are required without worrying about the presence of hemoglobin (from the blood) altering the results,” explains Dr Archana.
During the physical examination, a number of routine questions are posed: when did you have your last period, whether you use oral contraceptives or have recently used antibiotics, whether you have changed the brand of sanitary napkins you use. All of these may play a role in helping diagnose the reason for the appearance of any abnormal discharge.
“We do a clinical exam to determine whether it is normal or abnormal discharge. If we are in a setup where there is access to a laboratory, then we can immediately conduct a few tests and examine the sample under the microscope if needed,” says Dr Aarthi, “And once we determine the cause, we can give the appropriate treatment.”
Though several women experience these issues, many still feel embarrassed to come forward and consult doctors.
“For every 100 patients I see, anywhere between 20 and 30 of them might have these complaints,” says Dr Aarthi, “And yet, there is so little awareness among women about the issue.”
The role of feminine hygiene products
The idea that women must smell, look and feel “fresh” from head to toe is one outdated notion which needs to go, experts say. Several products are now available which guarantee this “freshness” of the female anatomy. The truth, however, is simple: women are human beings with basic bodily functions and not a piece of frozen meat which must remain “fresh.” Despite several knick-knacks and products available, experts agree that the vaginal environment naturally has mechanisms to keep itself clean and healthy.
When the natural protection offered by a woman’s body is disrupted through any means, this results in a chance of contracting an infection. The external area of the female genitalia, called the vulva, and the internal area (the vagina) all have natural fluids, and are lush with lactobacilli which help to maintain a normal acidic pH level. When this pH level changes, it allows for a number of issues to possibly arise. What many women don’t realise is that several products which claim to be helpful may actually be doing more harm than good.
“Some of these products have been in the market for 10 years or more now. A few are formulated to be pH friendly and won’t cause any disturbance to the natural pH found in the vaginal environment,” says Dr Pallavi Uday, a consultant from Hyderabad, “but others don’t.”
The vulva and vagina generally tend to be more acidic in nature, if the pH becomes neutral or even turns alkaline, it can cause issues.
“That’s not to say that these products are not useful, but one should take caution when using them. External products help the external area and can be used when needed, but someone doesn’t need to use a feminine wash on a daily basis. But if someone is prone to a particular issue such as a recurrent vaginal infection or a urinary tract infection then they might be recommended to use such a product on a more frequent basis,” says Dr Aarthi.
When selecting an intimate wash, most doctors recommend a pH friendly product between 4.5 and 5, that is soap free, mild, non-irritant, and prefer that women use one which may have a moisturiser.
“But this again can be problematic, because too much moisture in the genital environment can also cause certain infections. Ultimately it shouldn’t cause any irritation or allergies,” adds Dr Pallavi.
What is the best way to take care of one’s intimate regions?
“Never use dettol or savlon!” exclaims Dr Aarthi, “I cannot emphasise this enough. But many women are under the impression that using such commodities will help maintain a healthy environment, but in reality this may be contributing to the irritation they face.”
She also adds that other measures such as wearing loose comfy clothing, keeping the vaginal area fairly dry and cleansing oneself properly after a bowel movement (front to back) help ensure that a woman’s genital area is kept healthy. “Often times the contaminants found in the stools can cause infections. So it’s important that women ensure they are cleaning themselves properly. I’d also say that it’s best to avoid using pantyliners on a daily basis. It’s not needed. Pantyliners were introduced to protect the undergarments from staining during the last few days of one’s period, if you are using the same one from morning to evening the moisture will buildup and can cause an infection. Change pantyliners every 3 to 4 hours. Generally speaking, a simple wash with warm water itself is more than enough.”