You've probably spent more time learning about your car engine than your vaginal microbiome. The car engine information was freely offered. The vaginal microbiome was not.
The consequence: most women encounter their first yeast infection or bout of bacterial vaginosis with no framework for what happened or why. And a significant number are regularly using products that make these problems more likely.
How vaginal health actually works
The vagina is self-cleaning. This is not a simplification. It's an accurate description of a sophisticated microbiome. Lactobacillus species, primarily Lactobacillus crispatus, dominate a healthy vaginal environment and produce lactic acid that maintains an acidic pH of roughly 3.8–4.5. That acidity is the primary defense against pathogens, including the bacteria that cause BV and the Candida species that cause yeast infections.
The vagina does not require internal washing. Introducing anything that raises pH — soap, douche products, water: disrupts this environment. The consequence isn't dirtiness. it's the opposite of the intended effect.
The vulva (the external anatomy) does benefit from gentle washing with unscented, pH-balanced products. The line between vulva and vagina matters here. External is okay with care. Internal is not needed, and is often harmful.
A 2016 study by Crann et al. published in Reproductive Health found that women who used internal vaginal hygiene products were 3.5 times more likely to have BV and 2.5 times more likely to have a vaginal infection in the past month compared to non-users. The products marketed for vaginal "freshness" were associated with exactly the conditions they implied they prevented. This is the most consistent finding in vulvovaginal hygiene research: there are no outlier studies on the other side.
What's normal, and what isn't
Vaginal discharge is normal. Its consistency, volume, and appearance change throughout the menstrual cycle: thinner, more watery around ovulation. thicker and white in the luteal phase. lighter or absent during menstruation. This variation is hormonal and expected.
What warrants attention: discharge that is gray, yellow, or green. discharge with a strong, unpleasant odor (BV has a characteristic fishy smell, particularly noticeable after sex. Discharge accompanied by itching, burning, or swelling of the vulva. or any bleeding between periods or after sex that is unexplained.
Hormonal shifts change the picture. During pregnancy, discharge increases. After delivery, the vaginal environment shifts significantly. In perimenopause and menopause, declining estrogen reduces Lactobacillus populations, raises pH, and causes the vaginal tissue to thin and become drier. This is genitourinary syndrome of menopause (GSM) and is very treatable but rarely discussed proactively.
Internal douches of any kind. Scented wipes, soaps, or lubricants used internally. Bubble baths that contact the vulva regularly. Scented pads or tampons. Thong underwear with synthetic fabric daily (increases friction and moisture). None of these are necessary, and the scented ones specifically disrupt the pH environment that keeps the microbiome healthy.
Recurrent infections: when it's more than bad luck
Recurrent BV (four or more episodes per year) or recurrent yeast infections indicate something else is happening. For BV, the current research points to a complex biofilm issue. Gardnerella vaginalis forms a biofilm on the vaginal wall that makes standard antibiotic treatment temporarily effective but not curative. Extended boric acid protocols and Lactobacillus recolonization are areas of active research. your gynecologist can discuss current options.
For recurrent yeast, relevant factors include antibiotic use, uncontrolled diabetes, immunosuppression, hormonal contraceptive effects on vaginal pH, and the specific Candida strain (C. glabrata is less responsive to standard over-the-counter antifungals). Recurring infections are worth a proper culture to identify the strain.
When to see your OB-GYN
Any unfamiliar odor, particularly fishy or strong — BV is easily treated but doesn't resolve on its own and increases STI susceptibility.
Itching, burning, or swelling that doesn't resolve, especially if you've already tried an over-the-counter antifungal without improvement.
Unexplained bleeding between periods, after sex, or after menopause: always warrants evaluation.
Vaginal dryness or pain during sex in perimenopause or menopause. This is GSM, it's very treatable, and you don't need to tolerate it.
STI screening is a separate and important part of vaginal health that this article doesn't cover in full. ACOG recommends annual chlamydia and gonorrhea screening for all sexually active women under 25, and for older women with new or multiple partners. Regular Pap smear and HPV testing schedules vary by age: your OB-GYN can advise on what's right for your situation. These are routine and are not something to delay because of embarrassment.
References
- Crann SE, et al. Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey. BMC Womens Health. 2018;18(1):52.
- Ravel J, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA. 2011;108(Suppl 1):4680–4687.
- ACOG Committee Opinion No. 754: The utility of and indications for routine pelvic examination. Obstet Gynecol. 2018;132(4):e174–e180.
- Foxman B. Epidemiology of vulvovaginal candidiasis: risk factors. Am J Public Health. 1990;80(3):329–331.
- Koumans EH, et al. The prevalence of bacterial vaginosis in the United States. Sex Transm Dis. 2007;34(11):864–869.