With so much conflicting advice about the female body, it can be hard to know what's normal, what's not — and what women really need to ignore.
Is any pain during sex normal? Should you worry about discharge or the color of your period? Do you need to douche or steam clean your vagina?
“Asking questions and educating yourself is extremely, extremely important,” said Dr. Taraneh Shirazian, a gynecologist at NYU Langone Health. “I am always surprised in how many ways how little is known.”
To clear up the confusion, some doctors share the basics about what women need to know.
1. The vagina is a ‘self-cleaning oven.’
There are tons of products claiming to clean vaginas and lots of advice on steaming or rejuvenating them. But there’s no need for special products or rituals.
“The vagina is like a self-cleaning oven,” Shirazian said. “Bacteria and yeast exist in a normal symbiotic relationship in the vagina.”
While bacteria and yeast might sound dangerous or dirty, they keep the vagina balanced. Sometimes an overgrowth leads to infections, such as a yeast infection or bacterial vaginosis. As many of 75 percent of women will at some time experience a yeast infection, which occur when there’s too much Candida albicans. This causes itching and a thick white discharge. A buildup of atypical bacteria causes bacterial vaginosis, which leads to a fishy smell during sex and extra discharge.
But frequent douching or cleaning won’t prevent these. Over-cleaning actually leads to infections.
“Cleaning with a douche can disrupt the flora and cause problems,” said Dr. Christine Greves, a doctor at the Center for Obstetrics and Gynecology at Orlando Health. “Douches can irritate, and it doesn’t necessarily treat the problem.”
She recommends that women use a mild soap and only clean the outside of their vagina. It’s important to move from front to back to avoid introducing different bacteria to the vagina.
“What’s back is e-coli from the rectum and you can get a lovely urinary tract infection,” Greves said.
2. Discharge is normal.
Throughout the month women might notice a clear or white discharge. While it might seem alarming, it's often harmless.
“A clearish or whitish discharge that you notice periodically with your cycle is normal,” said Shirazian.
Some discharge can indicate a bigger problem. If it has an odor, lasts for a long time or is thick like cottage cheese, women should seek medical help. It could be a yeast infection, bacterial vaginosis or a sexually transmitted disease (STD).
“There are some STDs that cause discharge and we want to be on top of those,” said Shirazian.
3. Talk to your doctor if pain is a problem.
Most women experience uncomfortable, annoying cramps with their periods. But excessive pain during periods can be an indication that something’s wrong. Women with endometriosis and cysts often experience extremely painful cramps. And, some STDs cause pelvic pain.
“If someone has pelvic pain we do imaging and an exam to try to figure out the underlying etiology,” Greves said.
Three out of four women experience pain during sex at some point, she said.
But when it starts affecting quality of life, that's when to talk to a doctor. Endometriosis and vaginismus, a condition where any vaginal insertion is painful, can wreck a woman’s sex life. Pelvic floor physical therapy can help. Specially trained therapists use dilators and lidocaine to “help with relaxation of the pelvic floor,” said Shirazian.
But this treatment is certainly not appropriate for occasional pain or discomfort.
“There would be no reason to do pelvic floor therapy when women don’t have these conditions,” Shirazian explained.
Greves said for some women simply using lubricant might make the sex less painful.
4. Experiencing wetness during sex is OK (and helps).
When things become heated in the bedroom, women produce a clear liquid. This makes things work smoothly.
“It has to do with arousal,” Greves said. “Some women produce more than others.”
Lubricant production lessens as women age and they might experience more difficulty after menopause. That’s when they might want to consider using commercial lubricants.
“When you are post-menopausal you will value this discharge,” said Shirazian.
5. The shade of your blood during a cycle doesn't really matter.
“Periods can sometimes vary,” said Shirazian. “The color of the blood doesn’t matter that much. It doesn’t mean anything bad if it is dark or bright.”
Bright red blood is normally newer, while darker blood has been hanging out for longer, maybe overnight. While blood color doesn’t indicate a problem, women should contact their doctor if they soak through a pad within an hour or experience excessive clots.
Shirazian urges women to pay attention to their cycles. This will help them become familiar with what’s normal for them.
“Knowing the natural rhythm is important and then you will know what is off,” she said.