Intimate hygiene in menopause

Things to consider

The female genital apparatus is a complex system, regulated by mechanisms that change over the years. These mechanisms depend mainly on the hormonal rhythms peculiar to the different stages of a woman’s life.

A central role is played by estrogens, whose production in childbearing age decisively increases the amount of glycogen in the mucous membranes of the vagina.

Glycogen is metabolized by Doderlein’s lactobacilli, which during childbearing age, in conditions of well-being, constitute 90% of the vaginal bacterial flora. These “good” bacteria are able to transform glycogen into lactic acid, which in turn decreases the vaginal pH value.

The slightly acidic environment that is thus created represents an important line of defense against the attack of possible pathogens.

With the progressive decline in the secretion of female hormones (estrogen and progesterone) associated with the arrival of menopause, the female body undergoes a series of changes, such as an increase in weight (caused by a slowdown in metabolism), the appearance of abdominal swelling, a decrease in sexual desire, dry skin , night flushes (characterized by intense sweating and a feeling of heat in the face), which can create states of anxiety and stress. In particular, the genital and urinary system of the woman undergo physiological changes that are important to take into account during intimate hygiene, precisely to respect the delicate balance of the mucous membranes, avoid irritation and ensure maximum intimate well-being.

The first parameter to consider is the physiological pH which, from the slightly acidic values (3.5 and 4.5) typical of fertile age, rises a little more towards neutrality (pH 5-6). Respecting these values is essential to protect the endogenous microflora and prevent the onset of infections and colonizations by annoying microorganisms, such as candidiasis (commonly called candida), which in menopause can be favored by taking hormone replacement therapy, or bacterial vaginosis (caused by the excessive proliferation of the bacterium Gardnerella vaginalis), characterized by vaginal discharge grayish-white in color and an intimate foul smell, similar to that of spoiled fish, which can cause embarrassment and have a negative impact on social life.

On this front, the choice of an adequate intimate cleanser is crucial because a normal soap, solid or liquid, is on average too aggressive and excessively destabilizing for the genital mucous membranes. It is, therefore, necessary to move towards a specific product with pH around 6.

Another aspect to take into account is the phenomenon known as vulvo-vaginal atrophy, a rather common disorder during and after menopause, characterized by problems such as vaginal dryness and an increased predisposition to inflammation and infections. The woman feels discomfort, itching, irritation of the mucous membranes, unpleasant vaginal discharge, bad smells. The atrophy of the tissues can involve, in addition to the vulva and vagina, also bladder and urethra, causing symptoms such as urination urgency (favored by a weakening of the pelvic muscles typical of menopause), which in some cases can even cause incontinence, burning on urination, infections with recurrent cystitis. For this reason, today, the term vulvovaginal atrophy is preferred to the more appropriate one of genitourinary syndrome of menopause.

Women who suffer from this disorder may also experience discomfort or even pain even during sexual intercourse; in case of vaginal dryness, penetration occurs in the absence of lubrication (due to the atrophy of the Bartholin glands induced by the drop in estrogen) and can therefore cause abrasions (microscopic, but very painful) on the mucosa at the level of the vaginal entrance.

This symptomatology can therefore negatively affect not only the quality of life of the woman as such, but also the intimacy of the couple.

In addition, in most cases women do not know that the loss of tissue elasticity and vaginal dryness are aspects directly related to hormonal changes typical of menopause; consequently, they consider it, erroneously, a “temporary” annoyance and do not ask their doctor for help.

The common disorders that may occur at this stage can also be exacerbated by external factors. The use of inappropriate intimate hygiene products, some forms of contraception and the use of clothing that is too tight or synthetic can in fact affect the delicate balance of intimate areas. In addition, to better enjoy the menopause phase it is good to follow a varied and balanced diet (preferring light foods and avoiding foods rich in fats and preservatives), it is also very useful to regularly practice sports or physical activity.

Cleanser and emollient

With menopause, moreover, the trophic and secreting stimulus of estrogens is lost, which results in thinning, lower elasticity and reduced lubrication of the female genital mucous membranes.

It therefore becomes important to support these functions from the outside, using emollient, moisturizing and soothing cleansers.

It is important to keep in mind that traditional intimate cleansers tend to have an acidic pH and are therefore less suitable for intimate hygiene during menopause. To orient yourself in choosing the most suitable intimate cleanser, it may be useful to contact your trusted gynecologist, in order to avoid resorting to products that may then prove ineffective or even counterproductive.

In general, bearing in mind that health prevention passes through the balance of the vaginal ecosystem, it is undoubtedly advisable to focus on pH-neutral intimate hygiene products. It is important to take into account the potential soothing action against the most common annoyances, the degree of protection they can offer, their formulation.

This last aspect is particularly important: the presence of perfume in an intimate hygiene product is generally contraindicated for a menopausal woman. These substances almost always have an irritating action on the mucous membranes (making them more exposed to the attack of pathogens) and can cause an alteration of the vaginal microbiome and lead to a pH imbalance.

The ideal intimate cleanser, ultimately, should be delicate, not very foaming, refreshing, soothing and moisturizing, even better if with antibacterial properties. You can use specific products, specifically designed to counteract symptoms such as bad vaginal odor, itching or burning.

Particularly useful in case of skin and mucous membranes very sensitive, fragile or affected by irritation and redness are the formulations containing colloidal proteins of oats, rice or other cereals; olive oil, sweet almond oil or jojoba; coconut fatty acids; collagen or glycerin hydrolysates.

For a more intensely regenerating and soothing action, specific nourishing products can then be applied in the form of creams or gels, enriched with proteins or essential fatty acids and natural extracts with softening properties (horsetail, chamomile, mallow, linden or calendula) and restructuring properties (aloe and witch hazel).

On the market there are also supplements specifically designed for the climacteric period containing phytoestrogens (derived from soy isoflavones). Phytoestrogens, in addition to playing a preventive role against premenstrual syndrome and the typical symptoms of menopause, such as hot flashes, also seem to have remarkable antioxidant properties and seem to play a protective role against cardiovascular diseases.

A possible remedy against vaginal dryness can be represented by specific gels or creams with lubricating action, especially if their composition includes ingredients such as chamomile, mallow or calendula, with a calming and preventive effect against irritation and burning.

If the doctor deems it appropriate, the local administration of estrogen is also indicated to combat vaginal dryness.

Practical tips

In addition to relying on an adequate and quality intimate cleanser, to maintain optimal intimate hygiene, in menopause as in any other phase of life it is essential to remember some practical rules.

In particular, it is necessary to:

• Take care of daily intimate hygiene, in relation to needs, but without exceeding with washing: two a day are more than enough, and it is advisable to use it even before and after sexual intercourse. Excessive and too frequent washing can cause the opposite effect to that desired, causing an imbalance of the vaginal microbiome and lowering the immune system. Also avoid intimate deodorants.
• Perform washing operations with direct movements from the anterior area to the anus to avoid bacterial contamination of the genitourinary area. Fecal bacteria, if they lurk in the vaginal mucosa, can give rise to an annoying infection such as vaginitis or cystitis.
• After each wash, rinse thoroughly to remove all traces of detergent and dry gently, without rubbing as moisture promotes the engraftment of fungi and harmful bacteria.
• Use in contact with the vaginal area preferably cotton, silk, linen, microfiber or other natural fibers that allow better perspiration. Non-breathable synthetic fabrics can in fact favor an increase in the degree of humidity in intimate areas.
• Avoid wearing clothing that is too tight in the groin, such as jeans.
• Use the bathroom at home as much as possible and avoid public toilets or, if necessary, pay special attention. In public services, especially if not sanitized thoroughly, the number of bacteria to which one is potentially exposed is much higher.

Finally, it is important to use caution when resorting to solutions such as vaginal douches. Easily available even without a prescription, they are used with the aim of obtaining greater intimate hygiene by directing a liquid jet towards the inner walls of the vaginal canal. The liquids used are cleansing solutions based on water and other substances, designed to promote the hydration of the intimate parts.

The use of this method of intimate hygiene, although quite common, can however be useless, if not even counterproductive: thesolutions used for vaginal lavage can in fact cause a change in the composition of the local microbiome, exposing the tissues to potential opportunistic infections. It is also not excluded the risk that the same tool used for lavender is not immune to bacterial contamination, making the possibility of introducing harmful pathogens concrete.

Precisely for these reasons, gynecologists advise against resorting to this practice, which should be reserved only after the diagnosis of specific pathological conditions diagnosed by the specialist. In this case, under prescription and medical supervision, lavender can be considered sufficiently safe.