Prevent Vaginal Dryness and Itching, Really!

I think feeling dry and itchy “down there” is likely one of the top shared experiences of being a woman! At all ages and stages!

You may not feel comfortable discussing it due to embarrassment (many women don’t even mention it to their doctor). You may have attempted self-diagnosis of a recurring problem, potentially incorrectly. And you might have even tried to self-treat it with whatever over-the-counter potions you could find.

Unfortunately, research has found that many women self-diagnose any type of vaginal itch as being a yeast infection. Yet, it is estimated that 50 percent of women who use over-the-counter antifungal medications (thinking they have a yeast infection) do not have one!  (1)  In fact, in self-treating the itch, some women may douche or slather on a vaginal moisturizer or lubricant, both of which can make matters worse.

So what are the best treatments for these symptoms? Or better yet, how do you prevent vaginal dryness and itching in the first place?

While fluctuating and declining hormones do play a huge role in the health of your “V” (in this article I will reference many past articles on this same topic), there are many other underlying causes that can make women more prone to having vaginal dryness, vulvar itching and other quality of “V” (and quality of sex) symptoms.

These symptoms, collectively known as vulvovaginitis, don’t just occur in women going through menopause, although declining estrogen levels can certainly make things worse. These V symptoms often occur in women as young as their early 20s and affect almost every woman at some point in her life.

Some of the causes may surprise you. But it’s good for you to know what they are.

So let’s talk about,

• Vaginal pH (estrogen’s role, friendly bacteria, and the need for acidity)

• Every-day “irritant” contact exposures (involuntary leaking is also to blame)

• Gut health (gluten may be a root cause for vaginal itching and conditions such as Lichen sclerosis)

• What you can do starting today (to stop vaginal dryness and itching in its tracks)

Just like the diverse microbiome of trillions of bacteria found within the gastrointestinal system (the gut), a woman’s vagina has a mix of both beneficial bacteria as well as small quantities of pathogenic bacteria, such as yeast. Thankfully, those “bad” or opportunistic microorganisms are usually kept from growing out of control by the vagina’s acidic pH environment.

If you ever took chemistry you learned about pH, which stands for “power of hydrogen” and actually measures the total hydrogen ion concentration in any aqueous solution. The pH scale ranges from 1 to 14 with lower numbers being acidic (acids) and higher numbers being alkaline (referred to as bases). But what does all of that really mean to your vaginal health?

While it’s not important that you understand all the chemistry, note that in most cases an alkaline pH is preferred for optimal health. So as one important example, when you test your urine pH, you want to see an alkaline pH measure as that reflects an anti-inflammatory state.

However, one big exception to that general rule is the vagina.

An optimal vaginal pH is in the range of 3.5 to 4.5, which is slightly acidic.

Note that this changes (becoming less acidic) as a woman ages, especially during and after menopause, due to declining estrogen levels. I’ll discuss this in more detail below.

You can actually test the pH of your vagina with a pH test strip; just hold a test strip at the mouth of your vagina. If your test shows an alkaline vaginal pH it often means you have an infection or you have something else going on that may make your vagina more susceptible to infection or other V problems in the future. You’ll see it can also mean you have too much or too little estrogen (I’ll come back to that).

Baby girls actually begin life with a relatively high vaginal pH (an average of 7). Then in puberty, increasing levels of estrogen and glycogen (on which the friendly bacteria Lactobacilli thrive) result in greater levels of Lactobacilli colonizing the vulva-vaginal microbiome. Lactobacilli produce antimicrobial substances (lactic acid and hydrogen peroxide) that keep the vagina in a healthier acidic condition, protecting it against the infiltration of various pathogens such as bacterial vaginosis, sexually transmitted diseases, and yeast infections. (2,3). Lactic acid also has anti-inflammatory effects. (4). In studies, elevated vaginal pH greater than 4.5 has been associated with bacterial vaginosis which in turn has been linked to increased transmission of sexually transmitted diseases as well as pelvic inflammatory disease. (5)

The relative abundance of these helpful bacteria in the healthy human vagina is usually greater than 70 percent of the total vaginal microbiota, so you can see how important they are to vaginal health and keeping itching and infections at bay.

The loss of Lactobacilli dominance (with higher pH and the associated overgrowth of pathogenic bacteria) has also been associated with preterm births, maternal infections, and infertility. (6) So you want to keep your pH and bacteria microbiome healthy.

Things that can cause your vaginal pH to become more alkaline and therefore more prone to infection include: 

It is estimated that a woman uses approximately 11,400 tampons in her menstrual life! (19) Researchers from one study estimated that exposure to endocrine-disrupting chemicals from menstrual products such as pads, tampons, and liners is at least 10 times greater than estimated absorption rates through the skin elsewhere in the body. This is due to the vulva skin and vagina being so permeable. (20) Many of these products contain chemicals including bleach and dyes. On top of that, feminine hygiene products that have adhesive strips often contain additional chemicals. So while they may be convenient, be wary of them and check ingredients. (21) How do manufacturers get these products to look so white and pure? Bleach and chemicals such as formaldehyde…right up against your lady bits 24 hours a day! (22-24) Check out this earlier article I did on the health benefits of reusable menstrual pads that don’t contain all of the chemicals. While I’m not sure if the product is still available I love the idea of a more healthy pad alternative that is more sustainable as well. There are now a number of reusable cloth pads to choose from.

• Do you leak a bit when laughing or coughing, and now choose to wear a panty-liner or incontinence pad/underwear of some kind? Note that urinary (and fecal) incontinence can actually contribute to vulvar dermatitis. Incontinence products may contain chemicals as well as not allow the V to breathe! Many women will also wear one pad/liner all day which can contribute to irritation or even become a breeding ground for infection. (25) Better to try and correct the involuntary leaking issue and wear regular breathable underwear. I have written a lot about this: learn to do Kegels the right way to strengthen your pelvic musculature. To control accidental leaking many women in my community have used my feminine cosmetic cream for the vulva, Julva®.

• Latex condoms and some spermicides

• Are you allergic to your man? Well, not your man so much but perhaps what he has eaten recently or his particular bacteria microbiome… you can be allergic to something in his seminal fluid, as it can contain proteins of foods he has recently eaten… so if you are allergic to walnuts and your mate eats them, you can have a reaction to his semen. As noted above, semen is alkaline as well, which can create an environment more prone to infections. Protect yourself from sexually transmitted diseases if that may be a concern.

• Ingredients in various OTC moisturizers and lubricants such as preservatives, dyes, fragrances, and others can cause irritation or reactions. Lubricants containing glycerin in particular have been linked to changes in the vaginal flora and to bacterial vaginosis. Endocrine disruptors such as parabens are commonly used in personal lubricants. (26)

• Habitual use of bidet: There have been a number of studies on this; some have concluded that habitual use of bidet toilets aggravates vaginal flora, either by changing flora makeup (decreasing Lactobacilli) or by facilitating opportunistic infection of fecal bacteria or other pathogenic microorganisms. Here are a few studies if you are interested in reading more. (27-29) 

• Shaving and waxing products

• Products used on the hands: nail polish, hand lotions, sunscreen, antibiotic sanitizers, etc. can come into contact with vulvar skin and cause reactions.

• Baby wipes may contain chemicals that can cause a reaction.

• Wearing tight or restrictive clothing (such as tights, pantyhose)

• Wearing synthetic underwear that doesn’t breath (wear cotton or silk instead)

How you treat your gut microbiome (the millions of helpful gut bacteria such as Lactobacilli) can also help or hinder your V’s ability to fight off infections and all kinds of nasty critters.

Gluten and Leaky Gut:

Gluten is a food sensitivity for most people (not just people who have been diagnosed with Celiac Disease, a condition where any amount of consumed gluten results in serious damage to the gastrointestinal tract). Studies have found that gliadin (a component of gluten) results in intestinal permeability (leaky gut)  in everyone … whether or not they have CD. (32)

I’ve had so many patients and clients come to me with vaginal itching concerns, as well as vaginal yeast or bacterial infections. For some, it wasn’t until we removed reactive foods like gluten (my personal kryptonite is dairy) and worked to heal their leaky gut that they started to feel better. Gluten has been found to be a trigger for many symptoms by 20-45 percent of adults (not having CD) who self-report food sensitivities. (33) In every women’s restorative program I teach, including Magic Menopause, one of the first things I recommend participants do is remove reactive foods from their diet; it makes such an immediate difference in so many health complaints.

Here’s a great podcast that I did with Dr. William Davis, the author of Wheat Belly, about gluten’s impact on chronic disease development.

Food Sensitivities, Leaky Gut, and Autoimmunity:

Food sensitivities and resultant leaky gut have been shown to be root cause triggers for immune-mediated disorders such as Celiac disease as well as the thyroid autoimmune condition of Hashimoto’s.

Your vaginal microbiome—just like the gut microbiome (which contains over 70 percent of your immune system)—is also intimately involved in many immune processes and may be connected to your risk of developing an autoimmune condition affecting vaginal dryness and itching such as Lichen sclerosus (LS).

While the cause of LS is still not fully understood researchers believe that it may be an autoimmune disorder. Just as with other autoimmune conditions, it is thought that the body’s immune system loses the ability to identify itself and may mistakenly attack itself. In Hashimoto’s, the immune system attacks the thyroid. With LS, the immune system is thought to attack the vagina and surrounding tissue. (34)

Lichen sclerosus (LS) is a serious condition of the vulvar tissues. The skin becomes thin like parchment paper, very dry, and can itch terribly. It's a struggle for many women and the condition seems to be on the increase. It has had a bi-modal age distribution, affecting either pre-puberty girls (under 6) or postmenopausal women (over 60) the most, although it is seen more now with younger women as well. I think one reason for this is the inflammatory diet many people eat and how that affects the balance of the bacteria throughout your body (gut, vagina, skin, breast, and elsewhere).

As with other autoimmune conditions, there is thought to be both a genetic susceptibility to having LS as well as the presence of intestinal permeability (leaky gut). So an anti-inflammatory diet and lifestyle could be a key to solving this challenging condition. You can click here to listen to a podcast I did on the topic of natural remedies for Lichen sclerosus.

There has been a lot of research with linkages found between autoimmune conditions (like Celiac disease), leaky gut, food sensitivities (such as gluten), and skin conditions (even of the vulva and vagina). (35, 36)

What You Can Do Starting Today  to Stop Vaginal Dryness and Itching In Its Tracks

So we’ve seen that it is the rising and falling of estrogen levels—throughout a woman’s life—that leads to many symptoms that affect the quality of life, including vaginal dryness and itching, involuntary leaking, pain during sex, and diminished libido.

Estrogen levels impact the vagina’s collagen and hydration, with diminished levels leading to dryness and irritation. Fluctuating estrogen levels also affect vulvovaginal pH and the vaginal microflora compositions (allowing pathogenic bacteria and fungi to flourish, leading to greater infection risk).

Events associated with high estrogen levels affect the balance of friendly and pathogenic microorganisms. Common causes for vulvar-vaginal itching include irritant exposures along with vulvovaginal candidiasis (yeast infections) and bacterial infections. During the reproductive years, most women experience at least one yeast infection; approx. half will experience multiple episodes.

Gut imbalances, immune conditions, and other systemic health conditions can affect hormone balance, whether that be hormone production or detox (such as with estrogen). And all can affect the health of vaginal and vulva tissue. Some women are more affected due to genetic susceptibility; common polymorphisms have been associated with recurrent yeast infections, for example. (37)

You do need to optimize all of your sexual hormones (estrogen, testosterone, progesterone, pregnenolone, DHEA, and oxytocin) throughout your reproductive years and beyond, to address (and better yet, to prevent) vaginal dryness and itching, and to promote your best V health! Read more about that in the linked articles.

We’ve had a wonderful response to my feminine restorative cream for the vulva, Julva® from women of all ages, including those who have Lichen sclerosis. You can click here to learn more about the research behind Julva and what women’s pelvic health specialists are saying about it, at the linked article. Additionally, here are just a few of the many client testimonials we’ve received relating to LS… so impactful to these women!

Think about the timing of the itch, and its relation to sexual intercourse, menstruation, contraception, exercise (sweat and friction!), or medication use. Based on this evaluation is there anything you can change? Evaluate the products you use, especially those you use near, on, or in the V (this includes laundry-related products, bathing/skin care, etc.). You might find that products you use for lubrication are to blame due to chemicals they may contain. I recommend you make your own lubrication; it’s easy to use what you have in your own kitchen cupboard. Check out my video and article on using natural products you can find around the house to address dryness and V irritation! You can also read about how locally applied DHEA is an excellent solution and preventative measure for vaginal dryness and irritation.