The Ultimate Guide to Cleansing the Vulva

All So-Called Feminine Washes are Trash

A few weeks ago a woman asked the doctors of TikTok for advice. What was the right way to clean her vulva and vagina? Of course I replied, and the video went viral with over 6 million views. There were no memes or snarky clap-backs to explain the popularity, just an honest question and a reply from an expert, yours truly.

The response didn’t surprise me. After all, I answer this question almost daily in my day job as an OB/GYN who specializes in vulvar and vaginal conditions and it’s a big reason why I wrote the book, The Vagina Bible (which has four chapters dedicated to skin care and cleansing).

As there were so many questions in the comments section from the TikTok, I felt it was time for an updated post about this topic, and so I now bring you, ”The Ultimate Guide to Cleansing the Vagina and Vulva.” 

In a world full of patriarchal messaging about how vaginas and vulvas should be prepped for men, it’s no wonder people have questions. The disinformation is everywhere. Add providing good information about vaginas and vulvas in a non sophomoric way is often harder than it should be. After all, it’s 2022 and you can actually get shadow banned (as I have been) for using “vulva” and “vagina.” And when The Vagina Bible came out in 2019, advertisements were rejected by Facebook and Twitter because they contained the word vagina. I wish I were kidding. 

So let me give it to you straight, and don’t worry, I know all the common questions and I definitely have the answers. But if I don’t get to you your specific question, leave it in the comments below or tag me on the socials and I’ll collect them for a follow up post.

Agreeing on anatomical terms

Before we go any further, it’s important to make sure we are speaking about the same thing. People often use the word vagina to refer to the entire lower genital tract, but the vagina is inside the body. The outside, where the clothes touch your skin, is the vulva. The area where the two overlap is called the vestibule of the vaginal opening. Think of the vulva and vagina as two circles of a Venn diagram, the vestibule is where they overlap. Here’s an illustration from The Vagina Bible.

The vulva has keratinized skin, like you have on your arm or leg. This means the top layer consists of dead skin cells filled with keratin, which is a protein, and this layer provides a physical barrier and waterproofing to protect the skin. The skin here has sweat glands, sebaceous glands that produce sebum, specialized sweat glands called apocrine sweat glands, and pubic hair. The skin is coated with a layer called the acid mantle, which is an acidic film of sebum and sweat that provides another layer of physical protection, waterproofing, and protection against bacteria and viruses. The pH of skin in general is 5.5 and often the vulva is a little more acidic, between 4.5 and 5.5. The labia majora (the outer lips) are part of the vulva. 

Moving inward from the labia majora you find the labia minora, the inner lips. As you move along the labia from the outer surface to the inner surface the skin gradually becomes thinner and less keratinized. There is no pubic hair on the labia minora, but it has sebaceous glands. 

The vestibule is where the inner aspect of the labia minora joins with the vagina, and from here on up the skin is mucosa, so no keratin or acid mantle. The vagina has a microbiome, a bacterial colony that is essential for vaginal health. The pH of the vagina is lower than the vulva, between 3.5 and 4.5, and the vagina normally produces up to 3 ml of discharge a day. 

Agreeing on product terms 

Just like people say the word vagina when they mean vulva, people often confuse soap and cleansers. A soap is made by mixing a fat or an oil with an alkali. Soap is alkaline, meaning a pH greater than 7, but often as high as 10. Remember, the skin is acidic. Soap can raise the pH of the skin, disrupt the acid mantle, and leave deposits of carbonate salts all of which can dry and irritate the skin. The consequence of this is not just irritation from the soap, but when the skin barrier is compromised in this way the skin becomes more permeable to chemicals in everyday life, and this causes more irritation and inflammation. Soap can be a bar or liquid.

A cleanser works by using synthetic detergents known as syndets. The advantage of syndets are they can be formulated to a more acidic pH than soap, usually around 5.5 (normal skin). They are also less likely to dry and irritate. Cleansers often have additives, such as hyaluronic acid, glycerin, and ceramides, that act as an emollient or humectant or provide other functions to protect the acid mantle. Cleansers can be a bar or liquid. 

Many soaps and cleansers have added fragrance, and sometimes it is listed as fragrance or perfume, but it may simply be a botanical, like lavender or calendula. Natural fragrance from botanicals and essential oils can be every bit as irritating as synthetic fragrance. And some products have added chemicals for color.

How to Cleanse

First of all, please put nothing inside the vagina. No soaps, cleansers, douches, water, and don’t reach inside to try to scoop away discharge. All attempts at intravaginal cleaning are harmful and can damage the vaginal ecosystem, causing irritation, increasing discharge and/or odor, causing bacterial vaginosis, and even increasing the risk of sexually transmitted infections if exposed. 

What about the vulva?

There are no studies comparing washes, but I just spent a lot of time talking about how important the skin surface is and what can happen when it gets damaged. Soap is drying and can damage the acid mantle, and can set off a cycle of dryness, itch and irritation that can be very uncomfortable and is often mistaken as a chronic yeast infection. Because of the pervasive and harmful messaging many people think they aren’t clean enough, so they often over wash making their vulvar skin dry, irritated, and itchy, which is why they think they have an infection in the first place. They increase their washing to try to reduce the infection they don’t actually have, which only further aggravates the issue. And so on. 

The best product for the vulva is a gentle cleanser with no fragrance, natural or synthetic. It’s not essential to use a cleanser, some people prefer water for day-to-day cleansing, it’s really a choice. The times I specifically recommend a cleanser are the following:

• When people have incontinence, to remove any residual urine or feces from the skin.

• To remove products, as some won’t come off with water alone. Topical steroids for skin conditions or a silicone-based or oil-based lube that has smeared on the vulva after sex are a couple of examples. 

• Anyone with perianal dermatitis, a type of itchy rash around the anus. This is aggravated by the little specs of stool that are routinely left behind after wiping (don’t panic, this has been happening for well over 10,000 years) or blotting (which is less traumatic than wiping, although a bidet is best!). The bacteria and enzymes can irritate the skin and damage the acid mantle. People often respond to the itch and irritation by wiping more aggressively to make sure they are clean, but that further traumatizes the skin, making the issue worse. A daily cleanser in this area can be very helpful. Perianal dermatitis can be triggered by over wiping and is more common as we age as the skin gets more fragile.

So which cleanser? A cleanser that doesn’t have salicylic acid or any other acne medication with a pH around 5-5.5 that is fragrance free. Avoiding fragrance is ideal as that is a common source of irritation and also reinforces the false “you stink” patriarchal narrative. A gentle facial cleanser usually fits this bill, liquid or bar.

But what if I like soap? Okay, you do you. It’s your body and you can clean it how you want. As you age, the skin tends to get drier, so the soap that isn’t bothering you now may have more of an impact over time. Also, once people get barrier disruption from soaps and irritation it isn't always an easy fix.

But my soap is gentle! I am sure that is what the manufacturer says, but that means nothing right up alongside the equally meaningless hypoallergenic. Gentle may mean mean fragrance free, but it might also mean the mother of the manufacturer thinks it’s gentle. But soap is soap, it raises the pH of the skin and dries. 

Feminine Washes are Trash 

Look, there is no study that says the vulva needs a special “feminine” or “intimate” wash. None. So we go with basics of skin care. You want something that doesn't raise the pH, dry, or damage the acid mantle, meaning a cleanser. You also want a product that doesn’t have fragrance. Your vulva shouldn’t smell like “island splash” or “amber nights”, which totally sound like a cloying range of cocktails geared for spring breakers at the beach. Look, your vulva is a party all on its own. And it certainly doesn’t need God knows what other garbage is in it to make it a lilac color or pink. 

But I use an intimate cleanser with prebiotics/probiotics, isn’t that better? No. There is no data suggesting prebiotics or probiotics are of any help for the vagina or vulva, but I get there is a huge industry trying to convince you otherwise with advertising, not research. If you want to pay more for this unstudied ingredient, it is your body and your choice. I personally despise products that add ingredients like this to sound quasi medicinal.

But I use a feminine wash that is pH balanced and fragrance free. Isn’t that the same as a facial cleanser? Possibly, but if it is, then why do you need it? If you like to have specific washes for body parts, then sure, you do you, but it’s not offering you any advantage.

And let’s say say your “feminine” or “intimate” wash is indeed the same ingredients as a facial cleanser. When you buy it you are propping up the industry that makes money by telling women they stink. Look at this range of trash from Vagisil. They have literally linked feminine freshness with confidence. I mean what the actual fuck? 

I’m an OB/GYN and I study this shit for a living, and I have no idea what feminine freshness is, besides profits for CEOs. 

Every single “feminine” or “intimate”wash that I have seen directly or indirectly implies that women stink. I’ve seen awful or incorrect messaging about vaginal odor or “freshness” (code for vaginal odor) from basically every company. Also, a wash cannot correct vulvar pH, the best it can do is not damage it and the wash shouldn’t be anywhere near the vaginal pH, ya know?

People walk past shelves of products promising “feminine freshness” in Target and Safeway. They see it on Amazon. It’s everywhere, so of course they start to believe that vaginas stink and more specifically, that their vagina stinks. If vaginas smelled great, why would they sell so many products to de-stink them? After all, who doesn’t want to smell like chemical spring lilac? 

And then there is the use of the term vagina. The public isn’t generally worried about odors from vulvas, although Lume, the vulva and ass deodorant (no, really), is trying to “fix” that. What the public is encouraged to think stinks is the vagina, and the vaginal stink gets on your vulva. So there’s a lot of vaginal creep in advertising for products that are intended for the vulva. Here’s Honey Pot selling external vulvar products for “vaginal” wellness. For the record NONE of these should go in the vagina. 

This issue here is that many people already mistakenly use external products such as “feminine” washes and wipes vaginally, which is harmful. Yes, often there is tiny print on the bottle instructing not to do so, but when the advertising says “vaginal” wellness or “vaginal freshness”, why would you need to read the instructions? So when they see these products advertised for the vagina, that just reinforces what they are doing must be right. It may even encourage some to start using these products vaginally. After all, these companies must know what they are talking about. Right? The boxes look so pretty and professional and are “gynecologist tested”  (which means nothing by the way. It could have been tested and found to be terrible, and they never publish the results of these so-called tests).

And finally, studies tell us that use of “feminine washes” and their even more evil cousin “intimate wipes” are associated with an increased risk of bacterial vaginosis and urinary tract infections. The reason isn’t clear. These products could be damaging the acid mantle and skin of the vulva, changing the local microbiome, or it could be because they are being used internally. They could also be causing irritation that is misdiagnosed as bacterial vaginosis or urinary tract infections. And it’s also possible that people with infections are more likely to start using these products because they think they will help (they won’t). 

I personally refuse to give money to ANY company that profits from vaginal shame if I can help it.

For me personally, I don’t care if company X or Y makes a lovely “intimate” wash with a  pH of 5 that is filled with humectants that is the same as a gentle facial cleanser, because the very fact they have labeled it a “feminine” or “intimate” wash is a big part of the problem. I spend hours every WEEK undoing this harmful messaging. If these companies want to publish a high quality study showing their product is superior in some way, then of course, I’m willing to change my mind.

And if they make feminine washes for teens, they are at the top of my shit list. Gotta make them insecure early, amirite Vagisil?

And finally what product and how to use?

I personally like CeraVe products, I’m using the gentle foaming facial cleanser right now, but lots of people like Cetaphil or Eucerin. I know many people like Dove Sensitive Skin Beauty Bar, and the ingredients seem just fine. If what you are using is an unscented cleanser, you are probably fine. If it irritates, it doesn’t matter how good the ingredient list, so keep that in mind.

You don’t want to wash the mucosa (the vagina or vestibule). Put your cleanser on your hand or face cloth, and give yourself a swipe or two on the vulva without separating the labia. Don’t sweat whether you go front to back or back to front. If you want to give a gentle rub to foam it up? Sure, but don’t scrub because you are not washing COVID-19 off your hands. Then do the same around the anus. It’s also fine to use the cleanser in the groin. Don’t overthink it. If some cleanser sneaks onto the vaginal mucosa at the vestibule, it’s not going to kill you, just as it won’t hurt you if you get some facial cleanser in your mouth while washing your face, just try not to make it a habit. And remember, just water also works for many people. In fact, when people are over-cleaning and they can’t stop rubbing while they wash, I often have them stop altogether. Sometimes the over-cleaning isn’t the product, it’s the rubbing that goes along with the product, because rubbing can sometimes be traumatic like scratching.

I examine vulvas and vaginas every day and I’d guess about 50% of my patients just use water for cleansing, and I can’t tell which ones. Meaning, using water alone on the vulva doesn’t leave people smelling. If you are concerned that you have an odor, see a doctor or nurse practitioner with experience in the area.

If what you are using isn’t causing any irritation, it’s probably fine. However, keep in mind if it’s a soap or a “feminine wash”, over time it’s possible you could become irritated.

And “feminine freshness” is a non-existent thing born of the patriarchy. Over cleaning washing has been used historically in medicine because people didn’t know about the vulvar skin or vaginal ecosystem. Over cleaning the vulva and vagina is also part of our history because women have long been considered unclean and wetness was believed to be a sign of sexual experience, and hence unacceptable, hence many products for cleaning were drying. Overtime all of this has been rolled into the harmful search for the elusive feminine freshness. 

References

DermNet Soaps and Cleansers https://dermnetnz.org/topics/soaps-and-cleansers

Farage, M, Mailbach HI. the vulvar epithelium differs from the skin: Implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis 2014;51:201-209.

Schmid-Wendtner MD, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol 2006;19:296-302.

Mendes BR, Shimabukuro et al. Critical assessment of the pH of children’s soaps. J Pediatr 2016;92:290-295.