I’ve asked a lot about wiping, and the requests have increased as there is a viral TikTok about wiping. Does it have to be front to back? What if you can’t reach? Is back to front okay?

Wiping front to back for those of us with a vagina and an anus and who are past puberty is dogma. Some dude (almost certainly some dude, but I do not know for sure) likely wrote it once in a textbook a gazillion (okay, 50) years ago and it has been repeated it since. After all, the vagina is delicate, except of course when it is gross and dirty. So it must be protected. But also, get that gross vagina juice away from the delicate urethra. And keep that foul fecal matter away from the delicate vagina.

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Sigh.

The hypothesis behind wiping direction is primarily to reduce the risk of bladder infections (urinary tract infections or UTIs). The idea is to not drag fecal matter across the skin and introduce UTI-causing bacteria into the vagina, where it them might take up shop before heading to the urethra and bladder.

I often wonder if the medical professionals who are staunch advocates of this practice have actually worked through step by step what it’s like to wipe back to front versus front to back when you have a vagina and a little experience with wiping? Never once have I left the bathroom after wiping back to front in a cold sweat thinking, “That was a close call!” While you can’t see what you are doing, you can most certainly feel what is happening with a good degree of precision. It is entirely possibly to limit your toilet paper contact to the anal area.

Keep in mind, as soon as you have evacuated your bowels there is already a plume of fecal bacteria making its way back up to your skin from the toilet. Wiping with toilet paper isn’t going to remove that from your skin.

It is important to remember that a lot of this dogma is ancient, from the time when vaginas were literally considered dirty and medicine had very little understanding of the normal vaginal ecosystem, or the causes of bladder infections. As sexual activity is linked with bladder infections, and this link has been known for decades, I suspect there was a lot of “dirty girl” thinking. As if the whole area from the vulva on back were some kind of infectious, toxic wasteland.

We also have lots of issues worrying about “vaginal cleanliness”, so this “need” to wipe front to back also plays into that.

In addition, we in the West have bathroom prudishness to spare, which is a vestige from the British Empire. So it isn’t surprising that many here are very worried about cleanliness and the toilet. If you are interested in hearing more about this please check out episode 2 of my podcast, Body Stuff. It’s on poop and the history of toilets. You can find the episode here.

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Regardless, now we know better, so we should not put people on a panic over how they wipe.

What you should know is that there is no study that has shown wiping direction makes a difference. Admittedly there are no randomized trials, but there is one large study that looked at habits among women with a history of bladder infections and whether the women wiped back to front or front to back didn’t influence whether they had infections.

There is one study that asked pregnant women about their wiping habits and found those who wiped from front to back were less likely to have a UTI than those who wiped back to front, but it’s a terrible study. They literally presented no demographic data, most importantly frequency of sexual activity. They didn’t even provide the age of the patients. We have no way of knowing if those who wiped front to back were different in other ways that may have reduced their risk of UTIs. It is not possible to conclude anything from this study, and hence this is why it has not influenced guidelines.

Speaking of guidelines, the latest practice guidelines from the American Urogynecological Association guidelines regarding recurrent urinary tract infections do not list wiping from front to back as a recommendation. In fact, these guidelines say that wiping away from the urethra has not been shown to reduce the risk of recurrent urinary tract infections for adults.

Where specific attention to wiping is needed is for people who have fecal incontinence. If there is a large amount of fecal soiling, care must be taken not to get fecal matter in the vagina as stool will irritate the vagina, leading to inflammation and discomfort, and it is associated with an increased risk of bladder infections. We know this because women with fistulas (a connection between the vagina and rectum allowing fecal material to get in the vagina) are at increased risk of bladder infections.

While not toilet related, for people who have anal sex it is important to remember that a penis or sex toy should not go from the rectum directly into the vagina without being well cleaned.

What about young children? Stool can get into so many crevices when it has been smushed against the skin by a diaper. Infants in diapers often have gross fecal soiling, so doing your best to wipe away from the vagina and urethra is a good idea. In addition, young children who wipe themselves without adult guidance may not be the best wipers, so wiping back to front could potentially result in a significant spread of fecal matter onto the vulva. The pediatric vulva is also much more sensitive to irritants, such as stool, so being mindful of wiping practices for children is important.

What matters most with post voiding and post evacuation toilette, as it were, for those of us past puberty is to not get fecal matter in the vagina. If you don’t have medical conditions that increase that risk, then wipe as you please. Just don’t wipe aggressively, it is very easy to irritate the perianal skin with toilet paper. A bidet is also a great option. Just don’t use wipes, as they are a common source of irritation and even allergic reactions. The only exception with wipes is if you have fecal incontinence and need to clean up on the go.

For the record, I’m a blotter as that is probably the least irritating for the skin (I treat a lot of people with perianal dermatitis, so I’m all about protecting the perianal skin), but I’ve wiped back to front and lived to tell the tale. Sometimes your angle on the seat favors one direction, ya know?

And remember, most vulvar and vaginal cleaning rituals are exactly that, rituals born of dogma about the dirty, yet somehow also delicate, vagina.

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References

Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society Best-Practice Statement: Recurrent Urinary Tract Infection in Adult Women

Female Pelvic Med Reconstr Surg 2018;24: 321–335.

Scholes D, Hooton Thomas M, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk Factors for Recurrent Urinary Tract Infection in Young Women. The Journal of Infectious Diseases 2000;182:1177–82.

Dereje M, Woldeamanuel Y, Asrat D, Ayenachew F. Urinary tract infection among fistula patients admitted at Hamlin fistula hospital, Addis Ababa, Ethiopia. BMC Infectious Diseases 2017; 17:150.

Hooten Thomas M. Recurrent urinary tract infection in women. International Journal of Antimicrobial Agents 2001;17: 259–268

The Vajenda

How to Wipe After Going to The Bathroom