Vagina: What's typical, what's not

Vaginal health is an important part of women's overall health. Vaginal problems can affect fertility, desire for sex and ability to reach orgasm. Ongoing vaginal health issues can also cause stress or relationship problems and affect self-confidence. Know the signs and symptoms of vaginal problems and what you can do to protect your vaginal health.

What affects vaginal health?

The vagina is a closed muscular canal that extends from the outside of the female genital area (vulva) to the neck of the uterus (cervix). Various factors can affect the health of the vagina, including:

• Sex. Unprotected sex can result in sexually transmitted infections. Forceful sex or an injury to the pelvic area can result in vaginal trauma.
• Certain health conditions and treatments. Some conditions, such as endometriosis and pelvic inflammatory disease, might cause painful sex. Scarring from pelvic surgery and certain cancer treatments also can cause painful sex. Use of some antibiotics increases the risk of a vaginal yeast infection.
• Birth control and feminine-hygiene products. Barrier contraceptives, such as condoms, diaphragms and associated spermicide, can irritate the vagina. The use of sprays, deodorants or douches can cause or worsen irritation.
• Pregnancy and childbirth. During pregnancy, vaginal discharge often increases. Vaginal tears are relatively common during childbirth. In some cases, an incision made in the tissue of the vaginal opening during childbirth (episiotomy) is needed. A vaginal delivery also can decrease muscle tone in the vagina.
• Psychological issues. Anxiety and depression can contribute to a low level of arousal and resulting discomfort or pain during sex. Trauma — such as sexual abuse or a painful sexual experience — also can lead to pain associated with sex.
• Hormone levels. Changes in hormone levels can affect the vagina. For example, estrogen production declines after menopause and during breastfeeding. Loss of estrogen can cause the vaginal lining to thin (vaginal atrophy), making sex painful.

What are the most common vaginal problems?

Conditions that might affect the vagina include:

• Sexual problems. These might include persistent or recurrent pain just before, during or after sex (dyspareunia). Pain during penetration might be caused by involuntary spasms of the muscles of the vaginal wall (vaginismus). The muscles in the pelvic floor can become tense, causing chronic pain and pain during intercourse. Vaginal dryness, often occurring after menopause, also can cause pain during intercourse.
• Sexually transmitted infections. Various sexually transmitted infections can affect the vagina, including chlamydia, gonorrhea, genital warts, syphilis and genital herpes. Signs might include abnormal vaginal discharge or genital sores.
• Vaginitis. An infection or change in the normal balance of vaginal yeast and bacteria can cause inflammation of the vagina (vaginitis). Symptoms include vaginal discharge, odor, itching and pain. Common types of vaginitis include bacterial vaginosis, yeast infections and trichomoniasis.
• Pelvic floor relaxation. If the supporting ligaments and connective tissues that hold the uterus and the vaginal walls in place become weak, the uterus, bladder, rectum or the vaginal walls might slip down (prolapse). This might cause a bulge in the vagina or urine leakage during coughing and sneezing.
• Other rare conditions. Vaginal cysts can cause pain during sex or make it difficult to insert a tampon. Vaginal cancer — which might first appear as vaginal bleeding after menopause or sex — also is a rare possibility.

What are signs or symptoms of vaginal problems?

Consult your health care provider if you notice:

• A change in the color, odor or amount of vaginal discharge
• Vaginal redness or itching
• Vaginal bleeding between periods, after sex or after menopause
• A mass or bulge in the vagina
• Pain during intercourse

You might not need to see your health care provider every time you have vaginal irritation and discharge, particularly if you've been diagnosed with a vaginal yeast infection in the past and you're having similar signs and symptoms. However, if your symptoms don't go away after you use a medication that you get at your drugstore, consult your provider.

What can I do to keep my vagina healthy?

You can take steps to protect your vaginal health and overall health. For example:

• Be sexually responsible. Use condoms or maintain a mutually monogamous relationship with a partner who's free of sexually transmitted infections. If you use sex toys, clean them after every use.
• Get vaccinated. Vaccinations can protect you from HPV, the virus associated with cervical cancer, as well as hepatitis B — a serious liver infection that can spread through sexual contact.
• Do Kegel exercises. Kegel exercises can help tone your pelvic floor muscles if you have prolapse, leaking of urine or weakness of the pelvic floor.
• Know your medications. Discuss medication use and possible vaginal side effects with your health care provider.
• Limit the amount of alcohol you drink, and don't smoke. Chronic alcohol misuse can impair sexual function. Nicotine might affect sexual arousal. Substance misuse might also cause poor physical and mental health, which can affect sexual function.

While not all vaginal problems can be prevented, regular checkups can help ensure that problems affecting the vagina are diagnosed as soon as possible. Don't let embarrassment prevent you from talking to your health care provider about concerns you have about vaginal health.