Using bactericidal soaps and sex toys and having anal sex were associated with higher rates of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), according to a study in RBGO Gynecology and Obstetrics (Revista Brasileira de Ginecologia e Obstetricia). However, study authors caution, identifying these associations do not establish causality.
“Both too much and too little genital hygiene can be bad for the vaginal microbiota,” said lead author Marcela Bardin. She is a urogynecological physiotherapist in the Department of Gynecology and Obstetrics at the Universidade Estadual de Campinas in Campinas, São Paulo, Brazil.
Bactericidal soaps eliminate protective microorganisms, she explained, as do excessive vaginal douching or washing of the vulva and vagina. Rarely washing the vulvovaginal area enables accumulation of sebum, vaginal discharge, and other substances that may interact with temperature increases and pH changes to promote survival of harmful microorganisms over beneficial ones.
For the study, 307 women who presented at a local women’s hospital underwent gynecological examinations that included swabs and colorimetric pH strips. Participants also answered survey questions regarding genital cleansing and washing, sexual activity and related care, genital hair removal, and other topics.
When comparing results for 106 healthy controls against those of 141 women diagnosed with BV, VVC, or both, investigators found a significant association between BV and/or VVC and use of bactericidal soap (odds ratio/OR 5.47, p<0.001). Additionally, having anal sex and using sex toys within the past 30 days (OR 2.33 in both analyses; p<0.001 and p<0.03, respectively) correlated with presence of BV.
“It is very important that OB/GYNs guide their patients about those hygiene and sexual habits, especially when patients are struggling to fight recurrent vulvovaginal infections,” Bardin said. This education should be an important part of treatment, she added.
Factors that appeared to protect against BV and VVC included use of moist wipes and slightly acidic intimate soaps. Although 61% of participants believed hair removal probably harms genital health—and around ¾ reported vulvar irritation after undergoing such procedures—this practice did not impact the presence of genital infections.
Data regarding use of moist wipes and bactericidal soaps are rare in medical literature. Asking about these topics was important, Bardin said, because people tend to over- or underuse hygiene products for fear of harming their genitalia.
Many women reported washing the vulvar area with pH-neutral soap, probably believing that neutral pH could cause no harm, she added. “However, neutral pH means 7, which is too high for the genital area. Products can be wisely chosen when they respect local environmental characteristics.” Conversely, Bardin said, products that claim to eliminate bacteria or provide a wonderful scent are at odds with natural vaginal characteristics and likely foster imbalances that can lead to BV or VVC.
Ultimately, authors wrote, further studies are needed to better understand whether certain genital and sexual habits indeed promote or prevent vulvovaginal infections or imbalances of microbiota. The present study’s cross-sectional design could only detect genital-hygiene differences in the 2 populations studied, Bardin said, but not causal effects.
1. Bardin MG, Giraldo PC, Benetti-Pinto CL, Sanches JM, Araujo CC, Amaral RLGD. Habits of genital hygiene and sexual activity among women with bacterial vaginosis and/or vulvovaginal candidiasis. Hábitos de higiene genital e atividade sexual entre mulheres com vaginose bacteriana e/ou candidíase vulvovaginal. Rev Bras Ginecol Obstet. 2022;44(2):169-177.