Vagina: What's normal, what's not

Vaginal health affects more than just your sex life. Find out about common vaginal problems and ways to promote a healthy vagina.

By Mayo Clinic staff Vaginal health is an important part of a woman's overall health. Vaginal problems can affect your fertility, desire for sex and ability to reach orgasm. Ongoing vaginal health issues can also affect other areas of your life, causing stress or relationship problems and impacting your self-confidence. Know the signs and symptoms of vaginal problems and what you can do to protect your vaginal health.

What affects vaginal health?

	Female reproductive system
	Vulva

The vagina is a closed muscular canal that extends from the vulva — the outside of the female genital area — to the neck of the uterus (cervix). Various factors can affect your vagina, some modifiable and some not. For example:

• Unprotected sex. You might contract a sexually transmitted infection if you have unprotected sex.
• Aggressive sex or pelvic fracture. Forceful sex or an injury to the pelvic area can result in vaginal trauma.
• Certain health conditions. Diabetes and Sjogren's syndrome — an autoimmune disorder — can cause vaginal dryness.
• Medications and feminine-hygiene products. Prolonged use of antibiotics increases the risk of a vaginal yeast infection. Certain antihistamines can cause vaginal dryness. Superabsorbent tampons can lead to toxic shock syndrome — a rare, life-threatening complication of a bacterial infection.
• Birth control products. Spermicide and NuvaRing (vaginal ring) can cause vaginal irritation. Using a diaphragm or contraceptive sponge might pose a risk of toxic shock syndrome.
• Pregnancy and childbirth. If you become pregnant, you'll stop menstruating until after your baby is born. During pregnancy, vaginal discharge often increases. Vaginal tears are relatively common during childbirth. In some cases, an episiotomy — an incision made in the tissue between the vaginal opening and anus during childbirth — is needed. A vaginal delivery can also 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 an initial painful sexual experience — also can lead to pain associated with sex.
• Getting older. The vagina loses elasticity after menopause — the end of menstruation and fertility.
• Hormone levels. Changes in your hormone levels can affect your vagina. For example, estrogen production declines after menopause, after childbirth and during breast-feeding. 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 your vagina include:

• Sexual problems. These might include persistent or recurrent genital 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).
• Sexually transmitted infections. Various sexually transmitted infections can affect the vagina, including genital warts, syphilis and genital herpes. Signs and symptoms might include abnormal vaginal discharge or genital sores.
• Vaginitis. An infection or change in the normal balance of vaginal bacteria can cause inflammation of the vagina (vaginitis). Symptoms include vaginal discharge, odor, itching and pain. Common types of vaginitis include bacterial vaginosis, which results from overgrowth of one of several organisms normally present in your vagina; yeast infections, which are usually caused by a naturally occurring fungus called Candida albicans; and trichomoniasis, which is caused by a parasite and is commonly transmitted by sex.
• Pelvic floor relaxation. If the supporting ligaments and connective tissues that hold the uterus in place become weak, the uterus, bladder or rectum might slip down into the vagina (uterine prolapse). As a result, the vagina also is pulled down.
• Other diseases and 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.
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• Vagina: What's normal, what's not

  What are signs or symptoms of vaginal problems?

  Consult your doctor if you notice:
  
• A change in the color, odor or amount of vaginal discharge — especially when accompanied by a fever
• Vaginal redness, itching or irritation
• Vaginal bleeding between periods, after sex or after menopause
• A mass or bulge in your vagina
• A sensation of pressure or heaviness in your vagina

You might not need to see your doctor 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 experiencing similar signs and symptoms. However, if you choose to use an over-the-counter medication and your symptoms don't go away, consult your doctor.

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.
• Get vaccinated. Vaccinations can protect you from human papillomavirus (HPV) as well as hepatitis A and hepatitis B — serious liver infections that can spread through sexual contact.
• Practice good hygiene. Don't douche or use perfumed soaps. Don't use feminine sprays or scented tampons. If you use sex toys, clean them after every use.
• Do Kegel exercises. Kegel exercises can help tone your pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Once you've got the hang of it, do at least three sets of 10 Kegel exercises a day.
• Know your medications. Discuss medication use and possible vaginal side effects with your doctor.
• Limit the amount of alcohol you drink and don't smoke or use drugs. Alcohol and illegal drugs can cause sexual dysfunction. Nicotine can inhibit sexual arousal. If you're under the influence, you're more likely to take sexual risks.

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

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