Vaginal health is a critical part of a woman's overall health. Vaginal problems can affect a woman’s fertility, desire for sex and ability to reach orgasm. These problems may also cause physical and mental stress to the woman, adversely affecting her relationship with her partner and impacting her self-confidence.

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

• Certain health conditions or treatments. 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.
• Sex. Unprotected sex can result in a sexually transmitted infection. Forceful sex or an injury to the pelvic area can result in vaginal trauma.
• Birth control and feminine-hygiene products. Barrier contraceptives, such as condoms, diaphragms and associated spermicide, can cause vaginal irritation. Infections after childbirth or using a tampon for longer than 8 hours can increase the risk of toxic shock syndrome — a rare, life-threatening complication of a bacterial infection.
• Pregnancy and childbirth. If a woman becomes pregnant, she will stop menstruating until after the baby is born. During pregnancy, vaginal discharge often increases. Vaginal tears are relatively common during childbirth. In some cases, an episiotomy — (incision made in the tissue between the vaginal opening and anus during childbirth) — is required. A vaginal delivery also can decrease muscle tone in the vagina.
• Psychological issues. Anxiety and depression can contribute to a low level of arousal, resulting into discomfort or pain during sex. Trauma — (such as sexual abuse or an initial painful sexual experience) — also can lead to pain associated with sex.
• Hormone levels. Changes in a woman’s hormone levels can affect her vagina. For example, estrogen production declines after menopause and during breast-feeding. Loss of estrogen can cause the vaginal lining to thin (vaginal atrophy) — and making sex painful.
• Uncontrolled diabetes. Women with diabetes who have poorly controlled blood sugar levels are at greater risk of yeast infections than women with well-controlled diabetes.

At puberty, the vagina begins to produce discharge. This discharge is normal. It is mostly water and contains microorganisms. The discharge naturally keeps the genital area clean and healthy by removing dead cells from the lining of the vagina. The amount and makeup of normal discharge change throughout the menstrual cycle.

Normal vaginal discharge is clear to white and does not have a noticeable odor. Signs of abnormal discharge include a change in the color, odor, amount, or consistency from what is usual for a woman. A certain amount of vaginal odor is normal. If the odor is strong and noticeable, an infection or other problem may be the cause. If one feels that one needs to cover up the odor, one may have a medical condition that needs treatment. Sprays, deodorants, and douches are not recommended and may make things worse.

Estrogen helps keep the vaginal lining thick and supple and encourages the growth of lactobacilli. These bacteria make a substance that keeps the vagina slightly acidic. The acidity protects the vagina from harmful, disease-causing microorganisms. Yeast also may be present in the healthy vagina. The natural acidity of the vagina helps keep yeast and other microorganisms from growing out of control.

Vaginal infections can occur if anything disrupts the natural balance of the bacteria that normally are present in a woman’s vagina. Two common infections are yeast infection and bacterial vaginosis.

A yeast infection is caused by an overgrowth of yeast in the vagina. This can result from lubricants, spermicides, taking antibiotics (which destroy the “good” bacteria in the vagina), or pregnancy. The most common symptoms are itching and burning of the vulva. Yeast infections can be treated either by placing anti-yeast medication into the vagina or by taking a pill.

Bacterial vaginosis is caused by an overgrowth of the bacteria that normally live in the vagina. The main symptom is increased discharge with a strong odor often described as “fishy.” This infection is treated with antibiotics, either taken orally or by inserting into the vagina.

During pregnancy, the levels of the hormones estrogen and progesterone increase. As more estrogen and more blood flows to the vaginal area, the vulva may become swollen. The color of the vulvar skin and the opening of the vagina may darken. One may have more normal vaginal discharge. Hormonal changes also may cause changes in the balance of yeast and bacteria in the vagina. Vaginal infections are more common during pregnancy.

Decreasing estrogen levels can affect the vagina and urinary tract during menopause. Over time, the vaginal lining can get thinner, dryer, and less elastic. The decrease in estrogen also may thin the lining of the urinary tract. Because of these changes, many women have symptoms that are known as genitourinary syndrome of menopause (GSM).

pH is a way to describe how acidic a substance is. It is given by a number on a scale of 1-14. The lower the number, the more acidic the substance.
It has been known that without vaginal infections, vaginal pH is ≤4.5 during the reproductive years and >4.5 before menarche and after menopause.
Vaginitis - Symptoms (i.e. itching, burning, unpleasant odor, or unusual discharge) are likely caused by an infection that needs medical treatment.
In the presence of vaginitis, vaginal pH of >4.5 may indicate various infections such as bacterial vaginosis, trichomonas vaginalis, group B streptococcus or other pathogenic organisms. Changes in the vaginal pH, doesn't always mean that one has a vaginal infection. pH changes also do not help or differentiate one type of infection from another.
The doctor can diagnose a vaginal infection by using a combination of: pH, microscopic examination of the vaginal discharge, amine odor, culture, wet preparation, and Gram stain.

Douching is washing or cleaning the vagina with water or other mixture of fluids. Douching can lead to many health problems, including vaginal infections and sexually transmitted infections (STIs).

The word "douche" means to wash or soak.

Douching is different from washing the outer portion of the vagina during a bath or shower. Rinsing the outer portion of the vagina with warm water will not harm the vagina. But, douching can lead to many different health problems. Most doctors recommend that women should not douche.

Health problems linked to douching include:

• Bacterial vaginosis (BV), which is an infection in the vagina. Women who douche often (once a week) are five times more likely to develop BV than women who do not douche.6
• Pelvic inflammatory disease, an infection in the reproductive organs that is often caused by an STI
• Problems during pregnancy, including preterm birth and ectopic pregnancy
• STIs, including HIV
• Vaginal irritation or dryness

Tips on preventing vaginitis

• After using the toilet, always wipe from front to back. This may help prevent bacteria from getting into the vagina from the rectal area.
• One should wear cotton underpants during the day. Cotton allows the genital area to “breathe.” Avoid wearing underpants at night.
• Avoid wearing tight pants, pantyhose, swimming suits, biking shorts or leotards for long periods.
• Change the laundry detergent or fabric softener if one thinks it is irritating the genital area.
• The latex in condoms and diaphragms and the sperm-killing gels that are used for birth control can be irritating for some women. In such cases, one should talk to the doctor about other types of birth control.
• Avoid hot tubs.
• Bathe or shower daily and pat the genital area dry.
• Don’t douche