Professor Deborah Bateson — Pongy vagina

Yumi
If there's one thing that strikes fear into the hearts of many women that they never talk about, it's the heart-stopping, sweat-inducing worry of ever having a vagina that smells bad. And look, I have to say it, literally all vaginas have a scent. They've got their own little ecosystem down there, right? And it's cooking away. But sometimes things aren't as they should be, and it can get whiffy. We tracked down an expert who could unashamedly peel down the mystery around the smells that emanate from our bodies, whether it be a delicate, light, pleasant musk or a full-blown fishy vag. Professor Deborah Bateson is from the Faculty of Medicine and Health at the University of And I had a DNM with her for the Ladies We Need To Talk episode about pongy vaginas. I started by asking her the main reason why our vaginas might smell funky.

Deborah
The key thing is that your vagina does have a normal smell. So it's working out when it's different. A smelly vagina, pleasant smell, that smell we're familiar with, is actually the sign of a healthy vagina. It's caused by a mixture of a natural vaginal discharge, that's fluid from the vaginal walls, some cervical mucus. But the key component is this healthy, what we call microbiome, this healthy mix of healthy bacteria in the vagina. And when those change, if there's an imbalance in that bacterial flora, we call it, then that's when you can get that change of smell. And it can indicate, of course, that there's an infection, something's wrong as well.

Yumi
Yeah, sure. Okay. And do different smells mean different things?

Deborah
Look, they can do. I mean, look, sometimes I talk to women about, you know, they keep an app for their menstrual cycle. We really don't want people to be documenting their odours all the time because that's a bit intense. But certainly you might well notice a change. Well, certainly there's a change over what we call the reproductive life cycle. So, you know, the pleasant odour, that odour is going to be different. Say, you know, if you're pregnant, for instance, or after menopause, there's a change with the change of hormones over the reproductive cycle. But there may also be a change over the course of the menstrual cycle as well. And certainly you might notice a different odour, of course, at the time of menstruation. That's from the blood that's, you know, that's there in the vagina. But there, yes, there are those changes. There's a lot we don't know, but we are finding out more and more about this vaginal microbiome and that mix of bacteria that influences the odour. And it's a bit like saying vaginal discharge. Vaginal discharge is a healthy thing. You know that, you know, it's keeping the vagina healthy and clean and warding off infections. So it's about understanding that.

Yumi
So when you describe vaginal microbiome, it's just the vaginal tube, nothing to do with what's beyond it, past the cervix?

Deborah
That's right. This is to do with the vagina. Now, up above the cervix, there's the uterus. And in fact, we're finding out a bit more now about the uterine environment. But here we're talking about the vagina. And just to say, when we're talking about odours, sometimes you can mix it up as well with sweat, because so the vagina doesn't sweat. There's no sweat glands in the vagina. But the skin of the vulva, the hair-bearing skin, I suppose, that, you know, there's sweat glands there. And certainly, you know, if you've been running or, you know, sitting in a sofa or whatever and, you know, wearing tight lycra, and we know that, you know, that can create that sort of sweatiness. And that can obviously also add to the odour from, you know, I hate to use that term down there and we should always use the proper body parts. But you know, that, you know, obviously keeping things clean on the outside is really important. But it's also just remembering that, yes, the vagina doesn't sweat, it cleans itself and you don't need to clean the inside of the vagina.

Yumi
Yeah, well, I wanted to talk about that. How does the vagina clean itself?

Deborah
Yeah, so it is this, you know, it's wonderful, this wonderful microbiome. I mean, it manages this healthy mix of bacteria, which will have subtle changes throughout the, you know, the menstrual cycle. But it is your body's own regulation. It's keeping things in check with this, what we know is a healthy microbiome, is a microbiome that's got plenty of these, what we call lactobacilli. And they keep the vagina at a slightly acidic pH. And there's lots of different types. Again, we're learning a lot more. There's lots of different types of lactobacilli and some are healthier than others. Some may actually predispose towards infection. So it is just that self-regulation. And the body regulates itself in lots of different ways, of course. And it's about having that trust in your body. You don't need, you know, in fact, you certainly don't need vaginal deodorants because in fact, you know, to get your vagina to smell of, you know, rose petals or cucumbers or whatever, because that actually potentially is going to do more harm. Well, it's certainly not going to do any good and it may do harm by disrupting that microbiome. And then you get replacement with unhealthy bacteria. And sometimes that can even, you know, it can also lead to a condition called bacterial vaginosis, which is what we call a dysbiosis, where you've got these unhealthy bacteria. So it's just understanding that it does keep itself clean with this self-regulation. As soon as you add something in, then that can disrupt it. And of course, adding something into the vagina can also mean things like sex, for instance. So semen, you know, is a bit alkaline as well. So that's going to impact on the vagina, but generally it's going to self-regulate.

Yumi
Right, right. So, Professor, in your years of practice, have you noticed a rise in odour control products for vaginas?

Deborah
Oh, absolutely. So I think it's a rise in odour control products. And at the same time, I think, and it's hard to know which comes first, but that can also create anxiety. So certainly an increase in anxiety amongst women, I mean, often young women, but sometimes, you know, older women as well. Whereas maybe a throwaway comment from a partner or, you know, just this feeling that, and it can be debilitating that, you know, everyone can smell my vagina, you know, on public transport. Or I can't go into a new relationship because I know that, you know, this other person may notice this smell. And it can be so debilitating. And sometimes it's caught up with vaginal discharge as well. But just that feeling, and it is around this health literacy. I think we can do much more with young women. You know, in schools, it's not all just about preventing sexually transmitted infections and contraception, just understanding your body and that it does have this normal, what we call physiological smell. And I'd extend that to young men as well, who, you know, sometimes maybe they are intentionally being saying something cruel, but sometimes I think it's just a throw, as I say, a throwaway line which can be so debilitating. So that health literacy is all important.

Yumi
So why do you think women are becoming more self-conscious about their smells?

Deborah
I think partly think we can say it's a good thing, because now women are saying, look, I want to know about my body. So I suppose the other thing to say, you know, is it's great that women are feeling that they can ask their doctor about an odour, which perhaps would have been just too difficult to talk about before. But I also do think we must be aware to the tyranny of the pharmaceutical industry when it comes to selling products around women's health. And a lot of people are spending a lot of money on products where, you know, probiotics included. There's some interesting research, and I'm sure we're going to get there with probiotics that do work. There's some great, great research going on in the US and here. But at the moment, there's a lot of products on the shelf. You know, they're probably not going to do too much harm, but some might. So I think you need to be aware of that.

Yumi
Okay. Let's say that you don't have a health condition that's causing a strong odour in your vagina, but you have a really strong odour anyway, to the point where you are self-conscious about it. So I'm not talking about your daily, like, everything's okay, but just like a bit of a punch in the face kind of vibe. Is there something that women can do to help themselves in that situation?

Deborah
Look, I think if there's something that's so different, that's a bit of a punch in the face, and it doesn't disappear, I mean, I give it a, you know, see what happens over the course of the day or the next day and, you know, check out that there's nothing else going on that you haven't got some abnormal bleeding from the vagina or you haven't got a new abnormal discharge. I do think it's worth going to a women's health clinic, you know, a family planning clinic, for instance, or someone who is an expert in this area, because, you know, we've seen and smelt many, many vaginas in many years. And really, if we make that assessment that everything is fine, that can be incredibly reassuring. I do think, you know, there is that sort of thought of going to the chemist and looking at, you know, what you can buy to mask the smell. And that's where you can fall into danger and having a sort of vicious cycle, really. So I do think that if something, but give it a bit of time, it may just be, you know, something again, we all know, of course, our smell can be more acute at certain times. And you know, I think it is though about understanding your body. And what we really don't want is for people to suffer in silence, feeling really, really anxious that there's something wrong and that no one's been able to find out what that is.

Yumi
So in your clinical work, can you tell when someone's odour is like really

Deborah
Absolutely. I mean, it's absolutely. And, you know, if someone comes in with a, you know, saying they've got a discharge or an odour, then we would obviously do an examination. And we can tell, we can look at the amount of the discharge and the colour of the discharge. And you can actually, again, the key condition I suppose we're looking out for if someone talks about an off vaginal odour is this condition, bacterial vaginosis. Got a very characteristic smell. In the old days, we don't do it so much anymore. We used to do something called a whiff test where we'd have a bit of potassium hydroxide and mix it with the vaginal discharge and it would have a very characteristic odour. Really? And we'd say, yes, that's bacterial vaginosis.

Yumi
What causes bacterial vaginosis?

Deborah
Well, it is, so that is caused by an imbalance of, so a replacement of those healthy lactobacilli by other types of bacteria. So it shifts the pH of that, of the vaginal fluid, the vaginal microbiome environment from slightly acidic to alkaline. And it can cause a watery, greyish green discharge, a very characteristic fishy smell. So that's how people describe it. And it shouldn't be causing an itch or anything like that. And candida, you know, thrush generally doesn't have a strong odour. It certainly doesn't have an off odour. It can have that sort of yeasty odour. But the two are very different.

Yumi
But neither causes an itch?

Deborah
Oh, thrush, candida causes an itch. But bacterial vaginosis, it doesn't generally cause, well, it doesn't cause an itch, but it does cause this smelly discharge, which can be very distressing. But the key thing to know is that for both of those, but including bacterial vaginosis, there is treatment, so a course of antibiotics that your doctor can easily prescribe. There is a lot of work going on in this because we do know that around half of people will get the bacterial vaginosis back again. So there's some trials as well to look at whether treating a partner may be useful.

Yumi
And how much does underwear and overly tight lycra have to do with getting infections and getting...

Deborah
Yes, so underwear, cotton underwear and tight lycra and sweating and all of those things, that creates a perfect environment, that sort of dark, moist environment for yeast, so for candida. And again, it's the impact on the microbiome, but it's really, there's a lot of yeast just hanging around anyway and you just get an overgrowth of that yeast. Less so for bacterial vaginosis, but again, you're just wanting that good vaginal and vulval health care. And again, avoiding washing with perfume soaps and not wearing underwear at night, keeping the air flowing around the vulva is really important.

Yumi
Why do you think there's such a taboo around women's smells?

Deborah
Look, it's interesting, isn't it? I think there's a taboo around anything to do with women's genitals, their vagina. I think we can say vagina easily now on the television news, but vulva is still a taboo word. I think that people feel very anxious around that, not quite sure what it is and what the difference is. And vaginal odour, I think it is part of control of women. I think it's stigmatising, it's keeping women's sexuality locked away. And I think it's really part of women where, well, traditionally, historically, that place of women in the world. And luckily we're breaking that down now. And so we need to celebrate and recognise that this is a normal part of life.

Yumi
Yeah, because if your sexuality is right here, but very adjacent is the terror of being stinky and therefore shamed, it's really hard to relax into the sexuality part.

Deborah
I think that's right. And that anxiety, I mean, occasionally I've actually had couples where the woman has brought in maybe a female partner or a male partner in as well. So we could just discuss it and just, again, normalise things between people and just an understanding of this is a normal part of life.

Yumi
The experiences I've had, the smell is mostly the sweat glands on the outer areas of the vulva. And some people have a lot of sweat glands there and some people have not many. Is that right?

Deborah
Yes. And that can vary. And again, sometimes people can get, it can vary by genetics really, or it's just your body. So, and again, that can be also associated with more sweat from the armpits, for instance. And so it's just understanding your body, keeping that outside part clean. And again, if you're really bothered by it, then again, it's useful to go and see your doctor about it, but keeping that in control. And it is, it can be difficult to distinguish, but I've certainly had a few young women who've brought in their underwear because they're just terribly worried about the smell and sometimes staining on their underwear that they worry is associated with something that's wrong. And is there ever anything wrong? Well, sometimes there can be things wrong. So, so again, occasionally, I mean, this is a foul smelling odor over the course of many doctors' lives. We will have seen women where they've actually forgotten that they've had a tampon inside and that tampon has stayed there for quite a long time. Sometimes another tampon has been put in on top of the first one and that can cause a profuse, horrible discharge. And women can feel really anxious that, you know, they've got something terribly wrong. So, but in fact, it's just a matter of removing, removing that tampon. So just remembering.

Yumi
In that case, Professor, is it hard to get the tampon out?

Deborah
Oh, look, it can. I mean, I've always been able to get one out, but it can be a delicate process.

Yumi
So how can we embrace the smell of our vaginas more and just surrender to the fact that it will have an odour?

Deborah
I think it's, it's I think it's, talking about it like this. And look, I really don't want to promote necessarily Gwyneth Paltrow's, you know, candle that smells like a vagina, but it's great that people are talking about it at the dinner table. And so it does break down that, that taboo. So I think it really, I think what we really need to do is start, start at school, in fact. So I think it really is around age appropriate sex education, which is understanding our bodies across all genders as well, sort of understanding what the female body is like, what the male body is like, and that vaginal discharge is a normal thing.

Yumi
Can you tell us about the impact menopause has on the odour in your vagina?

Deborah
Yeah, so certainly again, the odour will change and you might notice a change, your partner might notice a change after menopause because what happens after menopause is you get that decrease in estrogen and that will have an impact on the, on the vaginal microbiota, as we call it. So certainly after menopause, you know, the vaginal secretions get less, the vaginal skin gets thinner and we can have this, what we call, I hate the term actually, but vaginal atrophy, which can cause painful sex. It can be really, really uncomfortable, but that will also have an impact, you know, that lack of estrogen. I've seen a quote where it says, oh, you know, the vagina may, may have more of a male odour. I'm not sure, you know, you haven't got testosterone there, but it's, it will certainly change.

Yumi
Does taking antibiotics wreck your vaginal microbiome?

Deborah
Yeah, so it can certainly impact on your vaginal microbiome as it can on your gut microbiome. So certainly if it can be a bit of a catch 22 sometimes, because we can give women a course of antibiotics for their bacterial vaginosis, but then that can have an impact on increasing the chance of them getting thrush. So it's a bit challenging. Thanks. Sorry about that. We can usually get that balance right, of course. Yeah, sure. But certainly, yes, if you've had a course of antibiotics for, you know, any sort of infection, a skin infection, that can absolutely impact on the microbiome and it's likely that, you know, thrush can come about as a result of that. And sometimes we know that contraceptive hormones as well as contraceptives, the IUD, for instance, copper IUDs, they can be in association with disruption to the microbiome and even to bacterial vaginosis. So again, if you're using an IUD and you notice most people, you know, it's fine, you know, vast majority absolutely fine. But if it's causing any trouble, you know, do go along and see someone about that. But certainly, you know, there's many reasons not to overuse antibiotics. And the world has woken up to the fact that if we use too many, then we might get resistance. But they can also have this other impact as well.

Yumi
Bacterial vaginosis is one of the primary causes of a stinky vagina. Yes. How do we avoid getting that?

Deborah
Yeah. So I think the main thing is around keeping your vagina vulva as healthy as possible. So, you know, we mentioned before about the tight lycra and wearing cotton underwear and not wearing underwear to bed or all of those things, not using deodorants, just, you know, just having good hygiene. Some people would say, you know, again, some people would suggest, oh, look, you know, give it a go. I've had couples where, you know, in long term relationships, they've given it a go using condoms because they felt that, you know, this bacterial vaginosis kept coming back even though they'd had treatment from him and that sometimes will work. There is a trial at Melbourne Sexual Health Centre, as I've mentioned now. We don't have the results yet, but possibly things are looking promising around treating male partners. We're about to start a trial around treating female partners as well. We know that women who have sex with women have a higher chance of bacterial vaginosis. So again, we're unlocking all this information. So it is around just if you're using sex toys, make sure that you're cleaning them appropriately. So it's that basic common sense. But you know, again, we do have to say, even for people that do all those things, you know, have the best approach to keeping things healthy, sometimes bacterial vaginosis can still occur and not to feel any shame or that you've done something wrong. Just know that this can happen and it can be treated.

Yumi
Yeah, sure. Can you explain, Professor, how intercourse can wreak havoc on your vagina?

Deborah
Yeah, so intercourse can sometimes wreak havoc because sperm is slightly alkaline. So again, you can imagine you've got that mix of the sperm in that ecosystem, which is slightly acidic and it can impact on the microbiome and tip it to having the more unhealthy bacteria. Generally, it's going to be very transient. And, you know, as I say, the vagina is very self-regulating. So generally, it's not going to cause a problem. But for some women, they may find that it does. Again, there's a lot we don't know. The alkalinity of sperm is going to vary from person to person. And potentially, there's all sorts of factors that will impact on that quality as well. But certainly, if you notice that you are finding that there is that change or you're developing that really strong odour that's unpleasant, then again, just do go along to your doctor.

Yumi
What are the three main takeaways for vaginal health that we should be incorporating into our lives?

Deborah
I think the main takeaways are, number one, that vaginal discharge, vaginal odour is normal and physiological and healthy and indicates that you're healthy. I think the second one is to know how to keep the vagina and the vulva as healthy as possible. So follow those common sense approaches around your underwear, not cleaning inside the vagina, understanding your body. So I think understand when to seek help when it's not normal. And the third is just all of us have that responsibility really for the younger generations as well to break down these taboos and make sure that we do talk about it in a respectful way. I mean, there probably is a time and a place to talk about vaginal odour, but what we do doesn't need to be every dinner conversation. But I do think it is just taking away that shame and that stigma. And I think having programs like this, Yumi, is my third takeaway.

Yumi
That was Professor Deborah Bateson from the Faculty of Medicine and Health at the University of Sydney speaking to me for the Ladies We Need To Talk episode on smelly vaginas. You can catch the full episode right here in the ABC Listen app.