Demystifying “Down There”

Brittany Powell-Savoy, WHNP-BC 

In a world of trending topics, one of my favorite things to discuss is vaginal health. That’s because it is relevant to half of the population, and no one talks about it. Vaginal health is part of women’s health. It is important, and it doesn’t have to be a mystery.

Many women will experience vaginal symptoms at some point in life. These may include vaginal odor, discharge, vulvar itching or vulvar irritation among others. Symptoms like these can be a sign that the vaginal ecosystem has been altered or disrupted.

“Ecosystem?” Yes! The vaginal ecosystem, also referred to as the vaginal microbiome, contains healthy bacteria, opportunistic “bad” bacteria, and candida (yeast).

Lactobacillus is a healthy vaginal bacteria that produces lactic acid and helps keep the vaginal pH low. A low pH, typically 4.5 or lower, makes it difficult for candida and bad bacteria to multiply and thrive.

Opportunistic, or “bad” bacteria, may be native to the the genital tract or introduced. Many bacteria are common in the genital tract in small quantities. When there is an overgrowth of these types of bacteria, symptoms may occur.

In a balanced ecosystem, varying strains of lactobacillus account for about 90% of bacteria found (Path Advantage, 2026). When our vaginal microbiome is imbalanced, infections are more likely to occur. Here are the most common infections I see day to day:

Bacterial vaginosis 

Bacterial vaginosis, or BV, occurs when opportunistic “bad” bacteria overgrows in the vagina. BV is the most common cause of abnormal discharge. “Normal” is usually clear or white discharge, without foul odor or accompanying discomfort. Abnormal discharge can vary in color and consistency. It may be excessive in amount or noticeably odorous. Bacterial infections can also be asymptomatic. When healthy bacteria are plentiful, infections are less likely to occur.

Vulvovaginal Candidiasis 

Commonly known as a “yeast infection,” vaginal candida is the most common cause of vaginal itching and irritation. Yeast infections occur when there is an overgrowth of candida in the vagina. Certain antibiotics can decrease the amount of healthy bacteria, creating an ideal environment for yeast to thrive.

Cross Roads Hormonal Health and Wellness Urinary tract infection 

Vaginal symptoms are often confused for UTIs. Urinary tract infections are characterized by frequent urination, pain with urination, urinary urgency, pelvic pain and/or low back pain.

Because the urethra is located directly outside of the vagina, it can easily be exposed to vaginal flora. In patients with recurrent urinary symptoms, a vaginal culture can be helpful in ruling out asymptomatic BV or candida.

Promoting vaginal health

A healthy vaginal microbiome can help keep infections at bay. Here are a few of my usual recommendations:

• Take probiotics regularly. A variety and abundance of healthy bacteria like lactobacillus keeps the vagina happy. Look for products that contain strains like L. crispatus, L. jensenii, L. gasseri and L. rhamnosus.
• Avoid scented soaps, lotions and hygiene products. They may contain chemicals that raise your pH or destroy healthy bacteria. You can wash with water only, or with a mild soap like Dove for sensitive skin. Use soap on the vulva, but not inside the vagina.
• Do not douche. You may have heard the vagina referred to as a self-cleaning oven. That is true! Let your healthy bacteria do what they do best. Douching can wash away healthy microbes and upset the pH balance.
• Wear cotton underwear and avoid tight, restrictive clothing. Cotton is breathable and will not trap moisture the way other fabrics might. Tight clothing can cause rubbing and friction that may lead to vulvar irritation.
• Keep any toys or devices clean. Wash with an antibacterial soap and dry fully after each use.
• Practice safe sex. Condoms can help limit bacteria you are exposed to and prevent transmission of STIs.
• Complete your medications. Even if your symptoms have subsided, make sure to complete any prescribed medications. Incomplete treatment leads to recurrence of infections and promotes antibiotic resistance.
• Abstain from sex during treatment. This gives your medication time to work without interruption.
• Schedule a visit. If you have any of the symptoms discussed above, contact our office to schedule a visit for further evaluation.