The vagina is self-cleaning – so why does the 'feminine hygiene' industry exist?
From talcum powder to jade eggs and douches, an industry has grown up to sell products – some of which are harmful – that play on women’s fears about being dirty or smelly
Which of the following should go nowhere near your vagina: a penis, a finger, a tampon or talcum powder? According to a jury in Missouri in July, it is the talc: the court found in favour of 22 women who claimed their ovarian cancer had been caused by their use of Johnson & Johnson baby talc, because it contained asbestos. The women were awarded $4.14bn in punitive damages.
This is not the first time a court case has found in favour of a woman claiming talc is carcinogenic: a California court did so last year, although the decision, also against J&J, was overturned on appeal and a new trial granted. According to a spokesperson, J&J “remains confident that its products do not contain asbestos and do not cause ovarian cancer and intends to pursue all available appellate remedies”.
Talc consists mostly of the mineral silica. However, because silica and asbestos are often mined near each other, talc could be contaminated with asbestos. The claimants’ lawyers in the Missouri case presented evidence that microscopic asbestos fibres had been found in many of the women’s ovarian tissues. “J&J sells the same powders in a marvellously safe corn starch variety,” said Mark Lanier, the lead lawyer, after the verdict. “If J&J insists on continuing to sell talc, they should mark it with a serious warning.” Six of the 22 women are already dead.
Deathly baby powder sounds like something Q would make for 007, but the idea that talc could be linked to cancer has been percolating for decades, although conclusions are still debated vigorously. Some studies have found a slightly increased risk; others have not. An NHS analysis in 2016 said it was “plausible that talc could work its way up into the upper genital tract and have some type of biological impact”; Ovacome, a charity that works to reduce ovarian cancer, does not believe a link has been proved. It says: “We still do not know what really causes ovarian cancer. But it is likely to be a combination of many different inherited and environmental factors, rather than one cause such as talc.”
So, while assertions and evidence continue to be thrown around, here is another question: why is any woman putting talc inside her vagina or on her vulva? (The vagina is a tube of muscle that joins the cervix and the vaginal opening; the vulva is the exterior genitalia.)
The vagina is an amazing organ. It is lined with a mucous membrane that protects against infection (necessary in any part of the body that opens to the outside world), as well as a clever, complex mix of bacteria – also known as vaginal flora – that does the same thing (only the bowel has more bacteria than the vagina). Together, they keep the vagina healthy. It is self-cleaning, too, keeping itself safe and hygienic with secretions. (One day, I will get used to gynaecologists referring to my vagina as “a self-cleaning oven”.)
All women have a DIY vagina-vulva-wash of mucus, which can vary in appearance and volume throughout the menstrual cycle. It is mostly highly effective, except in the case of infection, including STIs, which can be signalled by a change in colour, thickness or odour. (Odour can become slightly muskier due to exercise or sex; if anything is noticeably different, or you itch, get a medical professional to check it.) But you would not know about our natural powerwash from the size and value of the industry that has grown up to tell women we smell.
Of course, we all like to feel fresh and clean, particularly when we are bleeding. But for decades what is called the “feminine hygiene” industry has worked hard to increase our fears that we are not. Seventy years ago, women were being sold Kotex products that would make them feel “tangy”. Nothing has changed. Show me a sanitary pad or a tampon campaign that does not use the word “fresh” and I will swallow a bottle of vinegar douche. For every mention of “fresh”, look for the fear at which it is aiming: fear that we smell of period blood or are leaking; fear that we smell in general; fear that our sexual partners will mock or reject us because of what our vaginas and vulvas look or smell like. The jingle for baby talc was “a sprinkle a day keeps the odour away”. There is a reason that “you smell” is one of the most powerful playground taunts: it is the accusation we fear most and the hardest to protest. We all fear fishy.
The odds are your vagina and vulva look and smell normal, because, when it comes to genitalia, normal is a very big category. In a paper studying the range of female genital appearance, researchers at the Elizabeth Garrett Anderson hospital in London found that “women vary widely in genital dimensions”, but that “detailed accurate representations of female genitals are rare ... although representations of female nudity are common”. Rates for cosmetic genital surgery are soaring above rates of genital disease diagnosis. Something is deformed, but it is women’s thoughts, not their genitals.
To ensure cleanliness, the vulva needs nothing fancier than water, mild soap and a gentle pat dry (do not rub). The vagina does not need vajazzle, internal glitter bombs or leech therapy, a treatment touted as detoxifying by some eastern European beauty clinics (it is not). Jade eggs, which you insert in the vagina, are also a terrible idea, according to the gynaecologist Jen Gunter: “Jade is porous, which could allow bacteria to get inside and so the egg could act like a fomite … It could be a risk factor for bacterial vaginosis or even the potentially deadly toxic shock syndrome.” The mucous membrane that lines the vagina is also very porous. This makes the vagina an efficient route for absorbing medication and pathogens. Vaginal steaming – popularised by Gwyneth Paltrow, who supposedly sits herself over steaming herbal potions to improve her vulval and vaginal health – is not good for your vaginal wellbeing.
The outlandish stuff is one thing. But even a simple solution of vinegar and water sprayed up the vagina is a bad idea. Douching, as this is called, is done by one in five American women aged 15 to 44. Commercial douches can contain antiseptics, as well as potentially hazardous chemicals such as parabens, along with fragrances that are unknown: because these are cosmetic products, the US’s Food and Drug Administration requires only that manufacturers do not include anything “deleterious” in their products and trusts manufacturers to comply – it does not require any testing of products before they are launched. In short, products you are putting in close quarters with a highly porous part of your body are less stringently regulated than cough sweets. In the UK, they are regulated as general products, not medical devices; it is up to the manufacturer and seller to make them safe.
Anything introduced to the vagina risks upsetting the careful balance of bacteria, particularly if a woman is buying products because she thinks something is wrong. Researchers at the University of Pittsburgh found that the more women douched, the greater their risk of getting bacterial vaginosis, a mild infection that can cause itching and discharge (and therefore lead women to douche even more). If the women surveyed douched once a week, their risk doubled.
Douching has been linked to greater rates of bacterial vaginosis, premature births and cervical cancer. One study of 40,000 women in Puerto Rico and the US found douching doubled the risk of ovarian cancer. There were caveats, as an NHS article pointed out: the women, who did not have cancer, were followed over six and a half years to see whether they developed cancer and whether they douched. Forty women who reported douching their vaginas developed cancer. The researchers concluded a link; the NHS was more circumspect. Perhaps women with poor vaginal health are more likely to douche. The researchers did not enquire about risk factors such as a family history of ovarian cancer or whether the woman smoked.
“It’s a myth that the vagina needs extensive cleaning with perfumed soaps or feminine hygiene products,” says Vanessa Mackay, a spokeswoman for the Royal College of Obstetricians and Gynaecologists. “It’s a good idea to avoid perfumed soaps, gels and antiseptics, as these can affect the healthy balance of bacteria and pH levels in the vagina and cause irritation. Women are advised to use plain, unperfumed soaps to wash the area around the vagina (the vulva) – not inside it – gently every day. During a woman’s period, washing more than once a day may be helpful.”
I wonder if such statements would be necessary if “vulva” were as conversational as “sex”. If we discussed our fears about vulvas and vaginas – conversationally, with GPs or health professionals and with our partners – as easily as we seek help for a headache, the aisles of feminine washes, sprays, douches and wet wipes, all those sticking plasters on our fears and embarrassment, would vanish. “If nature had intended the vagina to smell like roses or lavender, it would have made the vagina smell like roses or lavender,” said Ronnie Lamont, an RCOG spokesman, in an interview for the NHS website. If we were more outspoken about genital matters, women’s health and confidence would be vastly improved, even if we might smell less fragrant.
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