Читать книгу The Vagina Bible - Jen Gunter - Страница 17

CHAPTER 8

The Bottom Line on Underwear

ALMOST EVERY WOMAN HAS BEEN TOLD at least once (and often more than once) to wear white cotton underwear as a medical recommendation to prevent yeast infections and other vaginal mayhem. This makes it sound as if vaginas and vulvas are accidents waiting to happen. The vulva can handle urine, feces, and blood, and vaginas can handle blood, ejaculate, and a baby, so this idea that a black lace thong is the harbinger of a vaginal or vulvar apocalypse is absurd.

I love pretty underwear. Perhaps it is from years of my mother buying the kind of underwear for me she thought “nice girls” (i.e., those who only have sex for procreation) should wear—hideously floral and large. It is also possible it’s from a lifetime of wearing surgical scrubs, where the only self-expression through clothing could be what was underneath. Regardless, if wearing lace or dyed fabric were bad for the vulva, I would know better than to expose myself to potential infection by wearing them.

Really, white cotton underwear doesn’t protect against yeast infections?

The white cotton underwear myth started before we knew about the vaginal ecosystem or the biology of yeast infections. How far it goes back I am not sure, but it wouldn’t surprise me if it dates back to the time when women were advised to douche with Lysol and “lace” meant “loose.”

There are low-quality studies that link polyester underwear and pantyhose with yeast infections. These studies interviewed women who did and didn’t have a history of yeast infections, and then asked them what kind of underwear they wore. The yeast infections were not proven by culture (the gold standard); rather self-diagnosis was used. This is problematic, for as many as 70 percent of women who self-diagnose with yeast infections are incorrect. When something bad happens, like vulvar or vaginal irritation, people are more likely to remember things they feel could be related than those who have not had the same bad experience. This is called recall bias. Finally, if you have a lot of itching and irritation and you have been told about wearing white cotton underwear, you may have switched and had a placebo effect. More recent studies of higher quality have shown no connection between underwear and yeast infections.

For underwear to cause an issue, it would have to change the ecosystem (perhaps by altering the pH of the skin), trap excess moisture, or cause friction. The combination of moisture and friction can cause microtrauma, which could allow the normal yeast on the skin to cause an infection.

Underwear can’t change vaginal pH; that is an inside job. There are a few studies looking at the effects of tight clothing on the vulvar skin, and there was no effect on bacterial colonization or pH. One study evaluated new underwear for athletics (performance underwear), which are not cotton but are designed to wick moisture away from the skin to improve comfort (wet underwear is unpleasant), and there were no health concerns. Thongs also appear to have no negative impact.

The only thing that can change the pH and microenvironment of the vulva is something occlusive—think waterproof, like plastic or latex. This can be an issue for women who have to wear waterproof incontinence underwear daily.

Underwear needs to fit correctly—if you are tugging at your groin or it is digging in or chafing, you could potentially develop skin irritation, but typically that kind of underwear is too uncomfortable to wear long enough to develop a health problem. It is probably also best to not wear underwear made of plastic or latex, as anything that causes you to sweat could be an issue.

What about a bathing suit?

The idea that women sit around in wet bathing suits all day intrigues me. I wonder if anyone promoting bathing suit panic has even seen a modern bathing garment? My suit tends to dry pretty quickly. That is sort of the point. Also, a little water against your skin is not going to damage anything. I mean honestly, if it does we have evolved rather unfortunately. Our vulvar skin gets wet a lot, and many humans spend a lot of time in the water. Dampness that dries relatively quickly is not going to cause an issue. If you sit in soaking wet clothes for several hours, you may develop skin irritation called maceration—a superficial skin injury from the combination of moisture and friction. This is why runners put petroleum jelly between their thighs before a long run, to prevent the maceration from friction and sweat. So if you throw on your clothes on top of a soaking wet bathing suit, you could potentially get some chafing, but the comfort factor of soaking shorts or pants is probably going to drive most women to change before they get a superficial skin injury.

Do I even need to wear underwear?

There is no medical reason to wear or not wear underwear. Many women tell me they don’t wear undergarments so their “vagina can breathe,” but the vulva and vagina don’t have lungs. The vagina doesn’t like oxygen, or even air. Occlusive garments such as incontinence products can affect vulvar skin integrity, so taking a break from these kinds of products if possible may help the skin, but otherwise the degree of air circulation that comes from wearing nothing is your choice.

Some women find the seams of pants directly against their skin uncomfortable, others don’t mind it, and some like how it feels. It’s all good. It comes down to comfort, how you feel about underwear, and whether you prefer to wash any vaginal discharge out of your pants, pajama bottoms, or your underwear.

Does it matter how I wash my underwear?

Women are told two competing things about washing their underwear: that they need to practically sterilize them, but also that they should use gentle detergent.

Let’s start with common sense. Every time you empty your bladder or bowels there is a microscopic plume of urine and feces that gets on your skin. It is not possible for the vulva to be sterile, and the vagina is full of bacteria. The only way you could make things worse bacteria-wise is if you rinsed your underwear in raw sewage (okay, I am exaggerating a little here for effect). You could wear the same underwear every day for a week, and while they might smell a little ripe from body odor and be a little crusty with discharge, they won’t cause an infection.

Clean underwear may matter medically after hair removal, although this has never been tested. All forms of pubic hair grooming (with the exception of trimming) cause microtrauma, and so freshly laundered underwear seems advisable. Remember, most vulvar skin infections start because there was a break in the skin, allowing the normal yeast or bacteria on the skin to breach the first line of defense.

Washing in hot water seems unnecessary with modern detergents. I’m certainly no home economist; however, I do my washing in cold water to save money (energy is very expensive in California) and for the environment. Every bit of electricity we use has some environmental footprint.

Perfumes and fragrances are known irritants (it doesn’t matter if they are botanical or lab made), and so it is best to avoid them in products that touch your skin, especially underwear, as the vulva is more prone to irritant reactions. A product can be fine everywhere except your vulva. I recommend using a detergent that is in the “free and clear” category. If you are not having any issues, then the “if it isn’t broken, don’t fix it” mentality is probably fine, but why needlessly expose yourself to a potential allergen?

If you are concerned that you could be having a reaction to detergent and switching to “free and clear” didn’t help, the next step would be a consultation with your gynecologist to rule out other causes. If nothing is found, a visit with an allergist or possibly a dermatologist (sometimes they do skin testing for topical reactions) might be a good idea.

Fabric softener and dryer sheets can also cause irritant reactions, so I recommend avoiding them. A capful of white distilled vinegar in the fabric softener dispenser works well in the washing machine to soften clothes cheaply, and it’s likely better for the environment. An added benefit of vinegar over fabric softener is that the latter can apparently increase odor and mildew if you have a front-load washer.

But underwear irritates me . . .

If it fits right and isn’t made of plastic or latex, and you are using the fragrance-free detergent and no fabric softener or dryer sheets, it is unlikely your underwear that’s causing the problem. The most common scenario is blaming underwear for unrelated symptoms. Some common causes of pain or irritation with the light touch or gentle friction of underwear are vulvodynia (a nerve pain condition of the vulva), and skin conditions like lichen sclerosus or lichen simplex chronicus (see chapters 33 and 35).

BOTTOM LINE

• Wear the underwear that you like and fits well.

• Avoid sitting around in soaking wet clothes long enough to get chafed.

• A clean pair of underwear right after you remove your pubic hair is wise.

• Occlusive undergarments could cause irritation.

• If you think your underwear is causing symptoms, it is more likely that you have symptoms you are erroneously blaming on your underwear.