There are a slew of over-the-counter products in the pharmacy (and supermarket!) isles that are supposed to help or cure itching, irritation and discharge “down there”, and/or make you feel fresh, smell like a garden and keep you dry. So when an article appeared in the Journal Menopause titled, “Over-the-counter treatments and perineal hygiene in postmenopausal women” I both read it and thought I should summarize it on this week’s website.
The authors who are physicians in the Department of Obstetrics and Gynecology at Brown University questioned 114 postmenopausal women, who were seen for routine gynecological care, on their use of over-the-counter (OTC) products. They grouped the products into five major categories: barrier treatments, powders, topical anesthetics, antifungal (yeast) treatments and topical steroids (hydrocortisone). The women were also asked if they douched, took sitz baths, used soaps with perfumes and/or waxed. (I know this is getting somewhat embarrassingly technical but the percentage of women who used the products or did this was surprising.)
Over 50% of the women reported using at least one OTC vulvovaginal treatment in the last three months, including barrier treatments, topical anesthetics, powders and an antifungals. Women often used more than one OTC product during that time. Eight percent reported douching in the last three months. More than 50% of women used pantiliners, pads or some sort of diaper for garment protection. Half of the women were sexually active and of those almost 50% reported using a product for lubrication with intercourse. (Remember these were post menopausal women.)
The authors then emphasized that some OTC products can cause adverse reactions. For example, topical benzocaine, a common ingredient in OTC products marketed for itch relief has been shown to cause severe contact dermatitis (an allergic skin reaction) of the vulva. Likewise absorbent products for garment protection can have ingredients such as rosins, colophony and methydibromoglutsronitril (I have no idea what these are!) which can also cause severe contact vulvitis.
Besides products that cause allergic reactions other products have been shown to cause harm. The use of talcum powder is associated with an increased risk of gynecologic malignancies. Talcum powder is widely available in United States and they found that 22.8% of postmenopausal women reported talcum powder use within the last three months. Another practice that has been shown to cause harm is douching. Douching leads to a disturbance of the normal vaginal flora and an increase in bacteria that don’t like oxygen (anaerobes). When they multiply, a condition called bacterial vaginosis occurs, which can then cause irritation, discharge and odor. This is the opposite of the freshness that douching advertisements promote…. The authors found that 8% of post menopausal women reporting douching within the last three months. Other medical literature has shown that 25 to 70% of reproductive age women report douching on a regular basis.
So what does this all mean? If you are using any of these products and start to feel irritated the first thing to do is stop. And certainly don’t douche or use talcum powder to ” freshen up”. If irritation or discharge continues make sure you tell your physician about your OTC perineal habits. Contact dermatitis is the most common cause of chronic vaginitis. The products you use to help you feel that all is right ” down there” may be making it wrong.