The Vagina Bible. Jen Gunter
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.
CHAPTER 9
The Lowdown on Lube
WOMEN REPORT THEY USE LUBE TO MAKE sex more fun, to try something new, and to make sex more comfortable. It’s also important to use lubricant with condoms as it reduces condom breakage—and no, saliva does not count, as it’s not a great lube. Despite what you may see in the movies, I’d skip honey. I’ve seen some irritating consequences.
According to a 2014 survey, 65 percent of women reported using lubricant at some point, and 20 percent said they had used lube within the last thirty days.
There are medical conditions that cause vaginal dryness, so if you’ve never needed lubricant before and all of a sudden you feel like your ecosystem has switched from garden to desert, it is worth checking out with your health care provider. The most common cause is menopause, but other causes of vaginal dryness include a yeast infection, breastfeeding, hormonal birth control that doesn’t have estrogen (for example, the Depo-Provera injection and the implant Nexplanon), and muscle spasm around the vagina (the tightness causes more friction, and it can be perceived as dryness).
I hear from women that some male partners “don’t like” lubricant or say it affects their erection. It’s only a few milliliters of lube (far less than an ounce), so it’s not exactly as if his penis is encased in pudding. I’m no urologist, but if he uses this “too wet” excuse, then either he doesn’t know what an excited vagina feels like or he could be projecting his medical condition, typically erectile dysfunction, onto you.
Vaginal lubrication is part of the sexual response cycle and can vary from day to day and from partner to partner. The amount of foreplay and penetration will also affect what you need. Sometimes your mind is raring to go and your body hasn’t quite caught up yet, so a boost from a bottle can get you there faster.
Whatever the reason, lube is your friend! I think of lubricant in the way I think of glasses—some people have always needed them, some of us need glasses as we age, and some just need glasses for reading. No one is judgy about glasses.
Remember, it’s not how you got to the party, it’s that you were at the party and had a good time!
The Choices
The lube section at the drugstore or online can be overwhelming, as there are a lot of options—even more so at specialty sex shops. However, at many sex shops you have a lube docent who can provide details on all of their offerings.
There are several categories of lube: water based, silicone, hybrid (silicone and water), oil based, and pure oil (think olive or coconut). Silicone lubricants stay around longer on the tissues versus water-based lubes, so you may need to reapply less and they can be used in the shower or bath. Some people find silicone harder to clean up than water based. Oil also has a lot of staying power and many people prefer the feel, but it can also stain sheets. Water-based lubricants are the easiest to clean up. All of these lubes are fine for anal sex.
Some people really care about the feel of their lube—sensation is very personal. I find there are two main tactile components to consider: the slip and the tackiness. Others are more bothered by the cleanup factor, some find taste an issue, and there are those who don’t care as long as it is wet and gets the job done! The great thing about lube is you get to be Goldilocks and try a few so you can figure out your preference.
In addition to feel and cleanup factor, it’s also important to make sure your lubricant doesn’t irritate the vaginal tissues or negatively affect the healthy bacteria. The World Health Organization (WHO) has guidelines for water-based lubricants. Specifically, they recommend a pH of 3.5–4.5 (the same as the vaginal pH) and an osmolality of less than 380 mOsm/kg (the concentration of molecules in water; low osmolality means fewer molecules and high osmolality means more).
The osmolality of vaginal secretions is 260–280 mOsm/kg. If the osmolality of the lube is higher, it can pull water out of vaginal tissues, potentially causing irritation and