Today’s installment of gynecologist versus celebrity arrives courtsey of Lo Bosworth, who I must admit I had never heard of before this week. She is selling products for vaginal health and they concern me greatly. I am a board certfied gynecologist so I get to say that.
Allie Jones from The Cut called earlier in the week to ask my opinion about Ms. Bosworth’s new line of vaginal care products. I told Allie how some of these products worried me and she accurately quoted me – you can read the interview here. However, after reading what Ms. Bosworth also told The Cut I feel compelled to add more. Here’s why.
Bosworth’s product line includes boric-acid suppositories, wipes, cleansers, and moisturizers, probiotic pills, vitamins and something called “Blue Tea.” I am going to address the products that concern me the most medically- the suppositories, wipes, and cleansers.
Boric Acid Suppositories
Ms. Bosworth is woefully misinformed about how boric acid should be used. I don’t ever give direct medical advice, but telling women not to use these is the equivalent of saying don’t play in traffic so I’m not exactly going out on a limb.
Technically boric acid is found in nature, but so is rattlesnake venom and both boric acid and rattlesnake venom are poisons. Boric acid can be fatal if taken orally, so the snake venom analogy is pretty apt. There are so many issues with boric acid that when I recommend it I have a lengthy safety handout that I provide. For example, if you use it vaginally and then your partner gives you oral sex it could be accidentally ingested so there must be strict abstinence.
An evidnce-based gynecologists recommends boric acid in two and only two medical situations, NONE OF WHICH CAN BE SELF-DIAGNOSED. We use it when there is azole-resistant yeast and as part of a very specific regimen for refractory bacterial vaginosis. Boric acid should never be used outside of those two specific reasons. So gynecologists should not “use it to spot-treat women when they’re just a little off down there.” And by the way, in the few situations where I do recommend it patients get it from Amazon or Walgreens and mix it up themselves for less than $10.
Chronic use of boric acid could easily damage the vaginal mucus and kill lactobacilli (the good bacteria). It is also caustic and can lead to vaginal abrasions.
To recommend a vaginal wash is to recommend damaging the vagina. I can’t state that strongly enough. Many intravaginal products damage the lactobacilli (the good bacteria) and studies tell us efforts to acidify the vaginal pH are futile because the lactobacilli maintain the vaginal pH not external forces. So who cares what the pH is of your vaginal wash because not only do you not need it and it can’t work, but it’s potentially harmful.
Do you need a pH balanced wash for your vulvar skin? Maybe Ms. Bosworth meant the vulva when she said vagina? Keep in mind every time you wash you strip away natural oils and good bacteria. As for Ms. Bosworth’s claim that “there is actually no clear literature that talks about eliminating soap from your hygiene routine,” the perils of over washing have been well-described and I see complications of that daily. Over washing can contribute to a condition called lichen simplex chornicus, an itchy ezcema-like condition of the vulva.
The pH of skin is about 5.0 or so. It can be changed temporarily with soap, but within a few hours goes back to 5.o. The point of soap isn’t to balance your pH, it is to remove dirt and harmful bacteria. As you are not eating food with your vagina or vulva it needs less attention from soap than your hands. If you feel you need soap for your vulva, use sparingly and use something without a scent that is mild, but honestly water is often enough. There are plenty of inexpensive soaps, like Pears or a liquid Castile soap that can do the job just fine for a fraction of the cost of Ms. Bosworth’s products.
I see more contact dermatitis from wipes than anything else. Bosworth’s “natural” wipes also contain benzyl alcohol which can be irritating. But the big issue is over cleaning. When you constantly strip oils and bacteria away you are making the skin more vulnerable and the dryness can cause micro abrasions and introduce yeast or bacteria into the skin. Overcleaning with wipes can also paradoxically increase odor due to the change in bacterial colonization and the fact that the sebaceous glands have to keep producing oil to make up from what you are stripping away, never mind that it reinforces the idea that women’s genetalia are are dirty.
But we use wipes on babies, you say! Yes, to remove smeared on feces (although a soapy washcloth works well too). Someone with fecal incontinence may absolutely need wipes, but no one else does.
The Worst Part – Vaginal Shame
If you thought random use of boric acid in the vagina was the worst part you would be wrong. It’s this quote that Ms. Bosworth gave The Cut, “We’re trying to eliminate the shame of having a vagina!”
Ms. Bosworth, there is no shame in having a vagina. How on earth did those words even come out of your mouth? What exactly about having a vagina is shameful? That it’s wet? That it smells like a vagina? You know what is shameful? Someone like you abusing your celebrity to prey on women to sell your products under some guise of health when what you offer is the exact opposite. Every single week I see a woman who has been made to feel unclean because of her normal vulva or vagina, be it by some asshole guy or well-meaning mother or stupid magazine artcile or ill-informed friend or a celebrity hawking vaginal cleanliness it doesn’t matter. I’m sick of society pushing a Stepford vagina and vulva on women. I’m sick of the message that women need some extra attention to cleanliness, because that implies vaginas and vulvas are naturally dirty and they most definitely are not. It implies that there is some shame to a vagina that is wet and a vulva that is not sterilized.
I understand many women get bad information from doctors about vaginal health (that’s one of the reasons I blog, to help pass on good information), but there are experts in the area and if you are having issues with irritation or itching seek one out don’t buy boric acid and wipes and pH balanced cleansers. Get a diagnosis before you start a treatment. If you aren’t having problems still don’t buy this stuff. If you want to speand money on your lower genital tract get a different vibrator or buy some sexy underwear.
Here’s a pro-tip for Ms. Bosworth or any other celebrity itching to start a line of vulvovaginal skin care – don’t. If you want to help women you don’t start by suggesting there is some hidden shame in having a vagina and selling unnecessary and potentially harmful products. If you are really interested in vulvovaginal health might I suggest medical school and an OB/GYN residency and a fellowship in infectious disease, like I did? Yes, I know it’s longer and less profitable than passing boric acid off as a safe, natural vaginal tonic or selling vaginal pH washes that are as helpful to the vagina as cigarettes are to the lungs, but in the end if your goal is to help people with vaginas you will eventually get there.
There is no shame in a moist vagina that smells like a vagina and I am sick of people saying there is.