Keto Crotch headlines have ricocheted around the Internet.

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Whether this is just a click bait sweet spot of vaginal panic + keto or something more orchestrated (the number of headlines that blossomed in such a short span was truly awe-inspiring) is hard to know. I am not a conspiracy theorist, but seriously it was nuts even by vaginal mayhem standards. Not even the power of winter vagina could do that!

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Before we dive further into Keto Crotch — words I never dreamed I would write — let’s be clear about one thing. The plethora of articles about supposed vaginal odors from food are misogyny (blatant or internalized), represent zero understanding of vaginal physiology, or both. If there were equal number of think pieces devoted to scrotum stank and anus aroma, I’d accept the Internet likes to obsess over intimate places and that false genital panics are an equal opportunity offense.

However, the lack of articles about the way a penis, scrotum, or rectum might smell depending on diet, weather, or underwear/jockstrap leads to only two possible conclusions: everyone thinks smegma has floral and pine notes and behind the scrotum is a pleasing mix of anise and musk OR these articles exist because it is only vaginal panic sells copy.

Back to keto crotch.

The claim: excess ketones from nutritional ketosis enter the vagina and change the smell.

Ketones 101

When the body doesn’t have enough sugar for energy (sourced from carbohydrates) or can’t use the sugar it has (in the case of diabetes) the liver breaks down fat for energy. Ketone bodies or ketones are by products of this process. The three ketones that are produced are acetoacetate, acetone, and beta-hydroxybutyrate. 

Normally, the concentration of ketones in the blood is less 1 mg/dl

Ketones are used as energy and any excess are removed. The main elimination route is the lungs. Acetone in exhaled breath produces a fruity, nail polish smell that should be familiar to every doctor. Excess ketones are also removed by the kidneys in the urine.

If ketones are produced to such a degree that the body can’t remove them fast enough, ketoacidosis develops meaning the pH of the blood drops (among other things) and this is a medical emergency. Ketoacidosis is not seen with nutritional ketosis, which is the goal of the keto diet.

What about sweat as a source of ketone removal? I can no find no convincing evidence that ketones are removed via sweat glands or that ketones increase in sweat with nutritional ketosis. It is quite possible people who think their body odor changes with nutritional ketosis are simply smelling their own keto breath.

If some new technology eventually tells us that ketones are in sweat, it will be something that happens to both men and women. Sweat and secretions from apocrine sweat glands (specialized glands in the groin) can contribute to genital odor for both men and women. This is why your underwear may smell a musky after wearing them all day after a heavy work out, but the odor is from the skin not vagina. I shouldn’t have to point out the unique smell of a well-used yet infrequently laundered jock strap, so no vagina required at all for underwear aroma. 

Keto rash, a real thing, is not from ketones in sweat, it is a condition called prurigo pigmentosa and is likely due to negative effects from ketosis on the immune system. That a diet induces a rash in this (or any manner, really) is not a selling point for me. But I digress.

How does the vagina fit into this? Ha ha. It doesn’t.

The vagina is not a filter for waste products. The lungs and kidneys are, which is why THEY dump ketones. 

Most of what makes up vaginal discharge and odor is an inside job — vaginal bacteria and the substances they produce, potentially harmful bacteria packaged for elimination on epithelial (skin) cells, epithelial cells, and cervical mucous. Only very tiny amount of what makes up vaginal secretions comes from the blood stream. Like the smallest, tiniest part of the 1-3 ml a day of vaginal discharge. This is called transudate and it is a ultrafiltrate, meaning it has few if any cells and no proteins. Transudate is fluid that has leaked from blood vessels close to the vagina, travelled through the smooth muscle of the vagina and between the cells of the vagina, and then into the vagina.

The idea that ketones can even make it into the vagina is not proven and to me seems suspect biologically. I can’t find any supporting data. The vagina uses sugar not ketones as an energy source (for lactobacilli, the good bacteria). So biologically, it seems the vagina would prefer to be ketone free.

I smell vaginas all day long (it is part fo the work up for vaginal conditions) and in the absence of two specific medical conditions (bacterial vaginosis and Trichomonas) there is a pretty uniform smell. I have many patients on the keto diet or who are paleo or vegetarian or vegan or, well, you get the point. I couldn’t tell you who is on what diet based on their vaginal exam.

Stop the Vaginal Panics

The false idea that food, especially punget food, can change vaginal smell is promoted by many magazines, “influencers,” and even doctors, who are all clearly woefully misinformed.

The myth is so pervasive that I have a whole chapter in my book, The Vagina Bible, walking people through the medical misinformation step-by-step. Seriously, if your GYN thinks food can change the way your vagina smells my advice is get a different doctor.

If ketones are in sweat (not proven) this would affect the smell of the “crotch” for women and men equally.

If you are on the keto diet and you think your vagina has a different smell, consult a doctor not the Internet. If your work-up is negative, it is entirely possible you are smelling your breath as nutritional ketosis can give you bad breath.

And why the Internet isn’t in a panic about Keto Breath and how it affects kissing, but is obsessed over non-existent Keto Crotch pretty much says it all.

Shaming women about vaginal health is profitable. 

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  1. Add 1 more “shame” to the long list that women must bear from birth until death. It starts with budding breasts, then bleeding from the vagina, then pubic hair, then sexual behavior, nursing breasts, hot flashes,sagging breasts, menopause back fat and on and on until death. The only shame is being born female, which means not strong enough for physical labor, not smart enough to be allowed an education and never clean enough from all that bleeding that happens and never stops until babies stop coming forth from the place that bleeds. Men have shamed us since the beginning of time which is the response of ignorance and uncritical thought. Those dirty, dirty women, shame on them and so it went and so it goes…is it getting better as we gain enlightenment? Brett Kavenaugh was appointed onto the U.S. Supreme Court in 2019, a sexual predator. No, we are not enlightened. Shame on us all.

  2. This seems to go along with the common internet advice that drinking gallons of cranberry juice and pineapple will make your vagina smell and taste sweet. I don’t know if that was an idea from a blogger or a genius marketing team for a juice company. I’m no expert but I don’t think vaginas can taste sweet, unless you’re literally dipping yourself in pineapple juice, a vagina cannot taste like a pineapple.

    1. Actually, the myth about drinking pineapple juice and eating pineapples applies also to men – that it will make semen taste better and improve oral sex.

  3. Well I’m sure Goop or some other company “who is there for us women” will find an awesome product to help with these odors! Maybe Pussy Willow Balm or Stinky Pussy Salve? It’s so sad that people even believe this is a thing now! Thanks for helping to clear up another Woman’s Body misconception.

  4. Dr. Gunter: You write that “The plethora of articles about supposed vaginal odors from food are misogyny (blatant or internalized), represent zero understanding of vaginal physiology, or both. If there were [an] equal number of think pieces devoted to scrotum stank and anus aroma, I’d accept [that] the Internet likes to obsess over intimate places and that false genital panics are an equal opportunity offense.”

    You are undoubtedly correct on several key points here, particularly the role of misogyny and ignorance in characterizing the natural aromas of the vulva as infelicitous and ascribing these normal aromas to pathological conditions. While it may be true that there are more “think pieces” (I’m sure you were speaking ironically when you used that phrase) about women’s private parts than there are about males’, this is entirely of a piece with how the fashion- and cosmetics-industries exploit women’s insecurities about themselves in general. I doubt that the proportion of magazine articles devoted to the “supposed vaginal odors from food” in comparison to the dearth of such articles on the effects of foods on men’s body odors is any different from the proportion of articles on women’s clothing, grooming, make-up and hair-styling relative to articles on such matters as they pertain to men (although that is probably changing somewhat). Women’s bodies and women’s appearances are routinely “policed” and “gendered.” Why should their genitals be treated any differently?

    That said, I beg to differ with your implication that the derogatory attitudes directed at women’s genitalia by men is entirely one-sided. This is a theme that you have struck previously but I wonder if you are not – whether consciously or unconsciously – omitting key evidence that would disprove your thesis. I am reminded of this, yet again, by your comment (quoted above) from which conspicuously absent is any reference to the intact penis. Of course there are few – if any – “think pieces devoted to scrotum stank and anus aroma.” Yet women (and men, for that matter) routinely make derogatory comments about intact penises. They make derogatory comments about how they look and they make derogatory comments about how they smell. Intact penises are regular fodder for stand-up comedians and for comedy movies. It remains perfectly acceptable, socially, to body-shame men who are intact and to advocate for male genital cutting on the basis of precisely the sort of unwarranted disdain for and ignorance about male genitalia as you rightly criticize when such such disdain and ignorance are directed toward female genitalia. You point out – and you are absolutely right to do so – that “shaming women about vaginal health is profitable.” Unfortunately, exactly the same can be said about shaming men (and, especially, shaming new parents) about intact penises. Neonatal circumcision generates hundreds of millions of dollars annually in the United States for physicians, hospitals, the bio-tech and cosmetics industries. Oprah Winfrey – who professes to be a champion of human rights – shills for SkinMedica, which manufactures a “beauty cream” (again, exploiting women’s insecurities about their looks, age and sexual appeal) made from fibroblasts taken – without consent – from amputated male foreskins.

    I would hope that, as a feminist, you support the principle of bodily autonomy for all and condemn the body shaming of anyone’s natural genitalia, whatever her, his or their sex or gender. Even more importantly, I would hope that, as a physician, you would condemn, in unambiguous terms, the profiteering from the performance of any medically unnecessary genital surgery, whether it be medicalized female genital cutting, medicalized male genital cutting, labiaplasty that exploits women’s insecurities and ignorance about their own genitalia, or neonatal male circumcision that exploits parents’ insecurities and ignorance about male genitalia.

    1. Thank you for this “what-about-the-mens-as-well” contribution to this thread.

      Now that you’ve dumped your “gotcha”, could you please stop it? Dr. Gunter is an obgyn, not a urologist. There’s no need for her to cover “both sides” all the time. Thank you for your cooperation.

  5. If you have keto crotch then that means you aren’t washing/wiping correctly after you use the bathroom when you pee(ketones).

    So if you, or anyone else, smells your “Keto crotch” that just means….. You and your bird are dirty. Hahahaha

    1. That’s what I’m thinking. When I’m on the keto diet, I pee A LOT. Could be some women arent wiping or cleaning themselves enough.

      1. Oh yes, those stupid dirty women who cannot even wipe themselves properly. And they don’t even use lysol to make sure their vaginas are clean and not stinking.

  6. I have been keto for several years. No smell whatsoever. And no more yeast infections.

  7. Misogyny? Please elaborate? I googled “keto crotch” and 4 of the top 5 articles were written by women, mainly citing personal accounts of other women from Reddit blaming their “stronger odors” on the diet. The only article written by a man was attributing the phenomena to his own genitalia. I’m not saying “keto crotch” is a thing at all but thanks for stirring the pot, “lasso of truth”.

    1. Women can also be misogynistic. Self-stigma is common, but often people don’t realize they hold themselves in shame.

      Please keep this in mind when you are posting as a person without a vagina in articles about vaginal health.

      1. I don’t think discussing my vaginal smells on the internet is self stigmatizing or misogynistic. As a matter of fact, the fact that women feel free enough to discuss their crotches openly is frickin’ awesome. I agree with Steve, calling the discussion misogynistic I think is missing the point.

  8. Apiacieae? No poison hemlock, please!
    For some decades I’ve wondered why the store aisles aren’t (equally) full of dick deodorants for guys. Forty zillion things in this world that (might) smell and this culture has to pick on just one? (Aside from the badness of smells being a subjective thing anyway…) Keep up the good work.

  9. Thanks for calling out junk science! While you’ve established that there is no link between ketones and crotch smell, would the higher fat content of keto alter vaginal flora, predisposing someone to vaginosis? I’ve seen some possible association from this journal article but it’s not particularly strong research (just associational): Not trying to cast any doubt on your posting of course. I value your work online trying to dispel myths and pseudoscience. Just wondering if the microbiome may be behind some of these “keto crotch” anecdotes. Thanks!

  10. The plethora of articles about supposed vaginal odors from food are misogyny (blatant or internalized), represent zero understanding of vaginal physiology, or both.

    Well I suppose it could depend on which members of the apiaceae or amaryllidaceae families Ms. Paltrow is recommending sticking up there this week…

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