How Stress Affects Vaginal Health

You might think of stress as being all in your head, but it very much affects your entire body — and that includes your reproductive system and vagina, if you have one. When we are under stress, whether a short term high-stress situation, like a job interview, or the longer term chronic stress that many of us live with on a daily basis, our bodies produce cortisol. Cortisol is a hormone that readies our bodies for the “fight or flight” response that was useful in the distant past when we needed to summon all bodily resources to run from a predator. However, in present days, we are living under high-stress conditions which leads to persistently high cortisol levels.  

How Stress Can Mess with Hormones

When the body produces too much cortisol over a long period of time, this starts a signaling cascade in the brain that ultimately leads to the pituitary gland failing to produce adequate levels of the reproductive hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The hormonal signaling of FSH and LH on the ovaries throughout the month is what leads to estrogen and progesterone production from the ovaries, allowing for a “normal” menstrual cycle.  When this is disrupted, you may notice missed periods, irregular periods, spotting between periods, mood changes and other irregularities. When this continues longer term, chronic stress can be a cause of low libido and infertility as well.

How Stress Affects Vaginal Health

Stress increases susceptibility to vaginal infections through several mechanisms, some of which are not yet fully understood.  A recent study from the University of Maryland School of Public Health showed that stress affects the composition of the vaginal microbiome.  Another study done in animals suggests that the change in estrogen levels seen in chronic stress may affect vaginal tissues, predisposing you to infections down there. The point is, while the exact cause/effect relationship is still being worked out,  it is clear that stress affects vaginal health.  These are a few vaginal health issues that are made more likely by stressful situations or chronic stress: 

Bacterial Vaginosis 

Bacterial vaginosis (BV) is a common cause of vaginal discharge in reproductive age women.  The most common presentation is the presence of a grey-white discharge with a characteristically fishy odor.  BV is caused by an upset in the normal bacterial content of the vagina. Typically, Lactobacilli species of bacteria dominates in the vagina, with other bacteria like Gardnerella species present in lower numbers in the background. When something disrupts the vaginal environment, leading to a higher than normal pH, this favors growth of Gardnerella. Then the excess Gardnerella bacteria creates conditions that lead to other unhealthy bacteria to grow in higher numbers. This bacterial disruption is what causes the symptoms of BV.  Douching, not using condoms, and having new or multiple sex partners lead to increased likelihood of developing BV, and stress may put you at greater risk of BV as well.     

Yeast Infections 

Yeast are always present in low numbers normally in the vagina, but certain conditions can favor growth of yeast. When yeast, specifically a type of yeast called Candida albicans, grows in high numbers or invades the deeper tissues of the vaginal wall, a classic “yeast infection” occurs.  Symptoms of a yeast infection include itching, irritation and thick, cottage-cheese like discharge. Certain conditions can predispose one to developing a yeast infection, including antibiotic use (the antibiotic prescribed for a different condition may kill the normal vaginal bacteria, allowing yeast to grow in higher numbers), any condition leading to compromised immunity (like uncontrolled diabetes or HIV) and increased estrogen levels (such as during pregnancy). Other conditions such as working out and not changing clothes or showering afterwards or wearing tight-fitting clothing can, in combination with other factors, encourage a yeast infection. 

Vaginal Dryness

Psychological stress can lead to decreased blood flow to the vaginal tissues which can lead to decreased natural lubrication during sex and general vaginal dryness, which in turn, can contribute to lower libido.  Additionally, when stressed, you may notice muscles are tense in various parts of the body. The pelvic floor muscles are also susceptible to this muscle tension, which can contribute to painful sex and even constipation!

Caring for Vaginal Health

Anyone with bothersome vaginal symptoms should seek medical care. Very mild BV and yeast infections may resolve on their own, but in general, if your symptoms are unpleasant OR don’t go away within a few days, you should be evaluated by a medical provider. These conditions are easily treatable, and not treating them has potential consequences. 

Untreated yeast infections can lead to extremely irritated vulvar and vaginal tissues, sometimes causing fissures (or small cuts) in these sensitive areas. These yeast infections can become more complicated to treat, requiring multiple doses of oral anti-fungals. BV, too, should be treated if it doesn’t resolve quickly on its own, and BV can actually increase your chance of getting a sexually transmitted infection (STI). In addition, untreated BV may lead to Pelvic Inflammatory Disease (PID) which occurs when an infection has spread into the uterus or fallopian tubes. PID can lead to scarring and even infertility (to test your knowledge of fertility and infertility, take this Nurx quiz).

Preventing Stress-Related Health Issues

Stress management is key!  So do whatever you can to help manage your stress levels.  For example, consider a meditation or relaxation practice where you specifically focus on tightening and then relaxing different muscle groups. During times of high stress, make sure to take time to focus on and care for yourself. While stress may encourage binging on unhealthy foods, try to eat a healthy diet high in plant-based foods.  Drink plenty of water.  Get regular exercise (and be sure to shower or at least change clothes soon afterwards).  Shower regularly and clean the external vulva with warm water and gentle, unscented soap. No need to clean inside the vagina, and especially avoid feminine washes or douches. During intimacy, devote plenty of time to foreplay to allow adequate lubrication of vaginal tissues. Be open with your partner about what is going on in your life and if you’re struggling with stress that may cause low libido.  

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