by Prof A. Kulenthran
Shakespeare once said that during a man's lifetime, he plays many parts; his acts being 7 ages, beginning as the infant and ending as the aged man.
The vagina and its lining are no different. It too undergoes 7 distinct stages - the foetus, the newborn, the child, the adolescent, the pregnant mother, the post-childbearing years, and lastly, the menopausal woman.
To a large extent, what happens to the vagina can have a profound effect on the exterior (the vulva). For example, candidiasis, an infection of the vagina, usually causes no symptoms to the vagina itself but will cause an intense itch on the vulva.
What is also little realised is that the vagina possesses an ecosystem of its own. It is a dynamic environment and the vaginal mucosa in particular undergoes changes with the differing stages of a woman’s life.
1. The Foetus
Before birth, the vaginal lining is only single-layered. But at that stage, it does not pose a problem because the foetus is under the protective custody of the mother’s uterus. But at birth, the vagina becomes exposed. There is always a chance for bacteria to enter and cause problems. In response, the cells of the vaginal lining become flattened and multi-layered so as to form an effective barrier against trauma or infection.
2. The Newborn
Besides this physical barrier, a protective ecosystem of its own evolves. The mother’s oestrogens are still circulating in the newborn and these hormones encourage the cells to store glycogen, a sort of sugar. There is an important purpose for this because, over time, the vagina becomes colonised by an acid-producing bacteria called Lactobacillus acidophilus.
These bacilli are capable of using the glycogen stored in the cells as a substrate to render the pH of the vagina acidic by producing lactic acid. The lactic acid produced renders and maintains the pH of the vaginal secretions to be between 3.8 and 4.2. This has a bonus effect – it promotes further growth of the lactobacillus and a favourable cycle is set in motion.
By perpetuating an acidic environment, the lactobaccili to some extent prevent the growth of “unfriendly” bacteria or even fungus. Not surprisingly therefore, these “friendly” bacteria are considered the guardians of the vaginal ecosystem.
3. The Child
But with childhood, the mother’s oestrogens have practically disappeared. So too does the glycogen storage. It is therefore at this time that the child's vagina becomes susceptible to infection or irritation.
It is not uncommon for a child to have a slight vaginal discharge. Proper hygiene must be enforced by the mother, in particular, the way the child wipes herself after toilet. But this is also the age of curiosity. Fingers may be inserted, and in some cases, objects too. Therefore, any vaginal discharge at this stage must be taken seriously.
4. The Adolescent
However, with puberty the oestrogens make a return and the vaginal ecosystem returns to its acidic and protective state. Feminine hygiene now becomes an important issue to her. Being confident of her cleanliness “down there” can affect her confidence and general disposition. Enforcing her vaginal ecosystem does help.
5. The Pregnant Mother
Once a woman becomes pregnant, the purpose of feminine hygiene takes a different turn. Her maternal protective instincts take over and any untoward vaginal discharge or change in the external genitalia is assumed to be adverse to her foetus. Even the slightest change is always consulted upon. The most common problem seen is a fungal infection called candidiasis, and thankfully, it is easily treated.
6. The Post Childbearing
Her post childbearing years are when she is climbing to the upper rungs of her career ladder. Again her sense of well being is important. The best dresses and the best cosmetics are incomplete without confidence in her feminine hygiene. A persistent vaginal discharge can subconsciously affect her confidence.
Besides, these are the years of most stress, be it at work or the home, and that does not help. Thankfully her oestrogens are still on a high and the protective vaginal ecosystem holds its own.
7. The Menopausal Women
But with the menopause, her oestrogens take a downturn. Without the support of oestrogens, the vaginal lining begins to thin out, referred to in medical parlance as atrophy.
Furthermore, the ability of its cells to store glycogen is compromised. This has an impact on the pH of the vaginal secretions. It loses its acidity, and thus loses the ability to sustain the growth of the guardian of the vaginal ecosystem - the lactobacillus.
Also, because of this thinning, the vaginal lining becomes susceptible to infections - a condition referred to as atrophic vaginitis. A discharge is the most common presentation. The patient describes it as staining and it forces her to use a panty-liner. An itch in the exterior may follow because of the discharge.
Ironically, she is by then resigned to the fact that she is “over the hill” and such things as feminine hygiene take a back-seat. But she must realise that a discharge, especially if it is blood stained or accompanied with an itch in the vulva, may be the first sign of something that is more sinister.
The main thing a woman can do to maintain proper feminine hygiene is to maintain the vaginal ecosystem in its most protective state. Suffice to say, maintaining its acidic state is the common ground.
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