Vagina: What's normal, what's not.

The vagina is a closed muscular canal that extends from the vulva — the outside of the female genital area — to the neck of the uterus (cervix). Various factors can affect the health of your vagina, including:

• Sex. Unprotected sex can result in a sexually transmitted infection. Forceful sex or an injury to the pelvic area can result in vaginal trauma.
• Certain health conditions or treatments. Conditions, such as endometriosis and pelvic inflammatory disease, might cause painful sex. Scarring from pelvic surgery and certain cancer treatments also can cause painful sex. Use of some antibiotics increases the risk of a vaginal yeast infection.
• Birth control and feminine-hygiene products. Barrier contraceptives, such as condoms, diaphragms and associated spermicide, can cause vaginal irritation. Infections after childbirth or using a tampon for longer than 8 hours can increase the risk of toxic shock syndrome — a rare, life-threatening complication of a bacterial infection.
• Pregnancy and childbirth. If you become pregnant, you’ll stop menstruating until after your baby is born. During pregnancy, vaginal discharge often increases. Vaginal tears are relatively common during childbirth. In some cases, an episiotomy — an incision made in the tissue between the vaginal opening and anus during childbirth — is needed. A vaginal delivery also can decrease muscle tone in the vagina.
• Psychological issues. Anxiety and depression can contribute to a low level of arousal and resulting discomfort or pain during sex. Trauma — such as sexual abuse or an initial painful sexual experience — also can lead to pain associated with sex.
• Hormone levels. Changes in your hormone levels can affect your vagina. For example, estrogen production declines after menopause and during breast-feeding. Loss of estrogen can cause the vaginal lining to thin (vaginal atrophy) — making sex painful.

What are the most common vaginal problems?
Conditions that might affect your vagina include:

• Sexual problems. These might include persistent or recurrent pain just before, during or after sex (dyspareunia). Pain during penetration might be caused by involuntary spasms of the muscles of the vaginal wall (vaginismus).
• Sexually transmitted infections. Various sexually transmitted infections can affect the vagina, including chlamydia, gonorrhea, genital warts, syphilis and genital herpes. Signs might include abnormal vaginal discharge or genital sores.
• An infection or change in the normal balance of vaginal yeast and bacteria can cause inflammation of the vagina (vaginitis). Symptoms include vaginal discharge, odor, itching and pain. Common types of vaginitis include bacterial vaginosis, yeast infections and trichomoniasis.
• Pelvic floor relaxation. If the supporting ligaments and connective tissues that hold the uterus in place become weak, the uterus, bladder or rectum might slip down into the vagina (prolapse). As a result, the vagina also is pulled down. This might cause urine leakage during coughing and sneezing.
• Other conditions. Vaginal cysts can cause pain during sex or make it difficult to insert a tampon. Vaginal cancer — which might first appear as vaginal bleeding after menopause or sex — also is a rare possibility.

What are signs or symptoms of vaginal problems?

Consult your doctor if you notice:

• A change in the color, odor or amount of vaginal discharge
• Vaginal redness, itching or irritation
• Vaginal bleeding between periods, after sex or after menopause
• A mass or bulge in your vagina

You might not need to see your doctor every time you have vaginal irritation and discharge, particularly if you’ve been diagnosed with a vaginal yeast infection in the past and you’re experiencing similar signs and symptoms. However, if you choose to use an over-the-counter medication and your symptoms don’t go away, consult your doctor.

What can I do to keep my vagina healthy?
You can take steps to protect your vaginal health and overall health. For example:

• Be sexually responsible. Use condoms or maintain a mutually monogamous relationship with a partner who’s free of sexually transmitted infections. If you use sex toys, clean them after every use.
• Get vaccinated. Vaccinations can protect you from HPV, the virus associated with cervical cancer, as well as hepatitis B — a serious liver infection that can spread through sexual contact.
• Do Kegel exercises. Kegel exercises can help tone your pelvic floor muscles.
• Know your medications. Discuss medication use and possible vaginal side effects with your doctor.
• Limit the amount of alcohol you drink and don’t smoke. Chronic alcohol abuse can impair sexual function. Nicotine might inhibit sexual arousal. Substance abuse might also cause poor physical and mental health, which can affect sexual function.

While not all vaginal problems can be prevented, regular checkups can help ensure that problems affecting your vagina are diagnosed as soon as possible. Don’t let embarrassment prevent you from talking to your doctor about any concerns you might have about your vaginal health.