What's Normal? Women's Sexual Health Experts Weigh In
Jan 07, 2022 Nicole Levine
When it comes to sexual health, one of the most common questions doctors hear is simply: "What’s normal?"
Whether driven by shyness, fear or squeamishness—they suspect more people have questions than are speaking up and asking. Sexual health experts Dr. Karyn Eilber, Dr. Alexandra Dubinskaya and Dr. Poone Shoureshi shared some of the more frequent questions they’re asked.
"There is a huge variation in what’s 'normal,' and so many people are too embarrassed to ask or don’t know who to ask," Dr. Eilber says. "People feel so ashamed of anything that might be perceived as unusual about their bodies, when 99% of the time, what they’re experiencing is perfectly healthy."
“The more we learn about our own bodies, the better we’re able to tell if there’s something off."
What is my vagina supposed to smell like?
When discussing vaginal scent, Dr. Eilber tells her patients to think about their mouths.
"The mouth is full of bacteria, which is why overnight your breath can start to smell so bad," she says. “We know that’s normal. The vagina is also full of different organisms—mostly bacteria—so it’s also normal for it to have an odor. And there’s no one scent every woman shares."
And none of them are likely to smell like a trip to the cosmetics counter. Scent can change based on many factors: age, exercise, hormonal fluctuations, menstrual cycle, intercourse, lubricants, soap, changes in your microbiome and more. In broad terms, any of these scents might occur:
- A metallic or coppery smell is normal while menstruating or near the start of your period. In women who don’t have a period, it could be a sign of bleeding that should be checked out.
- A slightly sour or tangy smell—like sourdough or yogurt—is a good sign the vagina has a healthy pH level and good bacteria are present. This scent might be more predominant after sex, as semen has a high pH level and can temporarily change the scent of the vagina. This scent can be more predominant after sex.
- A sweet scent—think earthy molasses not cookies—is not unusual due to certain bacteria.
- An ammonia or chemical scent is usually just urine, though sometimes it’s bacterial vaginosis (bacterial overgrowth) and worth having checked out if its persistent.
- A sweaty or even skunky smell isn’t unusual, due to sweat glands near that part of the body.
- A strong and unpleasant fishy odor could be an infection and is reason to consult with your doctor. A rotting, putrid smell is definitely not normal and could mean something is in the vagina—like a forgotten tampon.
When an unusual scent is accompanied by itching or burning, pain, thick discharge or bleeding (unrelated to your period), check with your doctor.
Karyn S. Eilber, MD
Karyn S. Eilber, MD
What kind of discharge is normal?
"Discharge is the rule, not the exception," Dr. Eilber says.
Dr. Dubinskaya adds that, like scent, variation in discharge is to be expected.
"The more we learn about our own bodies, the better we’re able to tell if there’s something off," she says.
Hydration, menstrual cycle, hormones, what kind of birth control you’re using, and age can all affect the quantity, texture and scent of discharge. Certain common medications, like antihistamines, can cause dryness.
There are a few common red flags for infection to keep in mind. Very thick, cottage-cheese-like texture, green color and a strong fishy odor are usually symptoms that warrant a visit to the doctor.
"Any big change with pain or some other symptoms is also worth having checked out," Dr. Shoureshi says.
What’s a normal cleaning routine?
All three doctors emphatically say there’s no reason to clean inside the vagina. It’s a self-cleaning system and introducing soap or other cleansers can disrupt the balance of healthy bacteria by changing the pH. Vaginas tend to be more on the acidic side of the pH scale, and cleaning tends to make them more alkaline, promoting the growth of infection-causing bacteria.
Washing the outside parts of the genitalia is sufficient for good hygiene, including under the hood of the clitoris.
"Not every woman realizes that, like an uncircumcised penis with foreskin, there is skin that must be retracted for cleaning," Dr. Dubinskaya says. "Otherwise, women can develop clitoral phimosis, pain, adhesions and impaired orgasm."
Is pain ever normal during sex?
For some women, some degree of pain can be normal. For example, post-menopausal women who haven’t had penetrative sexual activity in a long time might experience pain when resuming intercourse. In that case, some discomfort, pain or spotting afterwards can be very normal.
"A lot of women get concerned and stop being sexually active because of pain, when in fact one way to treat it is to be sexually active more frequently," Dr. Shoureshi says.
It’s like stretching a tight muscle. At first stretching may hurt, but with time and continued stretching, you can become more flexible.
As estrogen level decreases, that can cause the vagina to lose some of its elasticity—and that can be mitigated through regular sexual activity or the use of vaginal dilators that can be used to gently and gradually stretch the vagina to a functional size.
"You also don’t have to have penetrative vaginal intercourse to be sexually active," Dr. Shoureshi says. "There are other ways to be sexually active, as well."
Again, it’s a matter of knowing your own body. If pain is severe or accompanied by other symptoms, or the pain is unusual for your body—talk with your doctor.
Normalize personal lubricant
"We talk a lot about sexual dysfunction, but there’s less information available about what normal sexual function looks like," Dr. Eilber says.
Many people may have an engaged libido and sex drive, and might feel emotionally and mentally aroused, but their physical response might not be in sync. Hormonal changes, medications, birth control and aging can all affect a woman’s ability to self-lubricate.
Fortunately, personal lubricants are widely available.
"They’re recommended and there have been studies that show women who use personal lubricant during sexual activity experience more pleasure compared to those who don’t," Dr. Dubinskaya says.
Let go of the myths
Healthy human bodies are diverse, varied and come in many shapes, sizes, colors and fragrances. Getting to know your own body, expecting some changes over time, and advocating for your own happiness and pleasure are all positive steps toward embracing sexual health.
Too many people are influenced by what they see in pornography or read in pop culture—which can disconnect them from reality and cause embarrassment over scents and secretions that are completely healthy.
"No amount of eating pineapple is going to make your vagina smell better," Dr. Eilber says.
A more effective prescription than gorging on tropical fruits: Know and embrace your body.