Aunt Vadge: is stress and anxiety affecting my vagina?

Hello Aunt Vadge! 

Can anxiety/stress impact the health of your vaginal? I have been having awful cyclical discharge, itching and pain for the last month and a bit, but have tested negative for thrush and BV. It is making me more anxious and more stressed – and it seems to be getting worse.

Best,
Stressed

Age: 21
Country: Scotland

Dear Stressed,

Yes, stress does impact your vagina, but if the stress and anxiety has come from your vagina misbehaving, then it’s not the same thing. It can make it worse, but it’s important to clarify the distinction between the cause of your vagina problems, versus an exacerbation of your vagina problems (maybe).

The cause of your vagina problems is unclear at this point, but bear in mind that testing for BV and yeast isn’t always very comprehensive and bacteria can still exist that weren’t tested for. If you had a culture done, this means that your vaginal fluid sample was put into a petri dish, fed, and then the lab technicians see what grows the most. This isn’t foolproof, however, because not all microbes will grow in a petri dish – they don’t like it. So, some problem microbes can be missed.

This is why we recommend PCR testing, which looks for microbial DNA, and that can be of even a dead microbe. But, this isn’t foolproof either – you have to tell the lab what you are looking for before it can be tested, so if you are looking for a mysterious problem bacteria, you need a broader test than if you are looking for a yeast species.

Stress, anxiety, and how it affects your vagina

To answer your question much more specifically about stress and anxiety, there is much more below. You’ve brought up a really interesting question that most people don’t know about. That yes, stress does affect your vagina, in a pretty specific way.

This might seem a little complex, but it’s really interesting and I’ll do my best to explain it as simply as I can. This information will be so useful to you across your life, so take your time to understand this and let me know if you don’t understand anything and I’ll try again.

How your hormones affect your vaginal bacteria

Your normal menstrual cycle has different hormones fluctuating to cause different effects. That is, more or less ovulation and your period, which are typically a couple of weeks apart – first you ovulate, then if you don’t get pregnant, you get your period, and the cycle starts all over again.

One of these hormones, oestrogen, stimulates the cells in your vagina and keeps your vagina juicy and functional. As part of oestrogen’s action, it causes your vaginal cells to become higher in a specific sugar, called glycogen. Glycogen you can think of like glucose, but a variation – like we have brown sugar, raw sugar, white sugar, cane sugar, beet sugar, milk sugar, as a loose example.

There are quite a number of different types of sugar in our bodies, and they all have different names. Lactose may be one that you are familiar with – lactose is a form of sugar, found in milk. Glycogen is a form of sugar, but it’s an important type of sugar in your vagina, because it is the very specific form of sugar that feeds your good bacteria.

Just like animals, bacteria prefer, and require, specific types of food, and some can’t live without certain foods. For example a cow can survive on grains or hay, prefers green grass, but doesn’t have a digestive system set up to digest chicken, and vice versa for a wolf. Bacteria can only digest certain types of sugar, and one of the only sugars that your good vaginal bacteria – lactobacilli – can eat is glycogen.

You have an enzyme in your vagina – in fact the same one that is in saliva – that breaks these sugars into smaller parts so that the lactobacilli can actually eat them. Predigestion, you might say. This is the same way that a parent may chop up a toddler’s food into bite-sized pieces, and also what happens when we chew.

This oestrogen-makes-glycogen-and-then-your-enzymes-make-tiny-glycogen-bitties process is how your very specific vaginal microbes, your lactobacilli, are fed and kept happy. Other bacteria can and do prefer other types of sugars. Some bad vaginal bacteria can use the other types of sugars found in your vagina to survive, and take over when your lactobacilli are down and out.

This means that if your hormones are interfered with in any way – oestrogen – this source of sugar for your good bacteria is gone, and they starve. This leaves other bacteria free to enjoy the other forms of sugar in your vaginal tissues, and can result in low lactobacilli and high numbers of unfriendly bacteria. Enter stage left vagina problems.

Now to the anxiety and stress part

Anxiety and stress cause your body to produce adrenaline and cortisol. These are your stress hormones, and they make you feel those classic stress and anxiety feelings. Your heart might beat faster, you may have trouble sleeping, you may feel really anxious about just about anything you think of, and generally feel a bit off and tightly wound. This feels bad when it happens all the time, but those stress feelings are due to those specific hormones – adrenaline and cortisol – flooding around your body and brain.

If you take away the adrenaline and cortisol, you do not feel stressed or anxious. If you add in nice relaxing hormones, you feel good. A good example of this switch is in the morning, your body will squirt out a bunch of cortisol to wake you up and keep you going throughout the day. Then at night, your body squirts out some melatonin, which puts you to sleep. We are run off a set of hormone systems that tell us what to do and when.

The effect of adrenaline and cortisol on your body are numerous. They essentially block most of your body functions from working properly, because your body is preparing for action: fight or flight, which I’m sure you’ve heard of.

That is, your energy levels go up and you are alert and ready. When this happens about something that is stressful, but you aren’t going to run away or have a fight with, we just feel stressed and anxious and it doesn’t really seem to go away. This is school, work, relationships, family, moving house, travel. Not a bear chasing after us, being attacked, or other immediately stressful situations where our safety is under threat, but just life stuff.

Exciting things have the exact same effect on us – excitement and anxiety are basically the same thing, but excitement is associated with something fun or nerve-wracking in a good way, whereas negative feelings or situations can cause what we know of as anxiety. Think of the times you’ve been so excited you couldn’t sleep – same as being so stressed you can’t sleep.

It’s good to know this just because it helps you to understand that you are a creature, an animal, that is run off a series of systems. One of those systems kicks in when we are stressed, to help us through a stressful time. In our lives now, however, we are often stressed and anxious for long periods of time, when actually the point of this stress system is to give us superpowers when we need them, like to lift a car off a trapped person or stay up all night searching for a lost child or to run away from someone who is trying to rob you.

This means that our body is shutting down other systems to support the stress and anxiety. The first things you’ll start to notice if you are stressed is that your digestion isn’t working that well – you might lose your appetite or have increased appetite, you may have diarrhoea or your bowel may act up in some way.

You’ll have interrupted sleep, which makes everything worse because then you end up tired. You may get colds and flus more easily, because all your body’s resources are going into your stress system, instead of your immune system.

This diversion of resources weakens you over time. This is why chronic stress makes people sick – everything else just sort of stops working properly, and what this looks like over longer periods of time is getting sick. The way you get sick from stress will differ to someone else, but you will start to learn where your weak spots are.

One of your weak spots might be your vagina – your stress hormones start to block glycogen production in the vagina and your good bacteria starve. Your good bacteria can survive for a little while, but if you stay stressed, your good bacteria may start to die off. They are then replaced by other bacteria, which are likely to not be quite as friendly.

Cyclic vagina problems

You said in your letter that your problems were cyclic, but then say that they have been there for about six weeks. I’m not sure if that means your vagina problems are coming and going, but here’s that info anyway.

Cyclic vagina problems are linked with hormones. As your hormones change throughout your cycle, your vaginal flora changes – some kinds of bacteria get more food, say, when you ovulate, as there is a lot of oestrogen around. These bacteria then change when your hormone levels drop off during your period, when symptoms like bad smells or uncomfortable symptoms like itching or soreness can start to appear. These symptoms might go away when you don’t have your period, or pop up sometimes out of the blue mid-cycle.

It’s difficult to know what is happening in your vagina by your letter, but to answer your question, yes, stress and anxiety definitely affect your vagina (and the rest of you).

Learning how to reduce stress hormone levels to keep your good bacteria fed

Learning how to manage your stress and anxiety (read: lower your adrenaline and cortisol levels) will be one of the most important things you ever learn how to do. There are scientifically proven ways to do this that are free, and you can do yourself. These include learning how to meditate/mindfulness, gentle exercise (yoga, stretching, a walk around the block, cranking up the stereo and dancing to your favourites), singing, drawing, cooking, whatever. You’ll find the things that relax your brain and body.

There are also things you can take to help manage anxiety, since there usually isn’t just one reason for it, though there can be. You may be low in B vitamins, you may not be eating enough protein, you may not be eating enough food or the right kinds of food to support your brain. I am unsure if your vagina problems are in fact being made worse by stress, but it certainly doesn’t help. I can’t tell by your letter if you are already stressed and anxious, prior to these vagina problems, so I’ve tried to cover all bases here.

If you have a naturopath or herbalist around, and can afford to, they can take a look at your diet and what else you get up to in a day to see if there are any simple things you can do to change your response to stressful things in your life and help solve your vagina problems.

To help figure out what your vagina is doing, you may also like to get yourself some pH strips so that you can see where your vagina is at each day. You want the strips that have the full range, or at least between 3 and 8. You want the result to be between 3.5 and 4.5. Your pH will change across the month, so keep a record and see what is going on. Here’s how to test your vaginal pH at home. 

Here are some tips for clearing up an uninfected smelly vagina, for the meantime. There is plenty you can do, but you need to be sure it’s not something more serious – untreated infections can cause horrible problems, which you do not want! You may want to ask for a copy of your test results, so you can see which sort of test was done, and what the results were.

Let me know if you need anything else.

Warmest regards,
Aunt Vadge

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
Read more about Jessica and My Vagina's origin story.