Your Toilet Paper Might Be Behind Your Vulvar irritation

Studies estimate that up to half of women 24 years or younger will experience vulvovaginitis, defined as vaginal discomfort presenting along with itchy skin, abnormal vaginal discharge, dyspareunia (pain with sex) and/or dysuria (pain with urination). These symptoms can arise from bacterial, viral or yeast infections, contact irritation or allergies and can be quite challenging to diagnose because of the wide range of potential causes.

What’s one thing you never would have guessed may be your vulvar discomfort? Toilet paper.

Now before I get into it, it’s important to point that out toilet paper is not the most likely cause of vulvar irritation. More common causes of vulvar irritation include bacterial vaginosis, yeast infections and hormonal deprivation of estrogen or testosterone. However if you’ve seen a provider to rule out these common causes of vulvar and vaginal irritation symptoms like itching, redness, burning, sensitivity and/or tearing with penetration, turning to the products you use day in and day out may be worth your while.

Let’s take a moment to talk about treating the above symptoms with over the counter medications and anti-fungals. A 2002 study by Ferris et. al. found that of 95 women purchasing anti-fungals in a pharmacy for a self diagnosed yeast infection, only ~33% actually had a yeast infection upon testing. This number was no different for those who had previously been positively diagnosed. Positive diagnosis of a yeast infection previously did not improve the individuals ability to self diagnose subsequent symptoms.

So what does this tell us? We are not good at guessing accurate diagnoses when it comes to vulvar irritation. Of the 66% that did not have a yeast infection, testing revealed some had bacterial vaginosis, trichomonas vaginitis, mixed vaginitis and some didn’t test positive for any clear cause of symptoms on testing. Taking medication for vulvar irritation in the absence of an appropriate diagnosis can lead to unnecessary spending and delay in appropriate diagnosis. This goes for folks experiencing UTI like symptoms, too. If you’ve yet to see a provider to rule in or out possible causes of your vulvar irritation and have been treating with over-the-counter medications, the first place we recommend you begin is with your gynecologist.

Ok, let’s get to toilet paper.

A 2010 case study investigated the case of a woman with a 4 year history vulvar irritation that initially came and went but became more consistent with time. She found that her symptoms would improve with over the counter treatment but would return. During her most symptomatic times she reported difficulty walking due to discomfort. Symptoms persisted despite testing negative on vaginal and cervical cultures, but when she traveled to Europe, her symptoms completely abated only to return when she came back home Canada. As she traveled back and forth between Canada and Europe due to illness in the family, she noticed a complete absence of symptoms when she was in Europe and a return of symptoms when arriving back in Canada.

After years of symptoms, she deduced that toilet paper was the culprit. When she traveled to Europe, she used unbleached toilet paper. When she was home in Canada, her toilet paper was bleached. She was able to rid herself of symptoms entirely by switching to unbleached toilet paper when back home in Canada.

Amazing, right?

The researchers working on this case study investigated potential reasons for this connection by reaching out to toilet paper manufacturers in hopes of getting a full list of ingredients from common toilet paper brands. The companies they contacted were uncooperative and the researchers struggled to get a clear list of chemicals used in toilet paper production (shocker, I know). They were, however, able to find that higher quality paper products (typically more absorptive, thicker, whiter) often contain:

• formaldehyde

• chlorine

Thinner, typically cheaper, paper products typically lack these ingredients. These products tend to be thinner, have a brownish tint and are less absorptive.

Here was one of the researchers key takeaways:

"Patients who present with symptoms of chronic vulvovagintis should be clinically assessed for the presence of infection; if laboratory results are negative, physicians should advise patients to use unbleached or minimally processed toilet paper to see if symptoms abate, and to check the chemical content of personal hygiene or household products for possible allergens or contact irritants."

SO! Do we want to start obsessively ruling out products as a first line of defense? Probably not. But if you’re struggling to find answers to your irritation, this is an affordable, relatively simple direction to take your investigation.

Additional products that may be contributing to your vulvar itching, redness and pain:

• Scented wet-wipes: Your vulva is not dirty! Water is enough to clean yourself, but if you need to use wipes, go for something unscented with minimal additives.

• Scented soaps: Again, your vulva does not need scented products. Scented soaps, just like scented wipes, can irritate sensitive vulvar tissue and contribute to reactions that perpetuate discomfort.

• Douches: I have many feelings about vaginal douching. Your vulva isn’t dirty, and your vagina is definitely not dirty. Vaginal douching is harsh on your tissue and entirely unecessary.

• Fragrant sprays: If your vagina smells bad, you need a doctor, not a spray. Healthy vulvas and vaginas have a scent that varies based on diet, where you are in your cycle amongst other factors. But if you’re noticing a fishy or malodorous smell coming from your vulva, this may be a sign of infection. Contact your provider, not Goop.

• Fragrant laundry detergent and softeners: Just like soaps and wipes, scented products used on underwear can cause irritation in vulvovaginal tissue. Switching to an unscented detergent and softener will make for a happier vulva!

If you’re interested in learning more about common chemicals that appear in toilet paper and brands to consider if you want to find chemical free products, check out this blog post by The Filtery.

If you’re experiencing pain with sex, pain with urination, or vulvovaginal itching, pain or discomfort, give us a call. Our team is full of experienced pelvic floor physical therapists skilled in helping folks determine the why behind their pain in order to determine the clearest path towards feeling better. You can give us a call at 512-766-2649 or send us a message here.