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Boxers, Briefs And Bacterial Vaginosis: How Your Underwear Can Affect Your Health

Thongs, briefs, long johns, g-string, boxers, trunks: there's a bewildering array of undies out there. But which ones are best for the health of your nether regions?

Well, the style of underwear you choose is less important than the material it is made of. Natural fibres such as cotton are far better for the skin, especially the sensitive areas around the genitals, where breathability of the garment is important.

But, even if your pants drawer is full of cotton briefs, you'll still need to be wary of fit, dyes and dirt. Here's what women and men need to know about the links between their underwear and their health.

For those who have one, it's important to remember the vagina is a self-cleaning organ. It produces up to 5ml of fluid per day and has a balanced microflora consisting of many different bacteria – although it's typically dominated by those of the lactobacillus genus.

These bacteria produce lactic acid which ensures the vagina maintains the correct, typically slightly acidic, pH, reducing the risk of infection.

There's limited research on how underwear style might impact vaginal health. The most notable study, though, found that thong-wearers were more likely to report urinary tract infections (UTIs), vaginal yeast infections and bacterial vaginosis.

However, it may not be the thong itself that causes infection: in the study, UTIs were associated with oral sex and bacterial vaginosis was linked to non-cotton crotch underwear.

Bacterial vaginosis is a dysbiosis – a bacterial imbalance – in the vagina that can be caused by non-breathable underwear. Synthetic fibres, and the dyes used to colour them, can alter the conditions of the vagina leading to a sub-optimal conditions for good bacteria (such as lactobacilli) to exist.

Synthetic, dyed underwear can cause pH levels to increase to over 4.5 allowing anaerobic bacteria to thrive and lactobacilli to perish. These conditions can lead to bacterial vaginosis, or an increase in the growth of fungi such as candida albicans, causing thrush.

However, it seems that wearing tight-fitting clothing, including underwear, over time may increase candida levels in the groin.

Underwear that is too tight fitting can also cause friction and irritation around the genitals. This can result in anything from skin tags (which may look like genital warts depending on their location), ingrown hairs and blisters.

Forget the budgie-smugglers

In men, the testes are the primary site of sperm production. They hang away from the body to achieve a 2°C-4°C cooler environment. Testicular temperature is so important that the body has its own means – the pampiniform plexus – to cool the arterial blood as it flows into the testes.

There is scant research on the exact effect of underwear type on sperm quality and quantity. However, research found that those who reported frequent wearing of boxer shorts had a higher sperm concentration than those who wore other types of underwear. Boxers, also demonstrated and maintained a reduced scrotal temperature.

There's also research to show that increased scrotal temperatures in men from a variety of contexts and occupations, resulted in marked reduction in sperm count for weeks. Thankfully, in most settings sperm count is recoverable.

The impact across a number of weeks is likely because it takes approximately 74 days for a sperm to be born and reach maturity with ability to exit the body, and temperature can affect sperm at any point in its journey.

However, men who undergo vasectomy are advised to wear tight fitting underwear for at least 48 hours and up to seven days post-operation. The tight fit helps support the testes, reducing their movement and the strain on the very thin layers of fascia and muscles that cover the testes. Movement results in pain, as well as a risk of opening any wounds, and increases the chances of infection.

Keep it clean

Cleanliness of the body and the underwear is essential for everyone. Research shows that even clean underwear can contain 0.1b-10g of faecal matter, and those bacteria have the potential to make you ill.

Avoid brightly coloured underwear, choose natural fabrics and wash them regularly to keep your genitals happy. DenisProduction.Com/Shutterstock

Cleaning the skin, as well as your underwear, reduces the potential for fungal infections too, such as tinea cruis, sometimes known as jock itch.

This red or brown itchy rash is four times more common in men than women. Athletes typically present with fungal infections in their groin from increased heat and sweat generated while exercising. Sportsmen tend to develop the infection along the crease between the scrotum and thigh because of the tight-fitting underwear worn during contact sports.

You can go commando – but take care with zips

Foregoing the barrier underwear creates between sensitive areas can actually be beneficial. Going commando enables air to circulate, allowing secretions to dry naturally, reducing the moist conditions that can contribute to infections.

The main risk of going underwear-free seems to be for men who're careless with trouser fastenings. Injuries from zip fastenings almost always involve men damaging their penis or scrotum.

So, picking natural, breathable fabrics – and perhaps button-fastenings – are best for health down there. And always remember, if something doesn't look or smell right it is best to get it checked out.

Ask The Doctor: How Long After Stopping Family Planning Will I Get Pregnant?

I have been using family planning, including implants and injections for five years but want to stop. How long after stopping will I be able to get pregnant? Edith 

Although a number of women expect to get pregnant immediately after the removal of contraceptive implants and/or stopping to use contraceptive injections, the time taken may vary from woman to woman with some never getting pregnant at all.

Usually, when a woman stops using contraception, they are older and in this case, older age and its associated effects such as fibroids may delay a woman's chances of getting pregnant.

Many Ugandan women also fear pregnancy more than Sexually Transmitted Infections (STIs) and HIV infection so that while using contraception (it is only condom contraceptive that protects against both pregnancy STIs and HIV), they engage in unprotected sex much more, risking STIs that may not only delay but stop pregnancy altogether. 

The contraceptive implant referred to as Nexplanon used most nowadays is a small matchstick-like plastic rod that is placed under the skin of the upper arm where it releases the hormone progestogen to prevent pregnancy. 

Since the implant releases small, continuous amounts of hormone into the body for three years, once removed, the body immediately goes back to its original fertility range with a woman then getting pregnant immediately or as early as one week after removing the implant. 

After using contraceptive injections (effective for three months), some hormone still remains in the body. Because of this, fertility may take longer to return with affected women taking anywhere from six months to two years to get pregnant after stopping the contraception.

It is difficult to know how long you might take to get pregnant since you kept mixing different types of contraceptives apart from the other factors mentioned above coming into play. 

What causes an itchy vagina before a period?

When my period is about to start, my private parts itch a lot. I was advised by a nurse to put yoghurt in my privates to stop it. Is this okay? Eunice

Many women before, during or after their periods may suffer vaginal itching due to period-related  female hormone changes, a yeast infection, bacterial vaginosis infection or an allergic reaction to say, pads.

Candida, a common cause of vaginal itching, naturally occurs in the vaginal canal in low numbers. Reduced activity due to the presence of useful bacteria (lactobacilli), which create an acidic environment to limit the growth of candida and other germs including those that cause a fish-like smelling vaginal discharge (bacterial vaginosis).

It is envisaged that the destruction of lactobacilli bacteria and other normally vaginal canal occurring bacteria and overgrowth of candida here could be the cause of itching, requiring to apply yoghurt (because it has a type of lactobacillus) to reintroduce the lactobacilli.

Since there are numerous causes of vaginal itching, it is important to see your doctor who will investigate the cause of your itching before properly dealing with it to stem the itching. If the cause is overgrowth of candida, drugs that can be prescribed. These are more effective than using yoghurt, which may end up irritating the vaginal canal and cause worse symptoms.

I sweat too much and when this happens, I develop an uncontrollable odour. Sometimes, someone will know I have been to a certain place since this odour lingers. What can I do to stop it? Anonymous

Sweat itself has substances which do not cause it to smell. However, sweat may smell when left on the skin where the contained substances are broken down by skin germs, especially bacteria, resulting in body odour.

Therefore, the more one sweats the more the likelihood of the body getting the odour. This may be the reason why when you sweat a lot you experience the body odour more.

Whereas one may sweat a lot without a known cause (Primary hyperhidrosis, which is believed to be due to faulty nerve signals to the sweat glands) with the palms, soles and sometimes the face being affected, some people may sweat say all over the body due to certain causes (secondary hyperhidrosis).

This secondary hyperhidrosis may be due to conditions including infections, diabetes, menopause, thyroid problems, some cancers and use of drugs such as pain relievers.

Washing and drying the body often and properly, shaving hair in areas such as the armpits and using antiperspirants can all help minimise body odour.

If these measures do not help, then seeing one's doctor could be more important.

Is It Normal For Menstrual Blood To Have A Bad Odour?

Should periods be smelly or not?

Menstrual blood typically has a similar smell from month to month, but if you notice a terrible smell during your cycle, it could indicate something is wrong, especially since vaginal odours can indicate infection.

Period blood smells metallic due to the iron and copper content in the blood mixed with vaginal bacteria.

Why menstrual blood might have a bad odour

1. Menstrual products stay too long

Menstrual products can produce unpleasant scents if kept in or on for a long time. You should change them every eight hours, twelve hours, or twelve hours, depending on your preference. This can eliminate undesirable smells and lower the risk of urinary tract infections, sexually transmitted diseases, and toxic shock syndrome (a rare, life-threatening complication of certain bacterial infections).

2. Excess sweating

Excessive sweating during menstruation can also result in an mixture of salt, fat, and bacteria in the vagina. To treat this, gently wash your vulva with warm water and mild soap, then apply a soft cleanser free of scents. It is crucial to realise that STIs do not necessarily accompany an aroma or visible symptoms.

3. Changes in the vaginal microbiome

The menstrual cycle can produce unusual smells due to the combination of vaginal mucus and endometrial cells in the blood.

If your vaginal microbiome changes include douching, smoking, hormonal changes caused by pregnancy or menopause, and sexually transmitted infections.

To treat this, practice appropriate vaginal hygiene like bathing your vulva with warm water every day and after sex, wearing breathable cotton pants, washing new pants before use, and avoiding douching and scratching.

4. Bacterial vaginosis (BV)

It is the most prevalent cause of vaginal odour, resulting in a fishy scent that might mingle with blood during the period. Symptoms include burning, green, grey, or white discharge, and severe itching. You should see a doctor for medical treatment if you notice this.

5. Sexually transmitted infections (STIs)

Trichomoniasis, chlamydia, and gonorrhoea are examples of sexually transmitted illnesses (STIs) that have a foul odour and peculiar discharge, when mixed with menstrual blood, the smell can be bad. These symptoms last beyond menstruation and may include strangely coloured discharge, vaginal bleeding, abdominal pain, and itching or burning.

In conclusion, it is a red flag for your menstrual blood to have a smelly menstrual odour and you should check it

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