Answers to FAQs on Vulvar and Perineal Odor

Frederick R. Jelovsek MD

"My question is do you have any suggestions for how women can maintain a "nice flora scent" throughout the day without using douches frequently? Sometimes usually by lunch time 12:00 noon, when I go to use the restroom I notice a mild to moderate urine smell.

I do not currently suffer from a yeast infection, and take acidophillus on a regular basis to maintain a healthy urinary tract and decrease the frequency of yeast infections. I also use a mild soap without dyes or fragrance such as Dove in my genital area to keep it clean and free from irritation."

" I am 31 y.o. and have never had children, currently use Orthotricyclen® as my contraceptive method and have pretty regular menstrual cycles. I take no other meds."
anonymous

Odor is a very difficult medical topic to research. It is not a topic of concern for most physicians. Only rarely does it indicate a disease problem and usually in those cases the disease is caused by a bacterial infection. I really do not know any answer to this specific question other than some of the following observations and data about body odors.

What normally causes odor in the perineal and vaginal area?

Perineal odor is caused by oils in sweat gland secretions, vaginal secretions and urine if a woman is having urine leakage. All sweat gland secretions are basically the same components as urine so it is not uncommon to have a urine "smell" in the vulvar area which is really from sweating rather than from losing urine. Some people would describe urine odor as somewhat like ammonia.

Many of the foods we eat have odorous oils that end up being secreted in sweat. The more fat we ingest, the more oils are secreted. Vegetarians will have less "sweat odor" than meat eaters unless they are consuming a lot of pungent, spicy foods.

Skin bacteria can also react with sweat and produce noxious odors although some scientists question that this occurs to any major degree. It is very likely that some women have different genetic metabolism than others so that they produce different acids in sweat that give distinctive smells.

Finally, sweat glands can be depleted of their oils (temporarily) after they are excreted during sweating. After a vigorous workout, most women and men will tell you that subsequent sweating does not produce as heavy a body odor as when they first broke sweat.

You have probably noticed that yourself if you have been outside working on a hot day and then go shower, subsequent sweating produces less "smell" than it did before the shower. In this case you not only depleted the sweat oils but also reduced the skin bacteria that convert some of the sweat substances to acids and compounds that are odorous.

What about a fishy odor from the perineal area? What causes that?

A fishy odor from the vaginal area can sometimes represent a bacterial vaginosis. In this case the bacteria in the vagina are releasing amines which give a typical fishy smell.

There is also a metabolic syndrome called fish odor syndrome (trimethylaminuria) which is caused by abnormal excretion of trimethylamine in the breath, urine, sweat, saliva and vaginal secretions (4). The trimethylamine is produced by bowel bacteria that break down certain amino acids, carnitine and choline that occur in high concentrations in marine fish, egg yolks, soy beans and liver.

While this is a rare condition, it goes to show that bowel bacteria, skin bacteria and your own genetic metabolism interplay with ingested food to produce body odors beyond normal sweat gland oils and acids.

If you at all think that the perineal odor smells fishy, be sure to see you doctor for a vaginal exam to rule out bacterial vaginosis as well as eliminating liver, fish, soy beans, egg yolks and any nutritional supplements that may contain choline and carnitine.

I have heard of sex odors. How do those play a role?

We still do not know very much about pheromones which are compounds that give a "sexual smell" in both males and females. In women these substances are thought to originate from the vagina but it is more likely that they come from vulvar sweat glands.

What can I do practically about perineal odor? Can I use deodorant sprays?

It is best to try to control body odors by natural means rather than deodorant and antiperspirant cover ups because many women can get an irritant vulvitis from chemicals placed on the vulvar region. This does not happen with all women but does with some. If you think the odor is originating from vaginal secretions, be sure to see your doctor to be checked for bacterial vaginosis rather than using douche solutions. Chronic douching can actually cause a vaginitis.

Other things to do to help:

• have a daily aerobic workout before going to work - this can help dissipate sweat gland compounds and then
• bath or shower before work to remove as much skin bacteria as possible - this will help daytime odors.
• avoid seafood, liver and egg yolks as well as pungent vegetables such as onions, garlic asparagus etc., for awhile to see if this makes any difference.
• minimize stress and any sweating at work if possible - if you feel you have excessive sweating, ask your doctor about medications to help this.

I know of no way to have a "nice floral scent" in the perineal area by altering diet and skin bacteria. You will have to use some type of covering deodorant. Be very careful that you do not develop an irritant vulvitis.

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