Our Concept for Intimate Health

The female genital area

The female genital area is made up of an external and an internal genital area. The external genitalia include the labia minora and majora (5 and 6), the urethral opening (4) and the vulvar vestibule (7). The internal genitalia comprise the vagina (9) and the uterus (10). The bladder (1) also plays an important role when you have symptoms.

Grafik Aufbau Intimbereich (englisch)2

Genital complaints are widespread. Most women have experienced redness, irritation, itching and burning in their genital area at some stage and many women experience these symptoms on a regular basis. Acute problems in the genital area should always be discussed with a gynaecologist. But in order to get a better idea of the problem yourself and to take the appropriate preventive measures it can be really helpful to know the “Whats” and the “Hows” when it comes to your genitalia. If we consider what the genitalia have to do, they have a great number of tasks to “perform”. On the one hand they need to block unwanted pathogens entering the urethra and the vagina. On the other they need to provide the optimum conditions for sperm on fertile days. During pregnancy, then “defence” against intruders is the top priority. But how does it all work? Ideally the external and internal genitalia will be coated in a healthy bacterial flora. This is primarily lactic acid bacteria which – in simple terms – simply by their presence, leave no room for harmful microorganisms. They also promote an acidic pH value which keeps harmful bacteria in particular at bay.

In this way a protective acid mantle with a pH of 5.0 to 5.5 is maintained on your external genitalia (clean water has a pH of 7 on a scale of 1 to 14). The vaginal area (internal genitalia) has a pH of 3.8 to 4.4. During menstruation and around the time of ovulation this value is a little higher, during pregnancy the value is particularly low.

Genital complaints

The following table provides an overview of the most commonly experienced genital complaints. Find out more information on sexually transmitted diseases here.

Causes of vaginal dysbiosis

Many factors can disrupt the vagina’s natural balance and bring about a reduction in lactic acid bacteria, which causes the pH value to increase (over 4.4):

  • Taking antibiotics can also contribute to a reduction in “good” lactic acid bacteria. This gives vaginal fungi more room, and a higher pH value also makes it easier for unwanted bacteria to increase.
  • Excessive and/or incorrect hygiene routines can increase the pH value of the external and internal genitalia and reduce the number of lactic acid bacteria.
  • If your intimate area becomes too moist and warm, this can promote the growth of germs.
  • Hormonal fluctuations, those caused by the contraceptive pill, pregnancy or the menopause, for example, as well as diseases such as diabetes can have a negative impact on the vaginal area.
  • Alkaline bodily fluids such as blood (menstrual bleeding), sperm and post-birth vaginal discharge increase the vaginal pH value.

Symptoms of vaginal dysbiosis

Vaginal dysbiosis often results in a foul-smelling, grey-white discharge and an increased vaginal pH value (> 4.4). The number of pathogenic germs increases while the lactic acid bacteria count drops. Affected women are often completely free of symptoms, however.

Risks/consequences of vaginal dysbiosis

A vaginal pH value of over 4.4 is a sign of vaginal imbalance and lactic acid bacteria deficiency. This increases the risk of bacterial vaginosis and vaginal fungal infections. Particularly during pregnancy, vaginosis is one of the main causes of miscarriage and premature birth.

Vaginal dysbiosis diagnosis/testing

The vaginal pH value can be easily checked at home using an approved pH test.

Treating vaginal dysbiosis

The treatment goal for women experiencing vaginal imbalance is to restore a healthy vaginal environment. A course of lactic acid treatment helps to reduce the vaginal pH value and create ideal conditions for lactic acid bacteria to quickly multiply and once again maintain a low pH value.

Preventing vaginal dysbiosis

In the case of recurrent high pH values, a preventive dose of lactic acid taken every one to two weeks can help maintain the acidification of the vagina. The genitalia should be kept dry and cleansed very sparingly with an acidic (low pH) feminine hygiene wash. See section 11 for a summary of the main preventive Treatments.

Causes of bacterial vaginosis

Vaginosis is a sign of a lack of lactobacilli and results in the spread of unwanted (particularly anaerobic) bacteria. It is caused by the same factors which lead to vaginal imbalance (see section 3).

Symptoms of bacterial vaginosis

The external genitalia are rarely affected. The vagina shows only minor signs of inflammation. Typical symptoms include:

  • Itching or burning of the internal genitalia
  • Increased discharge with a fishy odour
  • pH value > 4.4
  • Pain during intercourse and/or urination

Risks/consequences of bacterial vaginosis

Bacterial vaginosis can result in ascending genital infections. This is where an infection travels counter to the flow of your secretions into your uterus, resulting in secondary diseases such as uterine inflammation, inflammation of the fallopian tubes right through to abscesses of the fallopian tubes and ovaries. During pregnancy, bacterial vaginosis can lead to waters breaking early (P-PROM), miscarriage, premature birth or fever during childbirth.

Bacterial vaginosis diagnosis/testing

Bacterial vaginosis can be reliably diagnosed when at least three of the following findings are made:

  • Homogeneous grey-white discharge
  • pH value > 4.4
  • Fishy-smelling vaginal secretions
  • Microscopic detection of “clue cells” by the doctor

Treating bacterial vaginosis

Treatment should be determined by a doctor and generally involves a complete analysis of the patient’s general condition. The patient’s partner should also be treated to prevent re-infection. A course of lactic acid treatment is a recommended means of relief.

Preventing bacterial vaginosis

A healthy vaginal environment is the key to preventing vaginal infection. A course of lactic acid treatment helps to bolster its natural protective mechanism. Regular pH self-monitoring is a very good way to detect a shift in pH and take active preventive measures yourself, particularly if there is a risk of miscarriage/premature birth caused by infection.

Causes of waters breaking

P-PROM is caused by increased internal pressure or a loosening of the foetal membranes. Both can arise as a result of inflammation due to infection. However anxiety and stress can also bring about premature labour and therefore cause the waters to break. The cervix plays an important role during pregnancy. It prevents ascending infections from penetrating the uterus and also closes off the uterus from the lower genital tract. It is made up of powerful muscles and is around 5 cm long. During pregnancy genetic changes can occur and these could lead to P-PROM.

Symptoms of P-PROM

When your waters break this leads to an outflow of amniotic fluid. The following symptoms are experienced very rarely:

  • Premature labour
  • Fever
  • Increased discharge

Risks/consequences of P-PROM

If your waters break early childbirth can no longer be stopped. It can only be delayed. This depends on the week of pregnancy and the baby’s condition. Once your waters break, this leads to a change in the flora (which progresses slowly if the vagina is healthy, but more quickly in the case of vaginal imbalance) and ultimately inflammation of the foetal membranes.

P-PROM diagnosis/testing

Because amniotic fluid enters the vagina, it can be easily detected using a vaginal pH test (pH value > 6.5). As there is a risk of confusion with urine (pH value between 4.8 and 7.6), vaginal pH in particular must be measured.

Treating P-PROM

P-PROM cannot be treated. Please see your doctor immediately.

Preventing P-PROM

It is very important to take note of risk factors:

  • Infections
  • Changes in the cervix
  • Vaginal imbalance
  • Stress and anxiety

Some of these risk factors can be prevented or at least reduced. Acidifying the vaginal flora is an easy, effective and accepted method. Taking additional care of the external genitalia also helps reduce the number of pathogenic bacteria.

Die Beachtung der Risikofaktoren ist ganz wichtig:

  • Infektionen
  • Veränderungen des Gebärmutterhalses und Muttermund (Zervix)
  • Gestörtes Scheidenmilieu
  • Stress- und Angstsituationen

Einige dieser Risikofaktoren können abgebaut oder zumindest verringert werden. Eine Ansäuerung der Vaginalflora stellt eine einfache und wirkungsvolle sowie verträgliche Methode dar. Durch die zusätzliche Pflege des äußeren Intimbereiches wird die Zahl der krankmachenden Bakterien reduziert.

Causes of fungal disease

Of all the different fungi, it is yeasts (candida) in particular that are most commonly found in the genital area. They are part of the normal human bacterial make-up. They have been shown to constitute over 40% of the gastrointestinal microbiota and up to 20% of the feminine genital microbiota without producing inflammation or any other symptoms. Over 90% of genital infections are caused by the yeast fungus candida albicans. The following factors increase the risk of infection:

  • Diabetes mellitus
  • Treatment with antibiotics
  • High doses of oestrogen
  • Being overweight
  • Excessive and/or incorrect genital hygiene routines

Symptoms of fungal disease

Fungal disease is almost always accompanied by itching. Burning pain can also be experienced if the skin has been badly damaged during a severe infection as a result of scratching and rubbing. Vaginal redness and swelling along with flaky, solid and in extreme cases crumbly yellowish discharge leave little room for confusion. Another very typical symptom is tiny rings of rubbed off pimples.

Risks/consequences of fungal disease

Particularly during pregnancy, the consequences for the newborn cannot be estimated. As it stands, no direct link has been found between fungal disease and premature birth, but secondary conditions for the newborn such as nappy rash and oral thrush can be traced back directly to the birth.

Fungal disease diagnosis/testing

A gynaecologist can diagnose fungal disease by detecting pathogens from the microscopic image and/or culture. One method of detection with antibodies in the vaginal secretions is gaining in importance. The most commonly found fungus, candida albicans, can be identified from the comfort of your own home using a simple self-test.

Treating fungal disease

The course of treatment will depend on the severity of the disease. As fungi are naturally present in the vaginal flora they present no risk to healthy people but can be extremely irritating. They do not always need to be treated, unless the patient experiences symptoms or if they are pregnant. Particularly when the patient experiences symptoms for the first time, they should consult a doctor for advice on the appropriate treatment. The vaginal flora can also be kept healthy using a lactic acid product to restore their natural balance.

Preventing fungal disease

What is important is a good genital hygiene routine, which helps to promote a healthy vaginal area and does not disturb it. As a preventive measure, the vaginal area can be treated with a course of lactic acid to prevent mixed infections caused by bacterial infection and fungi. See section 11 for other preventive Treatments.

Causes of cystitis

Urinary tract infections (UTIs) are among the most common pathogen-induced diseases. Between 50 and 70% of women will experience a UTI at least once in their lifetime and they occur 8 times more frequently in women than in men. This higher incidence in women is down to the female anatomy. Women have a shorter urethra than men and the anus is closer to their genitalia. UTIs are generally caused by pathogens in the woman’s gastrointestinal or vagina flora. The following factors also increase the risk of cystitis:

  • Hormonal fluctuations during pregnancy or menopause
  • Hypothermia
  • Stress
  • Sexual activity
  • Use of vaginal rinses and chemical contraceptives
  • Vaginal imbalance
  • Diabetes mellitus
  • Antibiotics
  • Diseases such as kidney stones, faecal incontinence and urinary tract surgery

Symptoms of cystitis

Depending on the severity of its progression the UTI may be uncomplicated or complicated. Uncomplicated infections may also be symptom-free. However they are often accompanied by a burning sensation or pain when urinating, a frequent urge to urinate (particularly at night) and urine leakage (morning leakage). With complicated infections, inflammation spreads as far up as the kidneys and causes kidney inflammation or inflammation of the renal pelvis. The disease has a severe progression and comes with a high fever, flank pain, blood in the urine and strong symptoms of illness such as nausea, vomiting and chills.

Risks/consequences of cystitis

There is a high risk that an uncomplicated episode of cystitis will lead to a complicated UTI. In the worst case this can lead to kidney failure. Particularly in pregnant women, cystitis is a risk factor for premature birth and developmental disorders in the child.

Cystitis diagnosis/testing

In practice urine test strips are often used to test for bacteria and signs of inflammation. Complicated and recurrent infections, however, require a urine culture to be prepared by a doctor.

Treating cystitis

In many cases the doctor’s recommendation will be a short course of antibiotics, but it may be extended to a more long-term course of treatment with a stay in hospital in the case of complicated UTIs. Whatever the case, patients must make sure they have an adequate fluid intake. The causes of the UTI must also be investigated in more detail and corrected.

Preventing cystitis

The most important preventive measure besides a thorough genital hygiene routine (see section 11) is to ensure your fluid intake is sufficient. During pregnancy, it is useful to regularly check your urine for leukocytes and nitrite, something that also takes place at check-up appointments. This enables the early detection and treatment of an increased bacterial count before symptoms occur and the pregnancy is put in danger.

Causes of vaginal dryness

The sex hormone oestrogen thins your secretions, which helps to keep the mucous membranes moist and protect against pathogens. The vagina often becomes dry as a result of oestrogen levels which are too low. This can occur during menopause, while breastfeeding or after having your ovaries removed. However, psychological problems, stress and an excessive genital hygiene routine can also dry out the vagina.

Symptoms of vaginal dryness

Typical symptoms of vaginal dryness include:

  • Pain during intercourse, possibly with minor bleeding
  • Burning and irritation in the genital area
  • Burning when urinating

Risks/consequences of vaginal dryness

In the long run a vagina that is too dry can leave the mucous membranes more porous and fragile. This increases the risk of fungal and bacterial infections. It also leads to a higher incidence of cystitis.

Vaginal dryness diagnosis/testing

The patient experiences significantly less or hardly any vaginal discharge. It looks pale and has a pH value of over 6 because there are (next to) no lactic acid-producing bacteria present. Vaginal pH can be determined quickly and easily by self-testing. The cause of the low oestrogen levels, however, must be investigated by a doctor.

Treating vaginal dryness

Naturally, the first course of action should be to investigate the causes of the oestrogen deficiency. The necessary remedy can vary as widely as the causes themselves. In cases of slight, temporary vaginal dryness, the vagina can be moistened using a water-based lubricant. Products containing lactic acid and courses of lactic acid treatment can help to restore the natural pH value. If the patient wishes to continue using care products, they should take care to avoid excessive cleansing with soap and aggressive products and select mild products with a low pH value instead. These generally also contain lactic acid.

Preventing vaginal dryness

Regularly checking your pH value and taking a preventive course of lactic acid treatment can help to promote a healthy vaginal area. Additional preventive measures are summarised later on in this document.

In addition to the disease patterns which can lead to vaginal or hormonal imbalance, there is a whole range of sexually transmitted diseases:

Viral diseases:

  • HIV infection and aids
  • Hepatitis B
  • Herpes
  • Genital warts caused by HPV infection

Bacterial diseases:

  • Gonorrhoea
  • Chlamydia
  • Syphilis

Single cell and multicellular parasites:

  • Fungal infection
  • Trichomonad infection
  • Scabies
  • Infestation of crab lice

As ever, the condom is the safest form of protection against sexually transmitted diseases. It cannot, however, protect the unprotected skin of the external genitalia.

When should I go to my doctor?

  • If this is the first time you have experienced symptoms.
  • If medication is not effective after three days.
  • If you are also experiencing fever and/or stomach pains.
  • If you are pregnant.

ELANEE product Solutions

ELANEE solutions fall into three categories: Diagnosis, treatment and prevention.

Acute problems in the genital area should always be discussed with a gynaecologist, particularly if this is the first time you are experiencing them. But with simple home testing kits you can diagnose many of the causes yourself.

The ELANEE Vaginal pH Self Test allows you to reliably measure the most important value of the female genitalia.

Women should check their pH value on a regular basis, particularly if they often experience genital symptoms. If the pH value is too high (over 4.4) they can restore the vagina’s natural balance with a course of lactic acid treatment before an infection develops. This is particularly important for pregnant women, because bacterial vaginosis is responsible for approx. 30 % of miscarriages/premature births. Given that vaginosis can develop within a matter of days, women who have previously experienced a miscarriage or premature birth in particular should check their pH value 2-3 times a week.

If a woman is already experiencing genital symptoms (e.g. burning, itching, discharge), the result of the pH test may give an indication of the possible cause. If the pH value is over 4.4 the cause is most likely bacterial vaginosis (in certain cases, however, it may be a mixed infection also involving vaginal fungi). If it is below this value, symptoms such as itching point more towards vaginal fungi. During pregnancy you can check to see whether there is a leakage of amniotic fluid. This has a pH of between 6.5 and 7. The test must be carried out inside the vagina because taking a measurement outside could lead to confusion with urine. In case of doubt, always consult your midwife or doctor.

Important to know! Not every pH test (e.g. pH test to measure your urine or litmus paper) can be used to measure vaginal pH. A suitable test must be approved for such use and must not introduce any problematic/toxic substances to the body. The ELANEE pH test features a “non-bleeding” indicator which does not leak any of the indicator substances onto the Body.

A fungal infection does not always necessarily entail a higher pH value. Women experiencing symptoms such as itching, burning and redness on the external genitalia as well as white, crumbly discharge can use the ELANEE Test for vaginal fungal infections to test for the yeast fungus candida albicans. This test will detect this most commonly occurring vaginal fungus. By placing the swab into a simple test cartridge you can test your vaginal secretions within 10 minutes from the comfort of your own home. If the test result is positive, you have a fungal infection (candidiasis). This can be treated with antimycotics (antifungal medication). The right form of treatment should be discussed with a doctor beforehand.

Burning while urinating, abdominal pain, frequent urgency to urinate and blood in the urine can also be signs of cystitis. For a quick and easy way to check for cystitis at home, use the ELANEE Urine Control Test5. This test measures five key parameters: glucose (sugar), nitrite, protein (albumin), blood and leukocytes (white blood cells). The result gives an indication of increased inflammation values – as experienced during cystitis – and whether this inflammation was caused by bacteria. Bacteria are verified by the presence of nitrite (a catabolic product of nitrate). The presence of blood in the urine can also be a sign of bacteria. Please see the instructions for use for a more detailed interpretation of the test result.

Treatment for bacterial vaginosis, fungal infections, cystitis etc. should always be prescribed by a doctor. Often antibiotics or antifungal medications (antimyotics) are used which not only reduce the number of “bad” pathogens but also reduce the number of “good” lactic acid-producing bacteria. The “good” bacteria then need to be boosted again after such a treatment.

Reducing the pH value can also be very useful way of treating vaginal imbalance (pH value of over 4.4).
The ELANEE Lactic Acid Treatment is a safe and effective way to make the vagina more acidic (reduce its pH value). It helps to restore and maintain the natural pH value of 3.8 to 4.4. This promotes the natural balance of healthy vaginal flora. The lactic acid gel is applied directly inside the vagina using the individually packed applicators and works for 7 days.

An intimate hydrogel can be a useful way to treat vaginal dryness. The ELANEE Intimate Hydrogel, a medical water-based lubricant, keeps the genital mucous membranes moist and coats them in nourishing panthenol. This helps to prevent vaginal injury and removes any unpleasant symptoms. The ELANEE Intimate Hydrogel is available in a 50 ml tube and can be used like a normal lubricant.

ELANEE Intim-Hydrogel abgenommener Deckel

The ELANEE Intimate Skin Care Cream is a regenerating cream for the external intimate area. The special skin care formula provides dry and irritated skin with moisture and, through its replenishing properties, leaves a pleasant protective layer. The skin remains supple and is protected from natural factors. Shea butter is a vegetable butter which is particularly gentle on the skin, and moisturises and replenishes the skin. It is particularly suitable for the care of dry, irritated skin. High-quality care oils such as avocado oil and lady’s smock oil are particularly well tolerated by sensitive, irritated skin conditions. The Intimate Skin Care Cream contains 20 ml and should be applied to the external intimate area once or several times a day.

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Particularly in pregnant women the vagina can be very acidic and can reach a pH value of 3.8. This low, natural pH value should not be disturbed by excessive washing or using the wrong kind of cleanser. The ELANEE 3.8 pH Intimate Washing Foam has a pH value of 3.8 and produces a white foam through its economical pump dispenser. Containing lactic acid and a blend of well-balanced caring substances, it helps to promote a healthy vagina. The vagina self-cleans by producing a small, barely noticeable amount of discharge. Using vaginal rinse to further cleanse a healthy vagina is not necessary and can actually cause problems.

Regularly checking your vaginal pH value using the ELANEE pH test, particularly during pregnancy, gives you peace of mind and can enable faster intervention. Slight shifts in pH can be treated with the ELANEE Lactic Acid Treatment, which restores the vagina’s natural balance before infections develop. During pregnancy, vaginal care routines should be supplemented by regular urine testing, which is also carried out by midwives and gynaecologists. With the ELANEE Urine Control Test5  you can test the urine for nitrite and leukocytes from the comfort of your own home in addition to your medical Check-ups.

Particular preventive measures

Disturbances of the external genitalia can affect the vaginal area and vice versa. For this reason, it is important to care for the external genitalia in the right way and protect them against harmful influences. See the following table for some tips: