What affects vaginal health?

The vagina is a closed muscular canal that extends from the vulva — the outside of the female genital area — to the neck of the uterus (cervix). Various factors can affect the health of your vagina, including:

• Sex. Unprotected sex can result in a sexually transmitted infection. Forceful sex or an injury to the pelvic area can result in vaginal trauma.
• Certain health conditions or treatments. Conditions, such as endometriosis and pelvic inflammatory disease, might cause painful sex. Scarring from pelvic surgery and certain cancer treatments also can cause painful sex. Use of some antibiotics increases the risk of a vaginal yeast infection.
• Birth control and feminine-hygiene products. Barrier contraceptives, such as condoms, diaphragms and associated spermicide, can cause vaginal irritation. The use of sprays, deodorants or douches may cause irritation or make existing irritation worse.
• Pregnancy and childbirth. If you become pregnant, you'll stop menstruating until after your baby is born. During pregnancy, vaginal discharge often increases. Vaginal tears are relatively common during childbirth. In some cases, an episiotomy — an incision made in the tissue of the vaginal opening during childbirth — is needed. A vaginal delivery can also decrease muscle tone in the vagina.
• Psychological issues. Anxiety and depression can contribute to a low level of arousal and resulting discomfort or pain during sex. Trauma — such as sexual abuse or an initial painful sexual experience — also can lead to pain associated with sex.
• Hormone levels. Changes in your hormone levels can affect your vagina. For example, estrogen production declines after menopause and during breast-feeding. Loss of estrogen can cause the vaginal lining to thin (vaginal atrophy) — making sex painful.