Please don’t take gynecological advice from Khloe Kardashian

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The latest celebrity to use the internet like a a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down.

But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office and threats of Russian espionage, so here we are.

“Strengthening tissue,” what Khloe claims vitamin E will do, is one of those quasi-medical terms often favored by those selling quack cures and supplements. I’m going to guess she means less likely to tear with penetration. Here’s some advice: If your vagina is tearing during sex you have a medical problem and should go to a board-certified gynecologist. If your vagina is fine and sex feels good, then leave it alone.

Healthy vaginal tissue will not tear unless is treated inappropriately, for example, sex with no foreplay or lube. This is because it has evolved to stretch. It’s also designed to withstand friction, because procreation involves friction.

The following image from this review paper is a visual nice summary:

f2-large

The vaginal mucosa (lining) has a protective layer of mucous and lactobacilli (good bacteria). The lactobacilli lower the pH and produce hydrogen peroxide, which actually kills harmful bacteria. The effect of vitamin E on this bacteria or the mucus is unknown.

See all those purple rectangles and squares? Those are the cells of the vagina mucosa (see the picture below for what they really look like under a microscope), layers of specialized skin cells that line the vagina and the layer directly underneath the mucus. I had a histology professor who used to say, “It looks so rough, but it feels so smooth.” Hey, mucus is our friend!

vagina__1__example_1__1_25

Anyway, there are lots of layers because during sex the friction can rub off several of the top rows. If that were your knee, you’d have an abrasion, but because this is the vagina there are redundant layers for protection and as soon as the top layers are rubbed off more are produced (it’s a bit like shark’s teeth being constantly replaced, no dentate vagina jokes intended). The effect of vitamin E of cell turnover in this layer is unknown.

The skin cells are also filled with glycogen which makes them plump, providing more cushion. The glycogen breaks down when the cells are shed and feeds the lactobacilli. We don’t know how vitamin E can affect that either.

Basically, it’s a well-functioning ecosystem.

Estrogen is the fuel that drives the vaginal epithelium-glycogen-lactobacilli complex and without it the layers of epithelium thin out, new cells are produced at a slower rate, and they have less glycogen (the prepubertal and postmenopausal images above). The vaginal mucosa becomes more fragile and can tear with minor contact. Other things that can lead to vaginal tearing are chronic yeast infections, skin conditions, and spasm of the levator ani muscles that surround the vagina (this causes a smaller vaginal opening so more trauma on contact with penetration).

There is one small study looking at a compound with vitamin E mixed with hyaluronic acid and vitamin A in menopausal women, but it’s a low-quality study. Some studies support vitamin E to protect the vulva against radiation injury during cancer treatment, but that cannot be extrapolated to health maintenance for women of reproductive age. It would be like saying you are going to apply sunscreen to prevent a sunburn so you will also put it on your hands, so you don’t get burned taking a pan out of a hot oven.

Okay you say, there is no evidence that vitamin E will make vaginal tissue healthier, but I’m willing to assume unknown effects on my good bacteria because I like how it feels. It is an oil so if that’s what you like to use as an external moisturizer or as a lube for sex, stick with coconut oil or olive oil. This is because studies suggest that vitamin E supplementation increases all-cause mortality. The skin a and vagina are both very efficient ways to absorb a variety compounds, so how much be absorbed if you are “slathering” it everywhere as recommended by Ms. Kardashian recommends? Right.

It is important to remember that antioxidants could easily have negative effects, such as promoting the growth of cancer cells. Vitamin E doesn’t know which cell is healthy and which is cancer. What could this do to a cell infected with the human papilloma virus? What if removing free radicals is preferentially better for a cell infected with high-risk HPV?

Megadoses of vitamins are gradually proving to be a big bust. Just because something is found in nature doesn’t make it safe, for example, we need oxygen to live but pure.oxygen can be highly damaging to the lungs. Slathering something associated with an increase in all-cause mortality all over your body isn’t advisable.

It’s best to eat your vitamins in food.

If you don’t have, any vagina issues don’t create them by taking advice from a Kardashian.

If you vagina hurts or you have pain with sex, see a gynecologist.

Khloe Kardashian may not give good gynecological advice, but she is without a doubt a PR genius.

Jennifer Gunter is an obstetrician-gynecologist and author of the Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

Image credit: Shutterstock.com

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