Jamie (body-focused therapist) explains how recurring vaginal infections may cause your pelvic floor to be tensed, and how you can get out of this step by step. 

Have you had a yeast infection or bacterial vaginosis more than once? Then you probably know the itching, the burning feeling, and the stinging pain when you pee. What's much less known is what all that itching and pain does to your pelvic floor.

In my practice, I regularly see women who develop vaginismus after months, sometimes years, of recurring infections. It's called secondary vaginismus: sex used to be fine, but somewhere along the way your body locked up.

Your pelvis braces itself

When you have itching and pain around your vagina, your pelvic floor responds with tension. That's a logical, physical reaction, not something you consciously choose.

After a single infection, that tension usually fades once the symptoms are gone. But when the infection keeps coming back, your pelvic floor never really gets the chance to relax, and your muscles stay a little bit 'on guard.'

Give your body time to settle

Once the infection has been treated and everything feels okay again, you often want to pick up where you left off. Having sex again as if nothing happened, and leaving that annoying infection behind you. Completely understandable, but if your pelvic floor is still tense from the whole ordeal, penetrative sex can suddenly hurt.

Never push through pain, but give your body the time it needs. You can also actively help your body release that tension after a yeast infection with specific yoga exercises.

Why the order of your exercises matters

If you're using yoga to support your pelvic health, do the exercises in a fixed order. Each pose has its own job, and they build on one another.

1. Liberate. You start by relaxing and mobilizing the joints in your pelvic area,
hips and lower back. Everything in your body works together, and your pelvic
floor needs the joints around it to be able to fully relax.

2. Release. Next, you loosen knots and trigger points in your hip muscles. Your
hips and pelvic floor work closely together. Your pelvic floor helps stabilize
your hips, and part of your hips actually belongs to your pelvic area. If your
hips are tight, there's no way around this step.

3. Unfold. Finally, you work on the flexibility and strength of your vagina and
the pelvic floor muscles around it. Only once the surrounding area has softened
does your pelvic floor get the space to give.

The exercises

1. Liberate: butterfly

Lie on your back, bring the soles of your feet together and let your knees fall open. Feel free to place two pillows, books or yoga blocks underneath for support. This pose loosens up your inner thighs, hips and pelvic floor.

Breathe in slowly and let your belly rise naturally as the air flows in. Imagine your vagina gently floating or melting. Keep your attention on the relaxing sensations and feel how your pelvic area slowly opens. Notice if you're still clenching or holding on somewhere? Let it go.

2. Release: high five hip flexor

Start kneeling on both knees, with pillows underneath if that's more comfortable. Bring one knee gently further back and let your hips and glutes move slightly forward. You'll feel the stretch at the front of your hip. Hold, then switch sides.

3. Unfold: child's pose

Spread your knees and feet gently apart. Lower your upper body and stretch your arms out in front of you, relaxed. Relax your shoulders, head and chest, and let your hips sink back toward your heels.

With every inhale, let your belly gently drop down. See if you can feel your anus, vagina and pelvic floor slowly blossoming with each breath. Take your time. Your body is allowed to soften.

How to approach it

Hold each pose for 90 to 180 seconds and repeat the whole sequence three times. Four or five times a week is enough, you don't need to do it every day.

Go slowly. Don't force anything. A mild stretch is all you need. If an exercise hurts, stop.

During each pose, bring your attention to your anus, vagina and entire pelvic floor. Try to feel them melting rather than clenching them together. As if you're letting a grape fall out of your vagina. Sounds strange, works well.

If you're in the middle of an infection right now, wait until the symptoms are gone and your tissue has had a chance to recover.

And if it doesn't go away?

Is sex still painful, even once the infections are under control? Then you're not broken, and you don't have to learn to live with it. Your body is stuck in a protective response, but it can always let that go again too.

For more information: visit @healingpainful.sex ¹

Have you ever started a new contraceptive and suddenly felt like your vagina was behaving differently?

Maybe your discharge changed, the smell changed, your period became lighter, or you suddenly seemed to get one vaginal infection after another. So is it possible that contraception influences your vaginal microbiome, or is it just a coincidence?

The short answer is: possibly, but it depends on several factors.

First of all, your vagina has its own microbiome, a little ecosystem of bacteria, including bacteria that help keep your vagina healthy. In many women, one form of bacteria are dominant that help maintain an acidic vaginal environment, which makes it harder for potentially harmful bacteria to overgrow. When this balance is disturbed, for example through changes in the body or hormonal changes associated with (hormonal) contraception, you may be more susceptible to problems such as bacterial vaginosis (BV).

Some studies show that, particularly during the first few months of starting a new hormonal contraceptive, such as the hormonal pill or hormonal IUD, there can be a temporary increase in vaginal infections or BV, with rates increasing around six weeks after starting. Over time, this tends to decrease again. However, other changes that can come with starting a new contraceptive, such as changes in sexual behaviour or condom use, can also influence the vaginal microbiome and may therefore contribute to this temporary increase in infections and BV.

At the same time, the longer-term picture can look different. Not all hormonal contraceptives contain the same hormones, doses or delivery methods. In long-term studies, many hormonal contraceptives, such as the combined pill, have actually been associated with a vaginal environment that contains more protective bacteria and fewer bacteria associated with BV. Research has also found an overall lower risk of BV among long-term hormonal contraceptive users. In contrast, studies have found a higher risk of BV among users of the non-hormonal copper IUD, which has been associated with changes in the vaginal microbiome, including fewer protective bacteria.

Recent reviews emphasise that we still don't fully understand how each individual contraceptive method interacts with the vaginal microbiome.

So if your vaginal health seems a little different after starting contraception, it doesn't automatically mean that something is wrong. Your vaginal environment is dynamic, and it can take some time to adjust to hormonal and other changes.

There isn't one contraceptive method that is universally “best” for your vaginal microbiome.

Research is still evolving and other factors, such as sexual behaviour, also influence your vaginal microbiome. What we do know is that the relationship between contraception and the vaginal microbiome depends on the method, and the individual.

If you notice persistent changes in discharge, a strong or unusual smell, itching, burning or discomfort, it's a good idea to get tested. BV, STIs, and other type of infections can have overlapping symptoms, so testing is often more useful and accurate than trying to diagnose the cause yourself.

Let’s talk about something we don’t talk about enough: herpes.
For something that is so common, herpes carries a surprising amount of shame. Saying “I have a cold sore” usually doesn’t cause much of a reaction. But saying “I have genital herpes” can feel like a very different conversation. One filled with embarrassment, fear of rejection and questions about what someone might think of you.

But medically, herpes is a virus, much like having a cold. It’s something your body can carry, sometimes without symptoms, and it doesn’t define who you are.

There are two main types of herpes simplex virus (HSV): HSV-1 and HSV-2. HSV-1 is often associated with cold sores, while HSV-2 is more commonly associated with genital herpes. But the line between the two isn’t as clear as we might think: both types can cause genital herpes, for example, through oral sex. And herpes is very common. The World Health Organization estimates that around 64% of people under 50 worldwide have HSV-1. Around 520 million people aged 15–49 are living with HSV-2. Many people don’t even know they have it because they have no symptoms or only very mild ones. Some people experience herpes outbreaks frequently, while others might never experience one or may only have one or two in their lifetime. So, if so many people have it, why does it still feel like such a big secret, and how did this secret occur?

How did the stigma start?

Herpes has been around for thousands of years, and until the 1970s, it was often considered a relatively minor and common infection. As societies began to talk more about sexually transmitted infections, these infections became increasingly connected to ideas about sex, morality and personal responsibility. Having an STI was often seen as evidence of being promiscuous, irresponsible or “dirty”, rather than simply having an infection.

Herpes became part of this conversation because it could be transmitted through sexual contact and, unlike some other common infections, remains in the body for life. The fact that it can be passed on without visible symptoms can also make people feel as though they have something to hide.

The way herpes was talked about in the 1970s and 1980s reinforced these ideas. Around the same time, the first effective antiviral treatment, acyclovir, was developed and introduced as Zovirax. Pharmaceutical advertising and media coverage brought genital herpes more into the public spotlight, often emphasising its recurrent and lifelong nature and its potential impact on relationships and sex. This did not create the stigma on its own, but it helped amplify fears and associations that were already there.

So the stigma surrounding herpes is mostly a reflection of the way we have learned to think and talk about sex, STIs and morality.

So why does the stigma still exist?

A big part of the answer is probably the words “sexually transmitted.” Once herpes becomes associated with sex, it can also become associated with ideas about being promiscuous, irresponsible or “dirty”. Suddenly, a virus becomes a judgement about the person who has it. We don’t usually question someone’s character when they have a cold sore. But when the same family of viruses is found genitally, the conversation can become completely different. The virus hasn’t changed. The meaning we attach to it has.

Research has linked herpes stigma with shame, anxiety, fear of rejection and difficulties talking about it with partners. For some people, the psychological impact can be more difficult than the physical symptoms themselves. Of course, herpes should still be taken seriously. It can cause painful outbreaks and can be transmitted even when there are no visible symptoms. But there is a difference between taking a virus seriously and being ashamed of having it. Having herpes doesn’t tell us anything about someone’s hygiene, morals, number of sexual partners or worth. It tells us one thing: they have a very common virus.
It’s time we stopped treating herpes like a secret and started talking about it like what it actually is. Herpes is a virus. The shame around it is something we created, and something we can change.

You just got through it, or thought you did, and then the itching is back. Sounds familiar? You are absolutely not the only one. Up to 75% of women will experience a vaginal yeast infection at least once in their lifetime, and for some of them, it keeps coming back. In this article we explain what's actually happening in your body, where the symptoms come from, and why some women just can't seem to shake it.

What is a vaginal yeast infection, exactly?

A fungus called Candida naturally lives in and around your vagina. That's normal and usually harmless, because the good bacteria in your vaginal flora keep its growth in check. When that balance is disrupted, Candida can multiply out of control. That's what we call a yeast infection, or in medical terms: vulvovaginal candidiasis.

In 85 to 95% of cases, the species Candida albicans is the culprit. But there are other Candida species too, such as Candida glabrata, Candida krusei, and Candida tropicalis. These so-called non-albicans species are becoming more common and are harder to recognize and treat, because they respond less well to standard medication.

The symptoms

The most common signs of a yeast infection are:

• Itching or a burning sensation in and around your vagina
• Thick, white discharge that resembles cottage cheese
• Redness and swelling of the labia
• A burning feeling when you pee
• Pain during sex

Itching is the most characteristic symptom, present in about 90% of women with symptoms. Important to know: not every woman with Candida in her vagina notices anything at all. Especially with non-albicans species, colonization without symptoms is fairly common.

What causes it

A number of factors can disrupt the balance of your vaginal flora and increase the risk of a yeast infection:

• Antibiotic use. Antibiotics don't just kill the bacteria making you sick, they also kill the good bacteria in your vagina that normally keep Candida in check.
• Hormonal changes. Pregnancy, the birth control pill, and even the normal fluctuations of your cycle can affect the balance. Symptoms are more common during the luteal phase of your cycle, when estrogen and progesterone are higher.
• Diabetes. With poorly regulated blood sugar, your urine (and possibly your vaginal tissue) contains more sugar, which feeds Candida growth.
• A weakened immune system. This makes you more susceptible to Candida overgrowth.
• Tight, non-breathable clothing, staying in wet clothes too long, or scented products used around your vagina.

Why it keeps coming back for some women

Doctors define a recurrent yeast infection as three or more symptomatic episodes per year. Why can't some women get rid of it for good? A few explanations from the research:

• Maintenance treatment isn't always enough. Maintenance fluconazole improves quality of life for 96% of women, but is not always durable: one study found that more than 63% of women still had an ongoing infection after completing maintenance therapy.
• Self-diagnosis is harder than it looks. The symptoms of a yeast infection overlap heavily with other causes of vaginal complaints. Research shows that only a portion of women who self-treat for a presumed yeast infection actually have one. That means some women may be using the wrong remedy, while the actual cause of their symptoms goes untreated.
• Candida doesn't only live in the vagina, it's also found in the gut. Standard vaginal treatments work locally and don't address a possible overgrowth in the gut. If that overgrowth is present, it can keep causing reinfection, even after the vaginal treatment seemed to have "worked." This could help explain why some women see their symptoms come back faster than others. Breaking that pattern means supporting the body from the inside too, not just treating locally.
• Non-albicans species are harder to treat. These species respond less well to standard azole treatment (such as fluconazole). The acidity of your vagina plays a role too: at the pH normally found in your vagina, some yeast species turn out to be significantly less susceptible to antifungal medication than at the pH used in standard lab testing.
• Other, not yet fully understood factors. Researchers also point to possible genetic predisposition and under-dosing or incorrect use of medication as factors that may contribute to recurrence, though more research is needed here.

What can help alongside medical treatment

A yeast infection won't go away on its own, antifungal treatment is needed for that. But a few habits can help reduce the risk of new episodes:

• Don't douche: this washes away the protective bacteria 
• Avoid scented tampons, sprays, or soaps around your vagina 
• Wear breathable, cotton underwear 
• Change out of wet clothing (swimwear, gym clothes) quickly 
• If you have diabetes: keep your blood sugar as well-regulated as possible 

There are also indications that diet plays a role in the health of your vaginal flora. Sugary drinks and meat appear to have a less favorable effect, while fish, nuts, and vegetables are associated with a healthier flora.

When to see your doctor

Contact your doctor if:

• Your symptoms return three or more times a year 
• You're pregnant
• You have diabetes that isn't well controlled
• Your symptoms are severe: extensive redness, swelling, or small tears in the skin
• This is your first time and you're not sure what's going on 

Getting an accurate diagnosis matters. What works for one woman may not work for another.

Wondering if your symptoms fit a yeast infection?

We got you! Our yeast infection self-test can give you a first, reliable indication at home of whether your symptoms fit a yeast infection. For recurring or persistent symptoms, or if you're pregnant or have diabetes, seeing a doctor or gynecologist remains important.

Jolien (body-focused therapist) explains here how vaginal complaints affect your connection with yourself. In this article, she shares exactly how this works, and what can help.

Maybe this sounds familiar. You've been dealing with recurring complaints for a while now, unusual discharge, pain or discomfort, recurring infections. The longer these complaints continue, the less love you feel for your vagina. It's as if you've unconsciously created some distance from this part of yourself. You'd rather not touch her anymore, or you find the idea of someone else getting close to her completely unappealing.

Vulvar or vaginal issues are something most of us will experience at some point in our lives. Whether it’s dryness, itchiness, infections or pain during sex. When these issues continue for longer, the impact is bigger than just the physical ailment itself.

What I see in my practice is how these issues can cause women to feel ashamed of their body and their genitals, to feel dirty or less attractive. It affects how much you can enjoy your body or feel like having sex.

When a part of your body causes discomfort or pain for a long time, we often tend to move away from it. Actually, this is a mechanism that helps us survive. Here's how it works.

At first, pain and discomfort let us know something's going on, so we can adjust our behaviour or choices and solve the problem. If we can't change the situation, another mechanism kicks in. The body adapts to this new situation, as best as it can.

We start living around the discomfort, and because of that we can dissociate from parts of ourselves. It's as if your pelvis or your vagina no longer fully belongs to you, you feel a separation. It becomes harder to feel connected to your vagina or to feel pleasure. You might also notice that you've come to sort of hate that part of your body, because why does it just never seem to work properly.

This is very understandable, but also unfortunate, because being less present in your body can directly affect the health of your pelvic area. When our awareness of a particular area of the body decreases, its functionality can decrease as well.
Blood flow can decrease, which means the tissue may receive fewer nutrients and waste products may be cleared less efficiently. The area can become more sensitive and more prone to pain and discomfort, or sometimes respond with numbness instead. When we feel less, we also become less able to listen to what our body needs in that area. Tension can build up, making it increasingly difficult to release. And so, you can end up in a vicious cycle.

It's very possible that in the meantime you (unconsciously) have started a war with your own body. You may have started to believe that something is wrong with you. That your vagina is letting you down. Or even that something about you is broken and needs fixing. You've lost the connection. We can often notice this in the language we use to talk about our own body. "That" vagina "down there" with "that" complaint. As if it's not about your own vagina, your own body, you’re talking about.

How do you break this cycle

It starts with restoring the connection with your body, step by step. By meeting your body again with softness and compassion, exactly where it is right now.

Wherever you notice the tendency to move away from yourself, see if you can move toward it instead. A bit like making contact with a deer in a meadow. You don't just charge at it. You start small and build up as trust grows. There's no rush.

You've probably spent a long time looking at your vagina mainly as a place that is broken and needs to be fixed. What if you try to set that aside for a moment. And see if you can make contact with your body from softness and love instead.

What does that look like

Making contact can happen in many ways, and it's important to find a form that you are comfortable with and brings you joy. That will be different for everyone. Before exploring this for yourself, it can help to start with the exercise described below. This exercise helps you come into safe connection with your pelvic area. After that, a curious encounter often becomes easier.

Step 1) Place your hand on your lower belly, pubic bone or vulva (wherever you feel like starting to restore contact)

Step 2) Notice how your hand feels on your body. Maybe you feel the pressure, the temperature, or other sensations in or underneath your hand. 

Step 3) See if you can direct your breath toward your hand. As if, on the inhale, you make space under your hand, and on the exhale, you sink deeper and deeper toward your hand and your pelvis.

Step 4) Imagine trying to reverse the touch. Instead of your hand touching your body, imagine that it's your body touching your hand. As if you're reaching outward from your pelvis. You can use your breathing to imagine this movement. Maybe you notice something very subtly shifting in the sensation. As if something becomes just a little softer.

And then… 

Repeat this exercise regularly, until you notice it's becoming easier and easier to make contact with your pelvis and vagina, to be present there with your attention from the inside out. From this foundation, you can go on to explore what your body needs further.

If after reading this you think: yes, I recognize myself in this story, but those exercises… phew. That really feels like a really big step. Don't worry. That's not strange to feel at all. When a lot has happened in your body, it can feel hard restore contact with softness and love. 

What matters is that you take small steps, that you don't force yourself to do something "because it's good for you." Often that's actually part of the problem. Is there one very small step you could take right now in your life, one that prioritises gentle connection with your vagina first? Something that feels like you can do with ease.

Maybe you need support in this process. Know that there are specialized professionals who can help you along the way, through (online) programs, education, (yoni or pelvic) massage or yoni mapping, and more. Don't carry this alone. You're really not alone in this.

Many women know their own bodies less well than they'd like to. That's not surprising: while boys and men can literally see their genitals, most of the female anatomy is hidden or barely visible. Time to change that. The better you know your own anatomy, the easier it becomes to recognize what's normal for you, and to talk about it, whether that's with your doctor or a partner.

The vulva: the external part

What most people call the "vagina" is often actually the vulva. The vulva is the external part of your genitals: the area between the mons pubis, the groin, and the anus. The vagina itself is the internal passage connecting the vulva to the uterus, so you can't actually see it from the outside.

Here's how the vulva is structured:

• Mons pubis: the soft cushion above the pubic bone, usually covered in hair. How much hair varies from person to person and also changes with age.
• Outer labia (labia majora): two folds of skin containing fatty tissue, covered in hair after puberty. Large, small, long, short, asymmetrical: it all occurs and it's all normal. They're also sexually sensitive and can swell slightly with arousal.
• Inner labia (labia minora): thinner, without fat, and can range in color from pink to brownish-black. They can protrude beyond the outer labia, be ruffled or smooth, and change color during pregnancy or with age. Here too: lots of variation, all of it normal.
• Vestibule: the area within the inner labia, surrounding the vaginal opening. Glands here produce fluid, especially during arousal, and the urethra also opens up in this area.
• Hymen: a thin rim of tissue at the entrance of the vagina. In children this can partly cover the opening; in adults, often only small remnants remain visible.

Just like faces or breasts, there's no such thing as a "standard" vulva. Shape, color, and size vary enormously from woman to woman, and that's exactly how it should be.

The vagina: the internal part

The vagina is the muscular canal that connects the vulva to the cervix. It's an elastic passage that can stretch, for example during sex or childbirth, and then return to its original shape. The vaginal wall produces fluid that helps keep the area healthy and supple, and its composition changes throughout your cycle.

At the top of the vagina sits the cervix, the passage to the uterus. This also feels different depending on where you are in your cycle: firmer and lower when you're not fertile, softer and higher around ovulation.

The clitoris: so much more than you think

The clitoris is probably the most underestimated organ in the female body. Most people think of the clitoris as the small, sensitive bud at the top of the vulva, where the inner labia meet. That's accurate, but it's only the tip of the iceberg.

The external part

The visible tip is called the glans clitoridis, and it's only a few millimeters in size. It's often tucked away under a fold of skin, comparable to the foreskin on a penis.

The internal part

Most of the clitoris is hidden inside the body. In total, the organ measures around 8 to 10 centimeters, made up of two "legs" and two bulbs of erectile tissue that extend along the vaginal wall, on either side of the vaginal opening. These structures fill with blood during arousal, exactly the way it happens with a penis.

This immediately explains why penetration leads to orgasm more easily for some women than for others: how close the internal parts of the clitoris sit to the vaginal wall differs from person to person. For some, this tissue sits closer to the vaginal wall than for others, meaning penetration can stimulate the clitoris more or less indirectly.

A few things worth knowing:

• The clitoris contains thousands of nerve endings, making it one of the most sensitive spots in the body.
• It's the only human organ whose sole function is pleasure.
• Arousal causes the erectile tissue to fill with blood, causing the clitoris to swell and become more sensitive.

A little appreciation for the clitoris.

For an organ that plays such an important role in female pleasure, the clitoris has remained surprisingly invisible for a long time. That’s exactly why we love seeing more attention being given to it today, not only in conversations about female health and sexuality, but also in art and design.

Selfness does this in a particularly beautiful way. They create jewellery inspired by the clitoris, turning a part of the female body that has long been overlooked into something you can actually wear and celebrate. A small but powerful reminder that the female body deserves to be seen, understood and appreciated.

Curious? Discover Selfness and their clitoris-inspired jewellery here

Getting to know your own body

Every vulva, vagina, and clitoris is different, just like faces or hands differ from person to person. Taking the time to look at your own body, for example with a hand mirror, can really help you learn what's normal for you. That way, you'll more easily notice when something changes, and you'll feel more confident talking about it, whether with a partner or a healthcare provider.

The vagina is not a sterile space, but a living ecosystem home to billions of bacteria, spread across dozens of species. Some estimates put the total bacterial population at 10 to the power of 10 to 10 to the power of 11 organisms. In most women of reproductive age, this ecosystem is dominated by lactobacilli, better known as lactic acid bacteria. These bacteria produce lactic acid and other protective substances, keeping the vaginal pH, typically between 3.8 and 4.5. That acidic environment makes it harder for unwanted microorganisms to gain the upper hand.

The role of lactobacilli

Lactobacilli produce lactic acid in two forms, L and D, and research suggests that D-lactic acid plays a particularly important role. They also produce hydrogen peroxide and bacteriocins, natural antimicrobial compounds that make it harder for other microorganisms to take hold. On top of that, lactobacilli attach themselves directly to the vaginal wall, physically competing with unwanted microbes for space.

Some species, such as Lactobacillus crispatus, are associated with a particular role in the vaginal ecosystem. Others, such as Lactobacillus iners, offer less stability and cannot produce D-lactic acid at all. Which species happens to dominate can differ from person to person, and even from month to month. Individual variation is normal, a healthy vaginal ecosystem doesn't look identical from woman to woman, and it doesn't need to.

A changing balance across every life stage

This ecosystem isn't fixed. It shifts constantly, shaped by hormones, age, and life stage.

• During the menstrual cycle, hormonal fluctuations influence which bacteria thrive.
• During pregnancy, the ecosystem actually becomes more stable and less diverse, likely supported by elevated estrogen levels.
• After menopause, estrogen levels drop sharply. Since estrogen helps mobilize glycogen in the vaginal tissue, and glycogen is the food source lactobacilli rely on to produce lactic acid, this decline often means less glycogen, disrupted lactobacilli, and a gradually rising pH. This is also linked to vaginal dryness and thinning of the vaginal tissue, which many women experience around this life stage.

What else can tip the balance

Beyond hormones, a number of everyday factors have been linked in research to shifts in the vaginal ecosystem:

• Diet. A shortage of certain vitamins and minerals, including vitamins A, C, D, and E, folate, and calcium, has been associated with a higher likelihood of disruption. So has a diet high in overall energy and fat intake. Since lactobacilli depend on glycogen to function well, and glycogen availability is influenced by diet and hormones together, what you eat and how your body is doing hormonally are more connected than most people realize.
• Antibiotic use. Antibiotics don't distinguish between unwanted bacteria and your own protective bacteria, which is why the ecosystem can take time to rebalance afterward.
• Douching and scented products. Washing away the vaginal environment, rather than just the outside, has repeatedly been linked to disruption of the natural balance.
• Smoking, contraceptive use, and sexual activity have also been identified as factors that can influence the composition of the vaginal microbiota, though the effect varies a lot from person to person.

Discharge is not a problem, it's a mechanism

What surprises many people is just how self-regulating the vagina is. Discharge is a completely normal, functional part of that mechanism. It carries away dead cells and bacteria, while the lactic acid bacteria present continuously works on the environment. Research has even shown that the vaginal ecosystem tends to be more stable over time than other bacterial habitats in the body, like the gut or the skin.

For everyday hygiene, this means less really is more. Lukewarm water on the outside is generally enough. Aggressive cleansing or douching risks washing away the very bacteria that are doing the protective work for you.

When something feels off "down there"

A disrupted balance, where other bacterial species start to take over, can show up as a change in discharge, odor, or irritation. You're not doing anything wrong if this happens to you. It's an incredibly common experience, and it says nothing about your hygiene or how well you take care of yourself.

If symptoms show up and don't settle on their own, or if they keep coming back, it's a good idea to have it looked at by your doctor for a proper diagnosis. Not every shift in balance needs the same fix, and getting a clear picture of what's actually going on is the most reliable way to know what will actually help you.

Recognizable? Discharge that's different from what you're used to, a smell that suddenly stands out, or just the feeling that something isn't quite right. If this sounds familiar, you're definitely not the only one. Bacterial vaginosis, often shortened to BV, is one of the most common causes of altered vaginal discharge in women of reproductive age. Worldwide, BV is estimated to affect approximately 23 to 29 percent of women.

A disrupted balance

BV is not an infection with one clear culprit. It's a disruption of the balance in the vaginal microbiome.

Normally, the vaginal flora is dominated by lactobacilli. These are bacteria that produce, among other things, lactic acid, contributing to an acidic vaginal environment. That acidic environment helps maintain the balance and makes it harder for certain unwanted bacteria to overgrow.

With BV, the number of lactobacilli decreases. At the same time, other bacteria, particularly anaerobic ones, get more room to grow. Think of species such as Gardnerella vaginalis, Prevotella, Atopobium, and Mobiluncus. So it's not about one bacterium suddenly causing everything, but rather a shift in the composition of the vaginal flora.

What you might notice, and what you might not

The most well-known signs of BV are thin, gray-white discharge and a noticeable, sometimes fishy odor. That odor can be more noticeable around or after sex, but can also stand out at other times.

When diagnosing BV, doctors don't just look at symptoms. They may also check the vagina's acidity, the odor of the discharge, and, when examined under a microscope, whether vaginal cells covered in bacteria are visible. These are part of what's known as the Amsel criteria, a method used in practice to identify BV. Important to know: not everyone with BV has symptoms. About half of women with BV notice little to nothing. As a result, BV is sometimes discovered by chance, for example during an examination for another reason.

Why does BV develop?

The precise cause of BV still isn't fully understood. That's also why BV can sometimes be frustrating: you can have symptoms, get treated, and still find that the balance becomes disrupted again later.

Research does show that various factors are associated with a higher likelihood of BV. Think of vaginal douching, smoking, antibiotic use, hormonal fluctuations, menstruation, and sexual activity. A new partner or multiple sexual partners are also mentioned in studies as factors that may be associated with BV. That doesn't mean BV is "your own fault." Nor does it mean BV is always caused by sex. The vaginal flora is a dynamic ecosystem that can change due to many different internal and external factors.

Is BV an STI?

BV is generally not seen as an STI in the classic sense of the word. With an STI, there's often a specific pathogen that's transmitted from one person to another. With BV, it's different: it's about a broader disruption of the vaginal flora, in which multiple bacterial species can be involved.

At the same time, sexual activity can indeed influence the vaginal balance. Semen, for instance, has a different pH value than the vagina, and contact with a partner can also affect which bacteria are present. Research shows that BV occurs more often in women with a new partner or multiple partners, and that partner-related factors may play a role in recurrent BV.

So it's better to think of BV as a condition where sex and partners can influence the vaginal balance, without BV being the same thing as a classic STI.

Why it's worth involving a doctor

BV symptoms can resemble other vaginal complaints, such as a yeast infection or an STI. Think of changed discharge, odor, itching, or irritation. This can sometimes make it difficult to assess yourself what exactly is going on.

A doctor can help distinguish between BV, a yeast infection, an STI, or another cause. This can be done through, for example, a physical exam, pH measurement, microscopic examination, or a lab test.

That's not just reassuring in terms of knowing where you stand. Research has also linked BV to increased susceptibility to certain infections and, during pregnancy, to adverse pregnancy outcomes such as preterm birth. This doesn't mean everyone with BV will experience serious consequences, but it does mean persistent or recurring symptoms deserve to be taken seriously.

Why BV sometimes comes back

BV can be stubborn. The standard treatment often consists of antibiotics, such as metronidazole or clindamycine. That treatment can work well, but in some women, the symptoms return. Various studies describe high recurrence rates, sometimes affecting more than half of women within a year of treatment. That doesn't mean you're doing anything wrong. Researchers believe recurrent BV may be related to, among other things, the difficulty of restoring a lactobacilli-dominant flora, biofilms in which bacteria can hide, or renewed disruption of the vaginal balance. This is exactly why it's important not to ignore recurring symptoms or keep trying to solve them yourself indefinitely. If symptoms keep coming back, it's a good idea to have things checked again.

Many women are taught the idea that the vagina should be extra clean, fresh, or odorless. That can make it feel logical to reach for special products, rinses, or treatments for this. Think of vaginal douching, where the inside of the vagina is rinsed with water or a liquid, or vaginal steaming, where the vulva is exposed to warm steam with herbs.

Still, it's worth knowing what actually happens when you do this, and why many health organizations and researchers are cautious about these kinds of practices.

Why the vagina already cleans itself

The vagina is a self-cleaning organ. Through discharge, shed cells, bacteria, and fluid are naturally carried away. That discharge can change throughout your cycle: sometimes it's thicker and stickier, and around ovulation often thinner and more watery. That's normal. So there's no need for internal cleansing to support this process. In fact, cleansing internally can disrupt the natural balance.

What happens with vaginal douching

With vaginal douching, the inside of the vagina is rinsed with a liquid, often water with vinegar or a commercial product. Many women do this out of a sense of hygiene, to reduce odor or discharge, or after their period or sex. The problem is that the vaginal flora is very sensitive. Normally, lactobacilli play an important role in maintaining an acidic vaginal environment. That environment helps preserve the balance. Rinsing internally can disrupt exactly those bacteria and the natural protective layer.

Several studies link vaginal douching to a higher likelihood of bacterial vaginosis. Associations have also been described with other gynecological complaints and infections, such as pelvic inflammatory disease and STIs. That doesn't mean everyone who has ever douched will immediately experience symptoms from it. It mainly shows that vaginal douching isn't a neutral habit, and that it can affect the vaginal balance.

It also doesn't mean there's anything wrong with you if you've ever done this. In many cultures, vaginal douching is taught as part of hygiene, often from a young age. The most important thing to know is that it's usually not necessary, and that stopping internal cleansing is often already a good step for your vaginal flora.

And what about vaginal steaming?

Vaginal steaming, also known as v-steaming or yoni steaming, is a trend where the vulva is exposed to warm steam, often with added herbs. It's sometimes offered with promises about detox, fertility, hormones, or general wellbeing.

Those claims aren't well substantiated. Researchers who analyzed online information about vaginal steaming found that the promises often lean on the idea that the female body is naturally dirty, out of balance, or constantly in need of improvement. That idea isn't just incorrect, it can also contribute to insecurity about normal odor, discharge, and bodily changes.

On top of that, the vagina isn't a place that needs to be "detoxed." Heat, steam, and herbs can irritate the sensitive skin and mucous membranes. It's also still not sufficiently clear what steaming does to the vaginal flora. Precisely because the vaginal environment is so sensitive, caution is important.

The idea of "clean" and "fresh"

Alongside douches and steam treatments, there are many intimate washes, wipes, sprays, and powders. The marketing for these kinds of products often suggests the vulva or vagina needs to be made extra clean, fresh, or odorless. But a healthy vagina isn't odorless, and discharge isn't automatically a sign that something's wrong. Normal discharge actually has a function: it helps the vagina keep itself clean and protects against irritation and disruption.

Of course, odor or discharge can sometimes change, for example due to bacterial vaginosis, a yeast infection, or an STI. But in that case, extra cleansing usually isn't the solution. It's better to have things checked to find out what's going on.

What actually helps

For everyday care, gently washing the vulva, meaning the outside, with lukewarm water is usually enough. You don't need to clean the inside of the vagina. It does that itself.

Scented soap, sprays, wipes, rinses, and many other products for internal use aren't necessary. They can sometimes trigger or worsen the very symptoms you're trying to prevent.

Do you notice an odor that's clearly different from normal, a lot more discharge, itching, pain, burning, or symptoms after sex? That's not a reason to start rinsing or steaming, but rather to check in with your doctor or get tested. That way you know what's going on, and you avoid disrupting the balance even further.

A bladder infection, medically referred to as a lower urinary tract infection, usually develops when bacteria travel from the gut area near the urethra, enter the urethra, and then multiply in the bladder. The culprit in most cases is Escherichia coli, often abbreviated as E. coli. This is a bacterium that occurs naturally in the gut, where it's usually harmless, but it can cause symptoms when in the wrong place.

Women get bladder infections considerably more often than men. The main explanation is anatomical: a woman's urethra is shorter than a man's, meaning bacteria have a shorter distance to travel to reach the bladder. In addition, the urethra, vagina, and anus are located close together. This makes it easier for gut bacteria to end up near the urethra. More than half of all women will have at least one bladder infection in their lifetime.

A number of factors can play a role in the development of a bladder infection:

Sexual activity

In younger women, factors such as a new sexual partner, more frequent vaginal sex, and the use of spermicide-based contraception are associated with a higher likelihood of recurring urinary tract infections. That doesn't mean sex is "the cause," but it does mean sexual contact can make it easier for bacteria to move toward the urethra.

Menopause

After menopause, the decline in estrogen plays a particularly important role. Hormonal changes also affect the vaginal environment: it becomes less acidic, and the share of lactobacilli can be disrupted. This makes it easier for bacteria to establish themselves. Other factors, such as urinary leakage, a prolapsed bladder, or urine that remains after urinating, can also contribute to recurring symptoms.

Diabetes

Several studies show that women with diabetes have a higher likelihood of recurring urinary tract infections. Glucose in the urine may play a role here, among other things, as it can create a more favorable environment for bacteria.

Pregnancy

A lot changes in the body during pregnancy. The growing uterus can put pressure on the bladder, and progesterone causes the urinary tract to work somewhat more slowly. As a result, urine can sometimes sit for longer, making it easier for bacteria to grow. Because urinary tract infections during pregnancy can have consequences for both mother and child, urine is monitored extra closely during prenatal checkups.

Not drinking enough

Not getting enough fluids can also play a role. Drinking less often means urinating less often, giving bacteria more time to attach and multiply. In women who drink little and get bladder infections often, drinking more water can help reduce the number of infections.

It's important to realize that there's rarely a single identifiable cause. For most women, a bladder infection results from a combination of anatomy, behavior, hormones, and sometimes medical factors. That also makes it a topic nobody needs to feel ashamed about: it happens to a great many women, regardless of hygiene or lifestyle.

The symptoms of a bladder infection are recognizable to many women: pain or a burning sensation when urinating, needing to urinate more often than usual, a constant urge to go while only passing small amounts of urine, and sometimes a pressing feeling in the lower abdomen. When the infection is limited to the bladder, urinary symptoms are usually the main feature, and fever isn't typically part of the picture.

When do we call it a recurring bladder infection?

Doctors define a recurring bladder infection as two or more infections within six months, or three or more infections within one year. This happens more often than many people realize: of the women who have one bladder infection, an estimated five to twenty-five percent go on to develop recurring symptoms.

Recurring bladder infections can have a real impact, not just physically, but mentally too. Many women describe feeling frustrated, insecure, or discouraged when symptoms keep coming back. That's completely understandable. Research shows that recurring urinary tract infections can affect daily activities, work, energy, and intimacy. If this sounds familiar, you're not imagining it, and you're definitely not the only one.

When is it a good idea to see your doctor?

Even with mild symptoms that don't clear up on their own after a few days, it's worth contacting your doctor, especially if symptoms keep coming back. A doctor can use urine testing, and sometimes a culture, to check whether it really is an infection, which bacteria is involved, and whether there are factors that deserve extra attention, such as changes around menopause, urinary leakage, or diabetes.

Some symptoms call for quicker medical advice, since they can point to an infection that has spread further toward the kidneys. Get in touch sooner if you experience: fever, pain in your back or side below the ribs, blood in your urine, or feeling clearly unwell alongside the usual urinary symptoms.

With recurring symptoms, the advice is: don't keep trying to solve it on your own indefinitely. Research shows that women with recurring urinary tract infections sometimes deal with symptoms for a long time before prevention is properly looked into. So it's entirely reasonable to actively bring this up with your doctor.

For women who are pregnant, there's an extra reason to always have symptoms assessed. Urinary tract infections during pregnancy can sometimes occur without clear symptoms, while treatment can still be important. That's why urine is routinely checked for abnormalities during prenatal checkups.

Good to know: bacteria in the urine don't always automatically mean there's a bladder infection. Especially in older women, bacteria can be present in the urine without any symptoms. Doctors call this asymptomatic bacteriuria. In many cases, this doesn't need to be treated. That's exactly why it's important to assess symptoms and urine testing together, rather than looking at a test result alone.

If you have a wish to have children, you may want to know what to pay attention to. How quickly it happens varies enormously from woman to woman. Here's how your cycle works, which days you're most fertile, and what factors play a role.

How quickly does it usually happen?

It's completely normal if it doesn't happen right away. Of all women trying to conceive, about a third are pregnant within 3 months, around 70% within six months, and 80% within a year. If it still hasn't happened after a year, that's a good moment to talk to your doctor or midwife. If you're 35 or older, this already applies after 6 months.

Your cycle, in short

Every month, your body goes through a series of steps to make pregnancy possible.

First, an egg matures in your ovary, while the lining of your uterus thickens to support a potential pregnancy. Then the egg is released: this is ovulation. Around this time, you're most fertile. If the egg isn't fertilized, your body sheds the lining and you get your period. Then the cycle starts again.

Cycle length varies from woman to woman: around 28 days on average, though anywhere from 21 to 35 days falls within normal variation.

When are you most fertile?

Your most fertile days are around ovulation. An egg can only be fertilized for about 12 to 24 hours after it's released, but sperm can survive in your body for several days. That's why having sex in the days before ovulation, not just on the day itself, already increases your chances.

Not sure exactly when you ovulate? Having sex every 2 to 3 days is a solid rule of thumb, since that's roughly how long sperm stay viable. You don't need to have sex every single day to improve your chances. A strict schedule often adds more pressure to an already stressful time than it helps.

It's worth knowing the reverse is true too. Ovulation doesn't always land on the same day every cycle, and it can shift because of stress, illness, travel, or simply from one month to the next. That means the days outside your fertile window lower your chances of pregnancy, but they don't rule it out completely. If you're tracking your cycle for any reason, it's good to keep that uncertainty in mind rather than treating any day as a guarantee, either way.

Certain body signals can hint that ovulation is approaching: discharge that becomes clearer and stretchier, sometimes mild cramping in your lower abdomen, and in some women a small rise in body temperature shortly after ovulation. Ovulation tests, which measure a hormone in your urine, can also help if you'd rather track this more objectively.

What affects your fertility?

Fertility is never one simple factor, and several things play a role for both women and men.

• Age. From around age 35, fertility gradually declines, and this effect is stronger in women than in men. This doesn't mean pregnancy is no longer possible, most pregnancies later in life go smoothly, but it can take longer.
• Weight and diet. Both being underweight and being overweight can lower your chances of conceiving. A healthy, varied diet and a folic acid supplement are recommended when trying to conceive.
• Lifestyle. Smoking, alcohol, and drug use all have a demonstrably negative effect on fertility, in both women and men. Long-term stress can also disrupt your cycle, which can make it harder to get pregnant.
• Work environment. Exposure to certain chemicals, radiation, or a highly stressful workplace can temporarily affect your fertility. If this applies to you, it's worth discussing with your employer or occupational physician.
• Medical factors. Certain conditions can affect your cycle or fertility, as can certain medications. If you're unsure, always talk to your doctor, who can advise you and refer you further if needed.
• For the man. Age plays a smaller role for men than for women, but lifestyle (diet, weight, smoking, alcohol, stress) also affects the quality and quantity of sperm.

What if it doesn't happen?

Sometimes it just takes a bit longer, without anything being wrong. But if it hasn't happened after a year of trying (or after 6 months if you're 35 or older), it's worth discussing with your doctor or midwife. Together with you and your partner, they can look at whether further investigation makes sense.

Trying to conceive, or newly pregnant? Chances are you've already heard that folic acid is important. What's less well known: there's a difference between folic acid and folate, and that difference is bigger than you might think.

Why folic acid matters so much

Folate is a B vitamin your body needs for cell division and for maternal tissue growth during pregnancy. Around pregnancy, this vitamin gets special attention, and for good reason. In the very first weeks of pregnancy, the embryo lays the foundation for the nervous system, including what's known as the neural tube.

Supplemental folic acid intake increases maternal folate status. Low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus.

Because this development happens so early, often before you even know you're pregnant, the advice is to start supplementing before conception. In many countries, health authorities advise women to take folic acid daily from the moment they start trying, and to continue this through the first weeks of pregnancy.

Folic acid and folate: not quite the same thing

Folic acid is the synthetic form of folate. Your body can't use folic acid directly: it first needs to be converted through several steps into 5-MTHF, the form that's actually active in your body. 5-MTHF itself doesn't need to go through that conversion and is immediately available for use and transport in the blood.

Research examining how these two forms behave in the body shows this difference in practice too: after taking 5-MTHF, the concentration of the active form in the blood rose much faster and much higher than after taking the same amount of folic acid.

Why this matters even more for some women

Some women carry a genetic variation in what's known as the MTHFR gene, the gene responsible for converting folic acid into its active form. With this variation, that conversion runs less efficiently. That means the body has a harder time turning folic acid into it's active form, while 5-MTHF skips that step entirely and can be used just as well regardless of this genetic variation.

Another point worth knowing: vitamin B12

High doses of folic acid can mask a symptom that's actually an important signal: anemia caused by a vitamin B12 deficiency. As a result, a B12 deficiency can go unnoticed for longer. 5-MTHF doesn't mask this signal in the same way, meaning a potential B12 deficiency can come to light sooner.

What does this mean for you?

This doesn't mean folic acid suddenly stops working. Supplemental folic acid intake increasing maternal folate status, and the link between low maternal folate status and neural tube defect risk, is extensively researched and well established. What the research on the two forms does show is that 5-MTHF has a number of practical differences: it's immediately available, it works even with an MTHFR variation, and it doesn't mask a B12 deficiency.

Not sure which form is right for you, or have questions about dosage and timing? Talk to your doctor, midwife, or pharmacist. A varied diet with vegetables, fruit, and whole grains also always contributes to your folate intake, as a complement to a supplement.

* Folic acid contributes to cell division and to maternal tissue growth during pregnancy. Both play a role in the very early weeks of pregnancy, when the foundations for the baby's development are being laid.

* Zinc contributes to normal fertility and reproduction. That makes it a nutrient worth considering not just once you're pregnant, but already while you're trying to conceive.

* Vitamin B12 contributes to normal red blood cell formation and has a role in the process of cell division. Both are especially relevant early in pregnancy, when your body is producing more blood and the baby's cells are dividing rapidly.

An STI, a sexually transmitted infection, is passed on through sexual contact. The risk is higher without a condom. Not everyone with an STI has symptoms, and that's one of the most important things to know: you can have an STI and not notice it yourself, while still passing it on to someone else. Most STIs are treatable. Here's an overview of the most common ones.

Chlamydia

Chlamydia is the most commonly diagnosed bacterial STI, especially among young people. Most people with chlamydia don't notice anything, and in these cases the infection often clears up on its own without causing damage.

Possible symptoms:

• pain or a burning sensation when urinating
• bleeding from the vagina during or after sex, outside of your period

Treatment: testing and treatment only happen if there are symptoms, using antibiotics. Without symptoms, testing at public health clinics is generally no longer necessary since 2025, as research shows the likelihood of harm in these cases is very small.

Gonorrhea

Gonorrhea presents differently depending on where the infection is located.

Possible symptoms:

• in the penis: usually symptomatic, such as discharge
• in the vagina: often no symptoms, meaning people may not know they have it

Treatment: antibiotics, usually given as an injection. Because the bacterium is becoming increasingly resistant to certain antibiotics, a combination of two medications is often used.

Syphilis

Syphilis progresses in stages, with different symptoms at each stage.

Possible symptoms (first stage):

• a painless sore or ulcer on the penis, vagina, anus, or mouth, which disappears on its own after a few weeks

Possible symptoms (later stage, if untreated):

• spots on the body
• flu-like symptoms, such as fatigue and headache
• with a long-untreated infection: damage to the heart, brain, or nervous system

Treatment: penicillin, in most cases given as a single injection. The earlier treatment starts, the better.

Genital herpes

Many people carry the herpes virus without ever developing symptoms.

Possible symptoms:

• painful blisters or sores on the penis, vagina, anus, or mouth

Once in the body, the virus doesn't go away, but symptoms can lessen or stay away after the first outbreak.

Treatment: there's no treatment that removes the virus, but antiviral medication can reduce symptoms and shorten the duration of an outbreak.

HPV and genital warts

HPV is a virus that most sexually active people contract at some point. It usually clears up on its own without symptoms.

Possible symptoms:

• small, usually painless bumps (genital warts) on the penis, vagina, or anus

Some types of HPV are linked to an increased risk of cervical cancer and other cancers, these are different types from the ones that cause warts.

Treatment: genital warts don't always need to be treated, they often go away on their own, though this can sometimes take a while. If they're bothersome, a cream, freezing, cauterization, or a minor procedure are options. A vaccine exists against the cancer-causing types of HPV, which is free in the Netherlands for young people up to age 18.

When should you get tested?

If you're sexually active, it's a good idea to get tested regularly regardless of symptoms. On top of that, get tested if you have symptoms, after sex without a condom, or if a partner turns out to have an STI. Most STIs can only be reliably detected after about two weeks. You can get an STI test through your doctor or, often free of charge, at a public health clinic.

If you're unsure or have questions about your risk, your doctor or the STI clinic at your local public health service (GGD) can give you personalized advice.

Your doctor calls it PMS. Your sister swears she has PMDD. And then PMOS shows up too, the new name for something you've probably heard of as PCOS. Three acronyms that look suspiciously alike but actually describe three completely different things. Here's what the science actually says, and where the confusion comes from.

Three terms, three different stories

PMS and PMDD are both about what happens in the week or two before your period: the luteal phase, the stretch after ovulation when progesterone rises and then crashes if there's no pregnancy. PMDD isn't a separate thing from PMS, it's really just the heavier version of it.

PMOS is a different story. It has nothing to do with the days before your period, it's about a hormonal and metabolic balance that sits differently all year round. Until recently it was called PCOS (polycystic ovary syndrome), but in early 2026 it was renamed worldwide to polyendocrine metabolic ovarian syndrome. The reason is surprisingly simple: the "cysts" in the old name aren't actually cysts, they're immature follicles, and they're not even required for diagnosis. The real issue sits deeper, in how your brain, insulin, and androgens (hormones present in everyone, including women) work together.

PMS: the familiar story

Roughly 8 out of 10 women notice something in the week before their period: bloating, tender breasts, headaches, irritability, or a dip in mood. That's normal and usually nothing to worry about.

It only counts as premenstrual syndrome once those symptoms are genuinely disruptive: at least one emotional and one physical symptom that keeps recurring the week before your period and fades within a few days of it starting. How many women actually meet that bar varies wildly by study and by country, some put it around 1 in 10, others closer to 1 in 3. That spread says more about how hard PMS is to measure than about how rare it is.

PMDD: when it goes a notch further

PMDD stands for premenstrual dysphoric disorder. The difference from PMS is mostly in how much weight the emotional symptoms carry: sharp mood swings, a sense of hopelessness, tension that won't let up, or the feeling that you're not fully in control. PMDD now has its own listing in the psychiatric diagnostic manual, not as a subtype of PMS but as its own condition.

It's much less common: estimates land somewhere between 1 and 6 in 100 women. Interesting detail: research suggests a rough premenstrual stretch usually isn't a totally new mood appearing out of nowhere. It's more often an existing tendency, toward overthinking, low mood, or stress, becoming temporarily amplified. Scientists call this premenstrual magnification. Falling progesterone is one working theory for why, though it's definitely not the whole story.

PMOS: why PCOS got a new name

PMOS is the most common hormonal condition in women, somewhere between 1 in 20 and 1 in 5 depending on which criteria are used. Diagnosis rests on three features, and you need two of them: disrupted ovulation (showing up as an irregular cycle), signs of excess androgens like unwanted hair growth or acne, and a particular appearance of the ovaries on ultrasound.

Here's the telling part: that ovarian ultrasound isn't even required. That's exactly why the name changed. The core problem isn't the ovary, it's a wider network involving insulin sensitivity, hormonal signaling from the brain, and metabolism. That also explains why PMOS behaves so differently from PMS or PMDD. It isn't a wave that rises and falls with your period, it's a setting that can shape your whole cycle, and over time, your broader health.

How do you know which one it is (and why hindsight tricks you)

There's no blood test that directly proves PMS or PMDD. The only real way to confirm it is tracking: writing down daily how you feel for at least two cycles. That's not doctors making things complicated for no reason. Research shows that people looking back from memory tend to overestimate how cyclical their symptoms really were. In hindsight, symptoms feel more neatly patterned than they actually were, or they were quietly present all month without you noticing. A simple diary keeps you from fooling yourself.

In practice, this rarely happens. Studies of doctors in the US and Japan found that only 8 to 24 percent actually use a symptom diary. So if you're wondering whether your symptoms fit PMS or PMDD, it can help to track for a couple of months.

PMOS works differently. There, a doctor looks at bloodwork, how regular your cycle is, and sometimes an ultrasound, mainly to rule out other hormonal causes. Because PMOS is tied to how your body handles insulin, blood pressure, cholesterol, and blood sugar often get checked too, not because something serious is assumed, but because catching it early makes the biggest difference.

What it can mean long term

With PMS and moderate PMDD, the effects usually stay contained to the days you feel off: less energy at work, more friction at home, a lower sense of wellbeing during that specific week. PMDD does tend to come with a higher likelihood of anxiety or a depressive stretch, and research points to a higher risk of suicidal thoughts in its most severe form. If that hits close to home: that's heavy, and it's worth bringing to a doctor, not something to carry alone.

PMOS is a different picture. Because it's linked to insulin resistance, it raises long-term risk for type 2 diabetes, higher cholesterol, cardiovascular disease, and fatty liver disease. Anxiety and a harder relationship with body image also show up more often. That makes PMOS worth looking at as more than just a cycle issue or a fertility issue.

What actually helps, and what's still thin evidence

There's decent evidence for a few simple things. Less refined sugar, saturated fat, salt, and alcohol, and more fresh, whole foods with B vitamins, calcium, and omega-3s, is linked to fewer symptoms. Regular movement too, though that research is mixed in quality. Talk therapy, especially cognitive behavioral therapy, shows improvement in multiple studies for both PMS and PMDD. And tracking how you feel isn't just useful for diagnosis, it genuinely gives you insight into your own pattern.

The idea that one herb or drink can "reset" your hormones isn't strongly backed by anything. That doesn't mean it's pointless to experiment with what works for you, it just means a healthy dose of skepticism is warranted for anything that sounds like a quick fix.

Listen to your body

PMS, PMDD, and PMOS are three different stories that happen to share a similar set of letters. The first is about a week before your period, the second is a heavier version of that, and the third is a hormonal balance that plays a role all year round. Tracking how you feel over a few months is, in all three cases, the best way to actually understand what's going on for you. And if symptoms are genuinely getting in the way of your daily life, work, or relationships, that's worth bringing up with a doctor.

Ever notice how one week you're unstoppable, and the next all you want is your couch and a bar of chocolate? That's not random. It's your hormones, quietly running the show behind the scenes. Here's what the science actually says about how energy, appetite, cravings, and mood shift across the menstrual cycle, and where some of the popular advice out there gets ahead of the evidence.

The four phases, in brief

A full cycle runs from the first day of your period to the day before your next one starts, typically somewhere between 24 and 38 days, though this varies quite a bit from person to person and even cycle to cycle. It's made up of two hormonal stories happening in parallel: what's going on in your ovaries, and what's going on in your uterus. In practice, people usually describe four phases:

• Menstrual phase: your period. Estrogen and progesterone are both at their lowest.
• Follicular phase: starts alongside your period and runs until ovulation. Estrogen climbs steadily, peaking just before ovulation.
• Ovulation: a surge in luteinizing hormone (LH) triggers the release of an egg. This is your fertile window.
• Luteal phase: after ovulation, progesterone rises to prepare the uterus for a possible pregnancy. If pregnancy doesn't happen, both hormones drop, and your period starts again.

Does your energy actually change?

Many people report feeling more energetic and motivated in the run-up to ovulation, and more sluggish in the days before their period. There's some biological logic here: energy metabolism does shift across the cycle, with the body relying more on fat for fuel and burning through stored glycogen differently during the luteal phase compared to the follicular phase.

Interestingly, a large research review looking specifically at how much people eat across the cycle found a consistent pattern: daily energy intake tends to be lower during the follicular phase, dips even further in the days around ovulation, and rises again in the luteal phase, sometimes by as much as 200 to 500 extra calories a day. The exact size of this shift varies a lot between individuals and even between cycles for the same person, and it isn't universal: several well-designed studies found no difference at all. So if you notice your appetite tracking with your cycle, that's a real and documented phenomenon, but if you don't, that's normal too.

What about cravings?

The luteal phase gets a well-earned reputation for cravings, and there's decent evidence behind it. Several studies have found stronger cravings for chocolate, sweets, and salty or fatty snacks in the days before a period compared to earlier in the cycle. Part of this may come down to progesterone slowing digestion and increasing the desire for energy-dense foods, and part of it may be tied to serotonin, a mood-regulating brain chemical that carbohydrates can temporarily boost.

Mood: what's really going on

Roughly 8 out of 10 people who menstruate notice some kind of physical or emotional change in the week before their period, things like irritability, low mood, fatigue, or bloating. This cluster of symptoms is commonly called PMS. But here's an important nuance: only about 1 in 10 experience changes severe enough to meet the clinical definition of premenstrual syndrome, and a much smaller group, around 7 in 100, experience the more intense premenstrual dysphoric disorder (PMDD), where symptoms are disruptive enough to interfere with daily life.

One thing worth knowing: PMS doesn't turn people into a "different person." Research suggests that when mood dips before a period, it's usually not a random or new mood appearing out of nowhere, but rather an existing tendency, like a leaning toward anxiety, low mood, or stress, becoming temporarily more pronounced. Scientists call this premenstrual magnification. Falling progesterone levels are one working theory for why this happens, though researchers are still debating the exact mechanism, and it's not the whole story.

It's also worth saying clearly: hormonal fluctuations are not a sign that emotions can't be trusted around your period. Studies comparing emotional variability between people with natural cycles and those on hormonal contraception, and between women and men, have generally found more similarities than differences.

Cycle syncing and seed cycling: what the evidence actually shows

You may have come across "cycle syncing," the idea of adjusting your workouts and diet to match each phase of your cycle, or "seed cycling," where you eat specific seeds (like flax and pumpkin during the first half of your cycle, sesame and sunflower during the second) to support hormone balance.

For cycle syncing broadly, the evidence is still thin: recommendations are largely based on general observations rather than solid trial data, and studies on energy intake across the cycle show wide individual variation rather than one-size-fits-all rules. This risks oversimplifying things, suggesting all women experience the same symptoms through the hormonal fluctuations of their cycle, when in reality that variation is exactly the point. This doesn't mean nothing good comes from keeping your cycle phase in mind when you notice differences in cravings or mood, but it's worth looking at this trend with a bit of nuance.

Seed cycling specifically, though, has more research behind it than it's often given credit for, particularly for PCOS and PMS. A 2025 systematic review pooled ten studies (635 women total) and found that seed cycling, especially flaxseed and sesame seed, was associated with more regular cycles, milder PMS symptoms, and favorable shifts in sex hormone levels (including FSH, LH, and the LH/FSH ratio) and metabolic markers like cholesterol and insulin resistance. Individual studies back this up: flaxseed supplementation has repeatedly been linked to improved insulin sensitivity and hormone profiles in women with PCOS, and sesame seed has been shown to ease dysmenorrhea and support more regular withdrawal bleeding.

There's also a reasonably solid biological story behind why this might work. Flaxseed and sesame contain lignans, plant compounds that can bind to estrogen receptors and help modulate how the body processes estrogen. Pumpkin seeds are rich in zinc, which supports the pituitary hormones (FSH and LH) involved in ovulation. Sunflower seeds are high in vitamin E and selenium, both linked to progesterone production and antioxidant protection.

That said, a few honest caveats matter here. Most of these studies are small, come from a narrow set of countries, and few include a proper control group, which makes it hard to say for certain that seed cycling itself, rather than the broader dietary changes that often go with it, is doing the work. A separate review looking specifically at the evidence base for PCOS reached a more cautious conclusion: while the individual seeds clearly contain beneficial nutrients, direct evidence for seed cycling as a specific protocol (this seed, this phase, this amount) remains limited, and larger, well-controlled trials are still needed to confirm it.

So where does that leave things? Seed cycling isn't just a wellness trend with no science behind it, there's a real and growing body of research, particularly for PCOS and PMS symptoms, and no studies report adverse effects. But it's also fair to say the evidence is still moderate-quality and evolving, so it's worth treating strong specific claims (like exact hormone percentage changes) with some caution until bigger trials confirm them.

Listening to your body

The bottom line: your energy, appetite, cravings, and mood really can shift across your cycle, and there's genuine science behind why. But everybody's pattern is different, and it can even change from cycle to cycle. Tracking how you feel over a few months can help you spot what's actually true for you, rather than assuming a general rule applies. And if premenstrual symptoms are seriously affecting your daily life, relationships, or work, that's worth bringing up with a doctor, since there are effective ways to manage it.