*Content reviewed by HotPause Health Medical Advisor & Board-Certified OB/GYN Dr. Beverly Joyce
Let’s talk about something almost every woman experiences, but very few feel comfortable discussing openly: vaginal odor.
Despite what the wellness industry and feminine hygiene marketing may suggest, vaginas are not supposed to smell like flowers, perfume, or nothing at all. In fact, a mild scent is completely normal and often reflects a healthy vaginal environment.¹
But changes in odor, especially if they’re sudden, strong, or accompanied by other symptoms, can sometimes signal that something else is going on. And during perimenopause and menopause? Hormonal changes can absolutely affect vaginal pH, moisture, bacteria balance, and odor too.²
The good news: most causes of vaginal odor are treatable, manageable, and far more common than you think.
First, What’s Actually Considered “Normal”?
Healthy vaginas naturally contain a balance of bacteria and yeast that help maintain an acidic environment. According to the American College of Obstetricians and Gynecologists (ACOG), changes in this balance can affect vaginal odor, discharge, and irritation.¹
A healthy vaginal scent may be:
- Mild or musky
- Slightly tangy or acidic
- Metallic during menstruation
- More noticeable after sweating or sex²
And yes, odor can naturally fluctuate throughout your cycle, after exercise, or during hormonal shifts.²
The vagina is also self-cleaning. That means you do not need scented washes, deodorants, sprays, or douching products to “fix” normal odor. In fact, these products can disrupt the vaginal microbiome and make irritation or odor worse.²
Why Vaginal Odor Can Change During Perimenopause and Menopause
As estrogen levels decline during perimenopause and menopause, the vaginal environment changes too.²
Lower estrogen can lead to:
- Thinner vaginal tissue
- Reduced lubrication
- Changes in vaginal pH
- Decreased healthy lactobacillus bacteria²,³
These changes can make women more prone to dryness, irritation, urinary symptoms, and shifts in odor. American College of Obstetricians and Gynecologists (ACOG) notes that atrophic vaginitis, now commonly referred to as genitourinary syndrome of menopause (GSM), can contribute to vaginal discomfort and changes in discharge or scent.⁴
Some women notice:
- A more acidic or sour smell
- Increased sweat-related odor
- Stronger odor after intimacy
- Odor changes related to urinary leakage
None of this means something is “dirty” or unhealthy. Hormones simply influence the vaginal ecosystem.
Common Causes of Vaginal Odor
1. Bacterial Vaginosis (BV)
One of the most common causes of a strong fishy odor is bacterial vaginosis, often called BV. BV happens when there’s an imbalance in normal vaginal bacteria. According to ACOG, the hallmark symptom is a thin discharge with a strong fishy smell that may become more noticeable after sex or during menstruation.¹
Other symptoms may include:
- Thin gray or white discharge or pale yellow
- Mild irritation
- Burning during urination
BV is extremely common and affects nearly 30% of women between the ages of 14 and 49.⁵ BV is treatable with prescription antibiotics.
2. Yeast Infections
Yeast infections usually cause itching, irritation, and thick discharge rather than strong odor.² Many women assume any vaginal symptom must be a yeast infection, but odor alone is often more associated with BV than yeast.
3. Sweat and Exercise
The vulva contains sweat glands, so it’s completely normal to notice odor changes after workouts, hot weather, or wearing tight clothing for long periods. Breathable cotton underwear, changing out of damp workout clothes, and gentle cleansing can help.
4. Hormonal Changes
Perimenopause, menopause, menstruation, pregnancy, and even stress can alter vaginal pH and temporarily change odor.²,³ Research published through the National Institutes of Health (NIH) has shown that declining estrogen levels during menopause significantly alter the vaginal microbiome, reducing protective lactobacillus bacteria and increasing vaginal pH.³
5. A Forgotten Tampon
A retained tampon can cause a very strong, foul, or rotten odor and should be addressed promptly by a healthcare provider.²
6. Sexually Transmitted Infections (STIs)
Certain STIs, including trichomoniasis, can cause unusual odor, discharge, irritation, or discomfort.⁶
When Vaginal Odor Is Worth Checking Out
A temporary shift in odor usually isn’t cause for panic. But it’s worth speaking with a healthcare provider if odor is accompanied by:
- Itching
- Burning
- Pelvic pain
- Green, gray, or unusual discharge
- Bleeding after menopause
- Pain during sex
- A sudden strong fishy or foul smell ¹,²
Odor that persists or occurs alongside irritation or discharge should be evaluated by a healthcare provider.²
What Not To Do
When women notice odor, many immediately reach for: Vaginal deodorants, scented wipes, douches, harsh cleansers, or over-the-counter “pH balancing” products. Unfortunately, these can often make things worse.
Douching in particular can disrupt the natural vaginal microbiome and increase the risk of irritation and infection.²,⁶
In general, gynecologists recommend:
- Washing externally only
- Using warm water and mild unscented soap if needed (rarely needed if you use your hand or washcloth with water)
- Avoiding scented products
- Wearing breathable underwear
- Staying hydrated
- Seeking medical care for persistent symptoms
- Do not use over the counter creams prior to seeing your HCP. It only makes it harder to diagnose the problem.
The Bottom Line
Your vagina is not supposed to smell like perfume. A mild scent is normal, healthy, and influenced by hormones, sweat, sex, exercise, and your natural microbiome. During perimenopause and menopause, hormonal shifts can make these changes even more noticeable.²,³
The important thing is learning what’s normal for your body and recognizing when something feels different. If you notice persistent odor, discomfort, unusual discharge, or irritation, don’t ignore it and don’t feel embarrassed. Vaginal health is health, period.
References
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American College of Obstetricians and Gynecologists (ACOG). Vaginitis. https://www.acog.org/womens-health/faqs/vaginitis
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Mayo Clinic. Bacterial Vaginosis Overview https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/symptoms-causes/syc-20352279
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Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas. 2016 Sep;91:42-50. doi: 10.1016/j.maturitas.2016.05.015. Epub 2016 Jun 1. PMID: 27451320.
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American College of Obstetricians and Gynecologists (ACOG). https://www.acog.org/womens-health/faqs/vulvovaginal-health
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Centers for Disease Control and Prevention (CDC). Trichomoniasis Fact Sheet. https://www.cdc.gov/trichomoniasis/about/?CDC_AAref_Val=https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm
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David J. Sanders, Saskia Inniss, Gregory Sebepos-Rogers, Farooq Z. Rahman, Andrew M. Smith; The role of the microbiome in gastrointestinal inflammation. Biosci Rep 28 May 2021; 41 (6): BSR20203850. doi: https://doi.org/10.1042/BSR20203850
