Underwear!

We very often underestimate the influence of underwear type, material, and changing frequency on genital wellness. Unfortunately, a limited number of studies include underwear specifics as possible factors in genital microbiome changes, perineal skin irritation, and the development of different infections. After data analysis, only 21% of studies evaluated the specifics of underwear, thigh clothing wearing, and the association with panty liners and perineal area irritation and vaginal symptoms.

A variety of natural and synthetic materials are used in the manufacturing of underwear. The most popular materials are cotton and bamboo, as well as nylon and polyester, which are synthetic. Choosing the right underwear can be challenging for many women, as the material and design are crucial factors in making a decision. However, despite several factors influencing women, Ruiz et al. (2019) found that 85% of women preferred cotton as one of their primary underwear materials.

Natural materials, such as cotton and bamboo, are among the best choices for panties due to their superior water vapour permeability, moisture absorption, and deodorising properties compared to synthetic materials. All these and more qualities are important for supporting the normal microflora of the perineal and vaginal epithelium. Although underwear material has not been directly associated with changes in the epithelial microbiome, synthetic underwear is a risk factor that increases the likelihood of changes in the epithelium. Klebanoff et al. (2010) studied hygienic behaviour associated with bacterial vaginosis. The study showed an increase in bacterial vaginosis among women who douched and chose nylon underwear compared to women who douched and wore cotton or other material underwear.

Unfortunately, a limited number of studies have evaluated underwear material influence on the normal perineal and vaginal microbiome. However, it is possible to conclude that the material of underwear alone does not have a significant impact on the microbiome of the genitalia and only a combination of multiple risk factors can significantly increase the likelihood of changes in the perineum and vaginal microflora.

Underwear material is not the only parameter that influences a woman’s perineal area. Wearing too-tight underwear and pants can alter the bacterial balance and cause physical damage to the skin. Klann et al. (2019) observed an increase in vulvodynia symptoms among women who wear thigh jeans or pants at least four times per week. Bahram et al. (2009) studied 500 non-pregnant Iranian women’s hygiene habits associated with bacterial vaginosis. Interestingly, 60% of women with a BV diagnosis preferred to wear tight underwear. Meanwhile, 72–82% of healthy women chose loose underwear. In conclusion, loose underwear and pants are more suitable for supporting a woman’s health; meanwhile, tight, fancy underwear should be avoided and is acceptable only for specific occasions.

Panty liners are advertised as easily usable, comfortable, healthy, everyday hygiene products widely used worldwide. However, most women have limited knowledge about the appropriate usage and different types of panty liners.

A wide range of panty liners are produced and sold daily, each with distinct characteristics. Schafer et al. (2002) demonstrated that hygiene products impermeable to water vapour increase skin water loss and humidity, resulting in mechanical and chemical skin irritation. Furthermore, Runeman et al. (2003) compared the influence of breathable and non-breathable panty liners on the perineal skin and mucosa.

The control group (no panty liners) and breathable panty liner group showed no difference in skin temperature, water loss, electrolyte balance changes, and pH. Moreover, the non-breathable panty liner group showed increased skin temperature, skin surface moisture, and pH of the vulvar skin, thereby significantly changing the vulvar microbiome. Although there was no difference between the no panty-liner group and the breathable panty-liner group, some studies have found that women who wear panty-liners daily and regularly change them have specific complaints. Ruiz et al. (2019) showed that 83% of women who wear panty liners every day and change them 4–5 times per day have complained about pruritus. According to the mentioned study, a broad spectrum of different panty liner types is found in shops. Moreover, most women are unaware of the kind of panty liners (breathable or non-breathable) they use daily.

However, choosing panty liners as everyday intimate hygiene products can be associated with already existing microbiome changes, mainly increased vaginal discharge. Klebanoff et al. (2010) found that panty liners are more prevalent among women who douche and, as mentioned earlier, douching is significantly associated with vaginal microbiome changes, an increase in vaginal discharge amount, and vaginal symptom development. It is not recommended to wear panty liners every day unless necessary.

The majority of women who follow specific healthy intimate hygiene rules, such as showering regularly, choosing cotton underwear, wearing loose underwear and pants, avoiding douching and not using panty liners every day, rarely showed complaints about increased or smelly vaginal discharge, vaginal symptoms, and vulvodynia. Additional studies are necessary to evaluate the preferred washing product usage during showers, the frequency of underwear changes, and preferences for panty liner types.

Not my own work! Taken from: (please read the full article, mentioned below, for more information)

Lohova-Matisa E, Rezeberga D, Miskova A. Feminine Intimate Hygiene: A Review of Healthy and Unhealthy Habits in Women. Medicina (Kaunas). 2025 Jul 19;61(7):1302. doi: 10.3390/medicina61071302. PMID: 40731931; PMCID: PMC12300265.

Copyright © 2025 by the authors.

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