Une mauvaise odeur vaginale est généralement le signe d’une infection gynécologique (vulvo-vaginite), même si l’odeur du vagin varie selon le cycle et les périodes de la vie. En fait, le vagin est tout un écosystème, qui entretient le bon équilibre de sa flore grâce à ses bactéries !
Donc, chaque vagin a « son » odeur, du fait des sécrétions vaginales ; une odeur vaginale forte ne veut absolument pas dire qu’il s’agit d’un manque d’hygiène. Par contre, c’est souvent le signe d’un déséquilibre de la flore vaginale, causé par une prolifération de bactéries.
Conseils d’hygiène, symptômes qui doivent vous alerter, Mia fait le point sur les causes des mauvaises odeurs vaginales.
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Toutes les femmes ont une odeur vaginale, et c’est normal ! En cause, les sécrétions naturelles du vagin, contenant de nombreux micro-organismes, qui permettent un bon équilibre de la flore vaginale. Ainsi, la bactérie la plus présente dans le vagin (attention scoop) est appelée bacille de Döderlein !
Même si en réalité, on parle d’un ensemble de bactéries.
Toutes ces bactéries maintiennent donc un bon équilibre, afin de protéger le vagin des infections. Lorsque cet équilibre fragile est rompu, l’odeur vaginale peut être modifiée.
Mais le parfum du vagin varie aussi de manière normale pendant le cycle menstruel et les règles. Par exemple, à leur approche, l’odeur du vagin peut être légèrement plus acide. Une odeur vaginale forte n’est donc pas nécessairement le signe d’une infection.
Par exemple, les rapports sexuels peuvent modifier temporairement l’odeur du vagin, tout comme le vagin d’une femme après la ménopause, n’aura pas le même “parfum” qu’une femme dans la trentaine.
Tous les vagins ont donc leur propre parfum (on parle souvent d’un parfum « musqué »), qui peut changer selon les périodes ou les dérèglements.
Il est donc important de connaître sa propre odeur naturelle, afin de déceler un changement anormal : une odeur différente n’est pas forcément alarmante, mais peut quand même être le signe d’une infection.
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Mauvaise odeur vaginale : quelles sont les causes ?
Les infections vaginales ou gynécologiques (vulvo-vaginites ou bartholinites) sont assez courantes. Le diagnostic devra identifier si des interactions médicamenteuses, une prise de drogues, des pathologies générales ou des IST sont responsables de cette odeur anormale.
Certains signes évocateurs doivent vous alerter. Par exemple, si cette odeur vaginale forte s’accompagne d’irritation, de démangeaisons, de pertes vaginales de couleur anormale (jaune, verte, etc.), il s’agit sûrement d’un déséquilibre de la flore vaginale, causé par une prolifération des bactéries : il faut donc en rechercher la cause.
Vous pouvez consulter un médecin traitant ou votre gynécologue. Nous allons énumérer quelques-unes des causes possibles de ces mauvaises odeurs vaginales.
Les mycoses vaginales
Les mycoses vaginales sont principalement causées par le champignon Candida albicans ; on estime que 75% des femmes peuvent être affectées au cours de leur vie.
Certains facteurs peuvent favoriser la prolifération de Candida albicans : un traitement hormonal de substitution, la grossesse, un diabète mal équilibré, la prise d’antibiotiques, une immunosuppression, les corticoïdes et des prédispositions génétiques.
Enfin, le mode de vie influence également le risque de contracter de mycoses : une mauvaise ou un surplus d’hygiène, se laver l’intérieur du vagin (« douche vaginale »), certaines pratiques sexuelles, des spermicides, la pilule contraceptive, l’habillement…
Le traitement n’est pas toujours nécessaire et dépend des symptômes. Toutefois, en cas de grossesse (les symptômes peuvent être plus sévères), un traitement local est recommandé pour une période de 7 à 14 jours.
La vaginose bactérienne
La vaginose correspond à la perte anormale des bacilles de Doderlein, représentant 95% de la flore vaginale. Ces bactéries protègent le vagin des infections, en maintenant notamment un pH acide. Lors de la vaginose, le taux de bacilles diminue, permettant la prolifération d’autres germes.
Même s’il ne s’agit pas d’une IST, la vaginose bactérienne peut être le reflet d’une certaine activité sexuelle : son incidence augmente avec le nombre de partenaires et le nombre de rapports. Il s’agit aussi de la cause la plus fréquente de la mauvaise odeur vaginale (pertes vaginale odorante).
Certaines pathologies gynécologiques et obstétricales (endométrites, salpingites, accouchements prématurés ou rupture prématurée des membranes…) peuvent être associées également à ces pertes malodorantes.
On estime par ailleurs que la vaginose affecte 30% des femmes qui consultent pour des IST, et peut atteindre 50% dans les populations à risque (prostitution par exemple).
Le diagnostic repose généralement sur un examen au microscope des pertes vaginales, et la mise en évidence des « Clue cells », ou par l’odeur anormale qui se dégage spontanément de ces pertes, similaire à une odeur de « poisson pourri ».
Le traitement repose sur la prise d’antibiotique par voie orale pendant 7 jours.
L’infection à trichomonase
Il s’agit de l’IST parasitaire la plus répandue dans le monde (170 millions de nouveaux cas par an). Elle se manifeste par des pertes vaginales anormales (jaunâtres ou verdâtres) épaisses et dégageant une mauvaise odeur.
La majorité des patientes ne présentent pas de symptômes ; ce qui généralement est la cause d’une persistance de l’infection. Le traitement est simple et repose sur une prise unique d’antibiotique (Métronidazole).
Pour conclure, rappelons que les mauvaises odeurs vaginales peuvent être causées par une mauvaise hygiène (ou un surplus d’hygiène), le stress, les antibiotiques (qui peuvent dérégler la flore vaginale), un cancer du col de l’utérus ou encore une fistule recto-vaginale, une ouverture anormale entre le vagin et le rectum.
Mauvaise odeur vaginale : des complications ?
Sans traitement, l’infection responsable de la mauvaise odeur vaginale risque de s’aggraver et augmente le risque de contracter d’autres IST ; la trichomonase accentue par exemple le risque de contracter ou de transmettre le VIH en diminuant les défenses immunitaires.
S’agissant de la vaginose pendant la grossesse, elle augmente le risque d’accouchement prématuré. Il est donc important de consulter dans tous les cas, si l’odeur du vagin est inhabituelle.
En conclusion : comment éliminer les odeurs vaginales ?
Lors d’un diagnostic en cas d’odeurs vaginales anormales, un médecin pourra effectuer un prélèvement afin de déterminer s’il s’agit d’une infection bactérienne ou parasitaire ; et ainsi proposer un traitement antibiotique adéquat.
Si la patiente présente une infection à trichomonase, le médecin recommandera généralement de traiter aussi le, la ou les partenaires sexuels.
S’agissant de la prévention, elle consiste évidemment à se protéger sexuellement (port du préservatif) lorsqu’on n’est pas en relation stable et durable, mais surtout à éviter les mauvais gestes (comme la douche vaginale). Une bonne hygiène intime est donc primordiale pour limiter le risque d’infection.
Attention : bonne hygiène intime ne veut pas dire se laver excessivement ! Le vagin « s’auto-nettoie », il ne faut absolument pas se laver l’intérieur du vagin (« douche vaginale ») ; cela dérègle sa flore naturelle et augmente le risque d’infection.
Préférez utiliser un savon doux ; tous les produits chimiques (déodorants, lingettes intimes, papiers toilettes parfumés, etc.) peuvent fragiliser les muqueuses du vagin et empêcher les sécrétions naturelles. La vulve et le vagin, par ailleurs, doivent toujours rester humide ; c’est pour cette raison qu’une lubrification naturelle s’opère.
Pour résumer, évitez les parfums ou les produits irritants ; pratiquez votre toilette intime 2 fois par jour maximum, en utilisant si possible, de l’eau tiède ou un savon au ph neutre. Un savon dédié à l’hygiène intime ou doux. Et ne frottez pas trop fort sous peine d’irritations !
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