Backcountry Hygiene Tips: An Interview with Two Gynecologists

When it comes to preparing for a thru-hike or for backpacking in general, hikers with vaginas may have some questions surrounding proper hygiene. A lot of folks don’t have access to medical professionals that can answer these questions, or it may be too embarrassing or uncomfortable to ask.

As the daughter of two gynecologists, I have unlimited access to gynecological advice, and I’ve long served as a liaison to those who aren’t so lucky.  I want to get this important information to as many folks as possible, so I compiled some of the most common questions and concerns I hear among hikers with vaginas, and went to my parents for their wisdom.

Dr. Kelli Beingesser, MD, FACOG has practiced obstetrics and gynecology for over 30 years in clinical and academic settings. She currently works with the Palo Alto Foundation Medical Group, where she serves as incoming Chief of Staff at the Sutter Maternity and Surgery Center of Santa Cruz. Dr. Beingesser specializes in minimally invasive gynecologic surgery and has passed on her knowledge and skills to gynecologists from all over the world.

Dr. Gail Newel, MD, MPH, FACOG is an obstetrician-gynecologist with a 35-year career in clinical and academic medicine and a strong interest in public health and policy/advocacy work. She is currently serving as Health Officer for the County of Santa Cruz, California, as well as working as a co-investigator and consultant for the UC San Francisco Preterm Birth Initiative.

Their answers to my questions have been lightly edited for length and clarity.

Madeline Newel: Is it better to wear underwear or to go commando?

Kelli Beingesser: Either way, but definitely go commando at nighttime. The vagina needs to breathe! It can’t be all sweaty and grimy. Holding in any kind of heat can lead to bacterial imbalance. It’s also better for the skin of the vulva to not be compressed in any kind of way.

Gail Newel: I totally agree, the more space and air the vulva can get, the better.

K: Some people have a lot of labia, so going commando could cause chafing and pain, so daytime underwear use depends on the person.

M: How about hiking in leggings? Is this a problem for breathability?

G: There are leggings that are synthetic and sit right up against your crotch and there are leggings that are more breathable and don’t sit up against your crotch. The main issue is: do they trap moisture up next to the vulva, which will change the flora? It’s like sitting in a wet swimsuit all day. What’s your experience with hiking in leggings, does it feel different?

M: I guess if I wear leggings all day and night, I feel…stuffy.

K: Exactly.

G: You need to air out your vulva and vagina. That’s the bottom line.

The hiking dress or skirt is a great choice of attire for maximum breathability.

M: Is it okay to re-wear the same pair of underwear for several days in a row?

K: Is there poop on them?

M: (laughing) Ideally not.

K: Okay, then it’s okay.

G: I think this varies a lot from person to person. Some people can tolerate the change in bacterial flora and others cannot. The smell and comfortability vary.

K: But it’s not dangerous.

G: It’s not dangerous.

M: Is simply rinsing underwear adequate enough to get by between proper washing in town?

G: If there is any kind of poop on your underwear, that can cause an imbalance in flora, especially yeasts. Any visibly soiled underwear should be changed and rinsing isn’t going to be enough.

K: Unless you rinse with boiling water.

M: By visibly soiled you just mean shit?

G: Dried blood is okay, that’s not going to bother anything. And discharge is so fine. Discharge is so normal.

M: How should one go about washing their vulva in the backcountry? Should one use water, soap and water, baby wipes, or just leave it alone?

K: No baby wipes. Both of us are adamant: no baby wipes. Soap and water is okay.

G: Baby wipes are bad for your skin and the planet. Leave it alone. Our bodies have been doing this for several millennia. They can take care of themselves.

M: What’s the best way to pee in the backcountry?

K: That’s a stylistic choice. It’s like, what’s your tolerance to getting pee on you? Which is no problem, to get pee on you. Not at all.

M: Is wiping really necessary, or is it okay to “drip dry?”

G: Drip dry is fine.

K: Absolutely.

G: If you are wet and your clothes stay wet, that can cause an imbalance, irritation, and chafing.

K: That’s why it’s so important to air it all out at nighttime.

This is one option for a peeing position (but I recommend lowering your britches).

M: Some folks like to use a “pee rag.” Is this an adequate replacement for toilet paper? How can folks properly care for one in the backcountry?

K: You don’t really need a pee rag, drip dry is totally fine. Other than the smell of it, I don’t think it is dangerous to reuse something.

G: Agreed.

M: So if someone prefers to wipe, you’re saying that it is safe to use a pee rag?

K: People have been using different fabrics or nothing forever and ever.

G: Yes. I do hesitate to recommend anything that is embedded with antimicrobial chemicals. Those destroy the really sensitive, wonderful flora of the vagina.

K: It’s like gentrification of the vagina.

M: Some folks like to use a “pee funnel.” What are the benefits, and how can hikers properly care for one?

G: Older people with vaginas like to use pee funnels because they don’t have to take their backpack off and squat, which all becomes harder as you get older.

K: There’s no huge need to sanitize it.

G: Urine is pretty sanitizing already.

M: How can hikers safely have sex in the backcountry, when they are out for many days at a time?

K: It’s really important that if anybody knows that they have herpes, they have to be super prepared for an outbreak. The hiking and the chafing is a setup for an outbreak. Some people who have frequent outbreaks might consider going on preventive everyday therapy for that. STI control and birth control should be handled just like when you’re not in the backcountry. Hydrate before, hydrate after. Pee before, pee after.

G: Condoms. PrEP. PEP. It’s really a good practice to pee before and after any kind of sex.

Author’s note: PrEP and PEP are taken to prevent HIV. PrEP stands for pre-exposure prophylaxis and PEP stands for post-exposure prophylaxis, so PrEP or PEP is taken before or after HIV exposure, respectively. 

M: What are the best options for birth control in the backcountry?

G: Well, I think it’s so great that there are so many options now for people to avoid having periods at all, or to manipulate their periods so they only have them when they want to.

K: It’s important to get that managed several months before you hit the trail. For example, when you put an IUD in, you can bleed for three months. Discuss it with your gynecologist and figure out the best thing. If one can tolerate the IUD, I’m a big fan. There is a lower-dose IUD. For people who are really sensitive to hormones, who might not tolerate the Mirena, it’s a good option. I use that frequently on patients.

M: And what about birth control pills? I know a lot of them state a narrow temperature range for storage, is that an important consideration?

G: No, not at all.

K: The Nuvaring might not be a good option, because that can go bad with temperature fluctuations.

M: When it comes to menstrual products such as cups, period panties, pads, or tampons, which is best for thru-hiking?

K: With respect to hygiene: tampons or cups.

G: Tampons or cups are the best because they don’t hold moisture up to your vulva.

M: Some hikers use a menstrual cup in the backcountry – any tips for keeping this method sanitary? Is simply rinsing in water adequate care?

G: Rinsing with water is fine on the trail, soap and water is better when you are in town. Boiling it in your camp stove is good, too.

K: You’re never going to get anything sterile, just super clean.

G: It doesn’t need to be sterile.

M: How should hikers go about dealing with a UTI on trail?

K: If you are a person who gets UTIs frequently, you might want to consider carrying a preventive antibiotic.

G: Same for yeast infections, if you’re someone who gets yeast infections frequently. The one-time oral pill is prescription only, but it’s so convenient, to be able to just have one little pill that works for 7 days to clear it up. So much better than having to carry days-worth of creams.

K: If you get a UTI, don’t blow it off. You don’t want a kidney infection or sepsis.

G: You can try lots and lots of hydration, but if your symptoms are getting worse, it can be life-threatening if you don’t get treatment. If you’re getting fevers or flank pain, that’s a dangerous sign and you need to get treatment.

M: What causes a yeast infection, and how can it be avoided in the backcountry?

G: A yeast infection is one kind of imbalance of the vaginal flora, where yeast overgrows the other flora in the vagina or on the vulva. It’s avoided by air – keeping things dry. And not messing around and putting other things up your vagina.

K: Everyone has yeast in their bodies. Sometimes it lives there peacefully, and sometimes it rears its ugly head as a big army of little yeasties. Most of the time if you leave it alone, your body will work it out. But if you have terrible symptoms, seek treatment.

G: People with penises can get yeast infections, too.

Dry out your clothing whenever you have the chance!

M: What other problems can arise in the backcountry?

G: When you’re in backcountry water sources that don’t have running water, like sitting water or warm pools, it can really impact your vaginal flora. People with vaginas can get pretty bad imbalances from that. Bacterial vaginosis (BV) is overgrowth of other kinds of bacteria, and it smells bad. It will go away on its own with time as your vagina resets, but for some people (those with penises, too) it can be persistent.

K: The pH of the vagina should be around 4.5-5. If it gets acidic, you tend to get yeast infections. If it gets more basic, you tend to get BV. For this reason, some of the treatment focuses around restoration of the pH of the vagina. That’s why you hear about some of the homeopathic remedies, like probiotics or yogurt.

G: But that’s why I keep saying, don’t put anything in your vagina. Your vagina knows how to take care of itself.

K: You end up chasing your tail, fluctuating back and forth.

M: Any other tips on general backcountry vaginal hygiene?

K: If you have an injury to the vagina or the vulva, take it very seriously, because you can really bleed and bruise in that area. So it’s best to stop and wait and don’t push forward to make sure that the bruise is not getting bigger and bigger.

G: If the vulva is expanding after some kind of trauma, that means there’s a blood vessel that’s bleeding into the space below, and that’s a need for medical treatment.

K: Ingrown hairs can be pretty serious because you can get a big boil, and usually pulling out the offending hair and allowing the area to drain or using some topical antibiotics can be helpful.

G: Also in case your tribe isn’t aware of this: the HPV vaccine is super effective for avoiding vaginal, cervical, vulval, penal, scrotal, anal, rectal, and pharyngeal cancers.

Do you have a burning (or itching) question that wasn’t covered in this conversation? Drop it in the comments and I will follow up!

Featured image: Graphic design by Jillian Verner (@yourstrulyjillian).

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Comments 9

  • soh : Dec 21st

    You are the coolest person I know and your moms are the coolest people I know!! This article was v helpful and I’m not even planning my next backpacking trip for another year or so. It still made me and my vag feel very normal 🙂

    Reply
  • Dana Suarez-Medina : Dec 21st

    This article was entertaining and an easy read. Good information to have just in case. Article crossed my path and I recognized the names and had to support ex-Fresno docs!

    Reply
  • Oreo : Dec 21st

    This article has been so helpful. Information for short trips to long thru hikes. An open conversation about our downstairs area can help prevent long term problems. Also thank you for using gender-neutral terminology, people with pensis/vaginas.

    Reply
    • Lauren : Dec 22nd

      This was super helpful! Thank you. I am curious to know why baby wipes are bad for you. I always bring them into the backcountry with me but now I’m hesitant.

      Reply
  • Kayla : Jan 4th

    There are not enough articles and info of this caliber out there !! Thank you! I just forwarded this article to all my hiking friends! Ditto to the comment above; I also really appreciate the gender-neutral terminology.

    Reply
  • Jess : Jan 6th

    Opinions on using (clean, white, ideally freshly fallen snow) snowballs as TP during winter travels?
    Also, opinions on merino vs synthetic underwear?
    Anyhow thanks for the article and all the info, and the gender neutral language too!

    Reply
  • Nancy Ball : Jan 10th

    LOVE this article! Great resource for women hikers and backpackers everywhere. I am sharing a link to it with all my women students and clients. Thank you so much!!

    Reply
  • Linda Haller : Jan 11th

    I’m also an ObGyn – friends with your Moms. Really excellent article. A couple thoughts – I’ve used “pee rag” – a kerchief I would wash out – in Nepal because you had to save the paper for poop. I preferred it to air drying to get dry and never had problems with infection or anything else. Also if you happen to have probiotics with you (some are ok in the heat) if you feel vaginal BV coming on with odor you can put one tab or cap in your vaginal preferably before bed & it can help stave off full blown BV infection, may help with yeast too but the diflucan pill mentioned is best for yeast. Great job.

    Reply

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