Sitz baths basics
By Sara Twogood, MD
Sitz baths are one of my favorite remedies – for vulvar irritation, inflammation, and the dreaded “I believe you and your symptoms, but I can’t find anything on my evaluation”.
So often, vulvar and vaginal irritation and inflammation start with a yeast infection or skin aggravation (like an ingrown hair or that fancy soap you thought you loved). Then the initiating factor goes away or the infection is treated but the skin inflammation persists. More treatments and creams don’t help. But sitz baths can!
The problem with sitz baths? They are often underrated by patients who may give the “THAT’S your treatment plan? I could have looked that up myself” initial impression. And they’re overlooked and under prescribed by doctors who may also think “prescription meds work better than that” attitude.
By the way – this article is specific for vulvar and vaginal irritation because that’s what I always talk about! Note that sitz baths are also commonly used for hemorrhoids and anal fissures and the studies are often intertwined.
What is a sitz bath?
It’s soaking the skin in water! And yes, in my area of expertise, this skin means the vulva, perineum, and sometimes anus.
Sitz is derived from the phrase “to sit”. I bet you could have made that educated guess yourself! But to be more specific, it comes from the German word sitzen which means “to sit”.
How to do it:
Fill a simple bath with a few inches of warm water
If you’re a bath hater and needs some alternatives, try:
Basin or a plastic sitz bath (available as pharmacies, medical supply stores, or the internet. Look for something like the picture. Fill with water, place it under the toilet seat if appropriate, then sit to soak the area.
A detachable shower head in shower will work to apply a steady stream of water.
If all else fails, apply a wet washcloth to the area.
Soak the vulva and perineum (the space between the vaginal and anus) in luke warm water for 10 to 15 minutes, once or twice a day, until symptoms improve.
If you’re using sitz baths for hemorrhoids or anal fissures then obviously you’ll aim to soak that region instead!
Most people notice a difference after 3- 5 days. I tend to recommend 7 days in a row for best effect and then as needed after that.
More specifics about the water:
Clean tap water in a clean vessel (clean bath, clean basin, clean washcloth)
In one study for hemorrhoids, ionized water was used. That can be considered too although it’s not necessary!
Ideal water temperature is 94 – 98 degrees Fahrenheit (34-37 degrees Celsius). Too hot of water can be more inflammatory for skin disorders. Hot water is, however, used for hemorrhoids and anal issues because it can relax the anal sphincter muscle.
Cold water is just fine and may actually provide more relief immediately after bath, just not overall. And cold water can be harder to tolerate and less comfortable – so lukewarm water is my recommendation!
After the soak, dab dry with a soft cloth or use a hair dryer on cold air. Don’t wipe or scrub – that can cause more inflammation.
Should there by anything else in the water?
Nope! No need to add anything to the water.
Epsom salts are sometimes suggested, but this is more for muscle relaxation and we aren’t trying to relax the vulvar muscles (because the vulva is the external part of the female genitalia and doesn’t have muscles).
I know essential oils may sound tempting or relaxing, but when we’re dealing with skin inflammation, pure oils may be more irritating and inflammatory.
Is there medical data to support sitz baths?
Yes and no. Sitz baths are one of those old European traditions that over time turned into common medical advice even though the data is mixed, and studies are limited. There’s not enough data to support a specific regimen. My recommendations for patients are based on the limited study data there is, expert opinion in the literature, and individualized care based on my patient’s concerns.
Why aren’t there more studies? When simple treatments are anecdotally used and helpful, there is no money to be made, and little to no risk involved, it’s difficult to get a researcher to do an investigative study to see if it works!
When not to use it?
Don’t do a sitz bath with an active genital herpes outbreak. The softening of skin around active lesions may make that skin more vulnerable and worsen the lesions!
As always, ask your doctor if this is right for you! I in no way mean to suggest this fixes all vulvar and vaginal irritation and inflammation … but it can be a temporizing treatment to decrease symptoms while you’re waiting for that gyno appointment.
What’s the difference between this and steaming?
Yes, I know Gwyneth says that steaming the vagina is good for it.
Steaming the skin when it’s irritated can cause more inflammation. And remember, we want to avoid heat on irritated and broken skin … and steam is hot!
Don’t buy into the hype! I love GOOP for other reasons but not this one.