On today’s episode of ask the experts we pit the gynecologic advice of Gwyneth Paltrow, a consciously uncoupled actress and self-professed lifestyle expert who dabbles in vaginal health, against that of yours truly, a board certified OB/GYN who has completed a 5 year OB/GYN residency and a fellowship in infectious diseases and is an expert in vulvovaginal disorders.

Ms. Paltrow, recommends a V-steam. Her words: “You sit on what is essentially a mini-throne, and a combination of infrared and mugwort steam cleanses your uterus, et al. It is an energetic release—not just a steam douche—that balances female hormone levels. If you’re in LA, you have to do it.”

My response: Don’t.

Here’s why.

The vagina (and uterus and vulva for that matter) should be viewed as self-cleaning ovens. We know that douching is harmful, heck, even seminal fluid can be harmful (exposure to multiple partners without condoms is a major risk factor for imbalance of the vaginal ecosystem). The upper and lower reproductive tracts have very intricate mechanisms for regulating local health and they are very easy to mess with. It’s a delicate garden, if you will. So one needs to be thoughtful, nay conscious about what one uses in said garden.

We don’t know the effect of steam on the lower reproductive tract, but the lactobacilli strains that keep vaginas healthy are very finicky about their environment and raising the temperature with steam and whatever infrared nonsense Paltrow means is likely not beneficial and is potentially harmful. Some strains of lactobacilli are so hard to cultivate outside of this the very specific vaginal environment that growing them in a lab is next to impossible. There is also the possibility that the “steam” from these plants could contain volatile substances that are harmful to lactobacilli or other aspects of the vaginal ecosystem.

Ms. Paltrow and the people who push V-steams also need a little anatomy lesson because unless that steam is under high pressure (like with ejaculation) it’s not getting from the vagina into the uterus. Air (whether hot of cold) does not magically wander from the vagina into the uterus. Heck, even water in the vagina doesn’t get sucked up by the uterus.

But what about the claim that the vagina has a lot of mucosa (true) and can absorb medications (also true)? Vaginal absorption of medications requires the right medication and dose and the right delivery vehicle. Steam does not meet this criteria. Aerosolizing a medication is effective for lungs, but the vulva, vagina, and uterus are all quite deficient when it comes to inhalation and gas exchange mechanisms with the blood stream.

I’m not sure what our gal GP thinks balancing hormones actually is (because it means nothing medical), but I am confident when I say that steaming your vagina with wormwood or mugwort will not do anything to hormones because these plants are not hormones. OK, sure, they are not estrogen or progesterone, but what if they are phytoestrogens?

While I can’t find any reliable literature that proves mugwort or wormwood are phytoestrogens or have similar properties let’s say for the sake of argument that these two plants are phytoestrogens. What does that mean? Phytoestrogens are plant-derived substances with estrogenic biologic activity (such as the isoflavones genistein and daidzein, which are found in high amounts in soy and red clover). However, studies haven’t shown that these proven phytoestrogens do much for menopausal American women in the way of treating hot flashes. This probably means that phytoestrogens might act like an estrogen in the lab on tissues, but aren’t very good at acting like estrogen in the body (or that the studies aren’t very good). However, there is one important sticking point about phytoestrogens and a potential vaginal route – phytoestrogens need to be digested to become more estrogenically active. Besides, acting like a hormone isn’t the same as being one. If a phytoestrogen does happen to makes you feel better in a womanly way it isn’t because it has mysteriously balanced your hypothalamus or pituitary (brain areas that are the command centers for hormones), but rather because of a peripheral effect. Think Band-Aid not a treatment. Or placebo (studies with phytoestrogens report up to a 59% placebo response rate).

So here’s the deal…

Steam is probably not good for your vagina. Herbal steam is no better and quite possibly worse. It is most definitely more expensive.

Steam isn’t going to get into your uterus from your vagina unless you are using an attachment with some kind of pressure and MOST DEFINITELY NEVER EVER DO THAT.

Mugwort or wormwood or whatever when steamed, either vaginally or on the vulva, can’t possibly balance any reproductive hormones, regulate your menstrual cycle, treat depression, or cure infertility Even steamed estrogen couldn’t do that.

If you want to feel relaxed get a good massage.

If you want to relax your vagina, have an orgasm.

Maybe tomorrow I’ll tackle sex bark…

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Late entry (7 pm PST) A a good friend who is an Allergist (and therefore someone who is likely to know) pointed out mugwort steam does at least sound better than ragweed stream (the allergenic plant to which it is closely related). Mugwort pollen is of course also allergenic. Needless to say the vagina (or vulva for that matter) is a less than ideal place for an allergic reaction. The vagina, like the inside of the nose, is mucosa and so there is no reason not to expect a similar reaction.