Is Keto Crotch Really a Thing?

That the ketogenic diet has come under scrutiny by nutritional experts is no surprise. Its strict requirements would raise anyone's eyebrows, and a July review by Frontiers in Nutrition wasn't the first to point out some key flaws: It's not necessarily a more effective weight-loss tool than any other diet, it has low long-term sustainability and it may open the door for plenty of diseases, from cardiovascular disease to Alzheimer's to diabetes.

However, the study skipped the side effects the diet may have on vaginal health. The term "keto crotch" undoubtedly originated from the depths of social media. However, even with limited scientific investigation, we know it's a complicated problem.

Sandra El Hajj, M.D., a naturopathic medical doctor specializing in preventive global health, and Jamie Hickey, an NASM, FMS certified trainer and ISSA certified nutritionist, helped shed some light on why the keto diet may cause vaginal discomfort.

Why is keto so popular?

People who want to lose weight tend to want the process to go as quickly as possible, and for many, the ketogenic diet looks like the easiest solution. The keto diet eliminates most carbs, and asks the dieter to consume high-fat foods such as meat, cheese and eggs.

The goal is to put your body into ketosis, a process in which the body converts fats into energy rather than relying on its usual fuel—carbs. The diet is somewhat easy to track, as there is typically no calorie counting, though it is recommended dieters pay attention to their macros and carbs. It's also spawned spinoff diets, like so-called dirty keto, lazy keto, Mediterranean keto and more.

The symptoms may indicate an infection, but El Hajj said that keto crotch is the same as keto breath, just from a different location in the body.

The diet has taken social media by storm. Browsing related hashtags and accounts, you'll find no shortage of success stories and keto influencers encouraging you to follow them on their respective journeys. What they're less likely to post are the side effects that come with a high-fat, low-carb diet.

Most keto devotees already know about "keto flu," but the physical effects go further than that initial drop in energy levels.

What's that smell?

One of the first symptoms of keto crotch mirrors bacterial vaginosis (BV). People who experience the condition report smelling a fishy odor in their urine and vaginal discharge, which can later develop into excessive vaginal discharge, vaginal itching and discomfort.

The symptoms may indicate an infection, but El Hajj said that keto crotch is the same as keto breath, just from a different location in the body. People who are following a keto diet have their energy and fuel broken down from fat sources instead of carbs, so as a result, ketones, which consist of acetoacetate, beta-hydroxybutyrate and acetone, are produced, which could result in a fishy odor.

El Hajj also warned other complications that could arise from keto diets can include kidney stones, hepatic steatosis and hyperproteinuria, to name a few.

All that green stuff

Because the ketogenic diet eliminates carbs and focuses on the consumption of high-fat protein sources, it is essential to include healthy green vegetables that are high in alkaline, especially leafy greens, with your meals.

You may know that the pH scale measures acidity and alkalinity levels. You may even know that when you're in your reproductive years, the vaginal pH is usually 4.5. However, on a high-fat diet, the vaginal pH average can jump to 5.1. When the pH of the vaginal fluid in the vagina is more than 4.5, it may indicate BV has occurred, which could correlate with the high-fat diet.

Hickey said that although a scientific investigation of keto crotch has yet to be conducted, there is a possibility that keto crotch is indeed caused by BV. Hickey stressed that lactobacilli play a crucial role in maintaining the vaginal microbiome by maintaining an acidic environment, and when bacteria other than lactobacilli replace it, you could get BV.

Don't make it awkward

Your OB-GYN has heard it all, seen it all and, yes, smelled it all. Keto crotch will not send your doctor running for the door; in fact, vaginal odor and bacterial vaginosis are pretty typical. Don't be afraid to make an appointment to get your issue taken care of right away. Your doctor can advise you on dietary adjustments that may be necessary. The longer you wait to treat your symptoms, the worse it can get—so don't make yourself miserable by putting off the decision to make an appointment.

Symptoms of BV can be treated with antibiotics, but there is always the possibility symptoms may return if you don't stick to providing your body with proper nutrition. Remember, the keto diet is not the only way to lose weight. Talk to your doctor if you're not sure the side effects are worth enduring.