’Keto Crotch’: the latest myth?

Recently, numerous articles have appeared simultaneously in popular women’s magazines about what has been called “keto crotch.” Many of those articles were accompanied by a picture of fish, just in case the readers’ virtual olfactory system needed some inspiration. What is this thing, “keto crotch”? Is this even a thing?

At first, I just brushed it off, laughing. I thought, “Is this their new invention to scare people off keto?” But then it occurred to me that if it concerns vaginas, as a woman, and as a family doctor who treats female patients, I should pay attention. And if my vagina was about to give off scents of bacon or organic churned butter, I would like to know! So, I decided to take a deeper dive into this new phenomenon.

“Keto crotch” actually refers to a temporary change in vaginal odor in women who are on a ketogenic diet. Intrinsically, it’s neither positive nor negative. It’s just a change of odor. But that wouldn’t get much attention, would it? All of the articles I have read actually used more pejorative descriptive terms, like “stinky side effect”, “smelly vagina”, “fragrant vagina”, “gnarly smell”, or “unfortunate odor”; some even calling it a “pretty major downside” of the keto diet, to be expected along with the “keto breath”, the “keto flu”, and the “keto diarrhea.” They make it sound like your vagina, on keto, might become totally disgusting.

Nearly each article cites a specialist, like an OB/GYN or a nutritionist. Most of those specialists are more nuanced, and remind readers that any significant change in the diet may have an impact on the pH of the vagina, which may be perceived as a change of scent. One nutritionist, however, explains that not only can keto change the pH of the vagina, but that pH change can result in bad bacteria growth, irritation, odor and infections. Basically, she was suggesting that keto will give you a bacterial infection called bacterial vaginosis.

Along those lines, another article cites a Reddit writer who said that her “keto crotch” was so bad, she had to keep panty liners in her bag and keep changing them every couple of hours because the vaginal discharge was so significant.

I have been eating low carb/keto myself for three years now, and I’ve been offering nutrition as a therapeutic option to my patients for almost as much time. I have never encountered such issues. But since there’s nothing in the scientific literature about the infamous “keto crotch,” I decided to ask around, as unscientific as that can be.

I polled the Facebook group I created for people who are interested in low-carb and ketogenic ways of eating, Keto Experts Qc, which is moderated by my multidisciplinary team and myself. Dozens of people reported either no change or a temporary change of scent that lasted a few weeks but couldn’t be described as smelly or pungent. Even a few same-sex partners confirmed that odor was practically unchanged.

I also asked Kristie Sullivan, who said:

In nearly six years of following a strict low-carb diet, and interacting with literally hundreds of thousands via social media and my Facebook groups (over 250,000 people like Low Carb Journey — Cooking Keto with Kristie), I have interacted in nearly every discussion imaginable regarding personal health and low carb or keto. Not once has the issue of foul vaginal odor been part of that conversation. Bad breath or changes in body odor are not uncommon concerns, but those tend to be experienced early in the adaptation phase and are not long term or ongoing issues. When compared to struggling with obesity and metabolic dysfunction, dealing briefly with body odor changes is pretty simple. 

Megan Ramos, CEO of Intensive Dietary Management in Toronto, also replied:

We’ve treated over 10,000 patients at this point. Approximately 65% of them are females. Not once did I have a woman bring up this issue with me. As a matter of fact, we’re seeing the opposite: women have less and less yeast infections and bladder infections, in particular our diabetic patients who normalise their blood sugars, and who stop taking their SGLT2 inhibitors (which is a drug that makes people pee out sugar).

Dr. Ken Berry, in his Youtube video on the subject, also confirmed that he treats a lot less vaginal and bladder infections in his patients on low carb.

Just as I was about to conclude that it was just a new myth, I received a few private messages from a handful of women who admitted that at some point in their keto journey, they experienced a less than pleasant odor emanating from their vagina, which lasted a few weeks, and went away on its own. None consulted their physician for this issue.

Keto is great for many things. It has helped many of my patients reverse their metabolic syndrome, obesity, type 2 diabetes, chronic pain, chronic fatigue, etc. It can definitely help people achieve a better metabolic health, but as I often tell my patients, it isn’t a cure-all. You can still catch or develop diseases and illnesses while on keto, like the common cold, glaucoma, or cancer. In a study on the prevalence of bacterial vaginosis (BV), it was found that 29.2% of the more than 4,000 women surveyed and tested had a BV, but 84% of them were completely asymptomatic. So BV is quite frequent.

The poor lady who had to change her panty liners every two hours, and the women who took the time to write privately to me had likely been suffering from something other than “keto crotch.” Perhaps they had bacterial vaginosis? In any case, any woman who notices a significant change in her vaginal odor or discharge should seek medical attention and get a proper diagnosis. And please do not douche!

What amazes me is the fact that these articles about the keto crotch are all over the place, at the same time, going viral, and all are negative. It seems to me that it could possibly even be a concerted effort, cleverly orchestrated. But why?

Every article I have read had a common take-home message:

• “keto is a fad weight-loss solution”
• “if you’re interested in trying this high-fat, low-carb diet, hearing about keto crotch may be a deterrent”
• “it might actually make you rethink a low-carb diet”
• “another excellent reason not to cut out carbs”
• “the good news is that there are foods that can combat offensive odors and actually add a sweet smell or taste to the vagina, like fresh fruit, fruit juices, whole grains and Greek yogurt”
• “carbs never sounded and smelled so delicious”
• “it may be the strongest argument for eating carbs yet”
• “experts have also warned about how the high-fat food intake could be damaging to someone’s health”
• “it is ‘common sense’ for everyone to avoid the keto diet,” and of course
• “your doctor may advise you to go back to a balanced diet.”

The reason this campaign of fear is centered around the vagina is pretty simple. According to an article in Psychology Today, while men’s biggest concern with their genitalia is the size of their penis, for women, it’s odor. Women worry that what’s between their legs smells like (in descending order): fish, vinegar, onions, ammonia, garlic, cheese, body odor, urine, bread, bleach, feces, sweat, metal, dirty feet, garbage, and rotten meat.

My personal belief is that someone out there isn’t liking how the low-carb and ketogenic diets are helping hundreds of thousands of people regain their health, stop certain medications, and achieve a healthy weight. And since science is backing low-carb and keto diets, dealing with this inconvenient situation might be best accomplished with a well-orchestrated viral campaign of fear, preying on women’s insecurities and biggest intimate concerns, setting up anxiety and doubt, to deter them from even trying the keto diet.

Sadly, the underlying message seems to be, “Food as a therapeutic option is dangerous; better stick with medications and long-established commercial weight-loss programs, which are much safer for your vagina, and therefore, for you.”

I am not laughing anymore. This possibly misogynistic campaign of fear is causing harm. My advice is simple: don’t fall for this. Denounce this potentially orchestrated misinformation.

And now, we can all sit and wait for the other side’s next move. What will it be? Keto causes unibrows, or will make you die four years sooner (oh wait, this has been done already), or attracts spiders in your bedroom while you sleep? All bets are off!

—
Dr. Èvelyne Bourdua-Roy

 

Image from John Zahorik, on Twitter

 
 

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