Vaginal wind – what’s the cause of queefing?

As a pelvic floor and vaginitis expert I am referred several patients a year who have concerns about excessive vaginal wind. It is unknown how many women have this concern as many don’t discuss it out of embarrassment. Physical manipulation causes air to move in and out of the vagina (for example with intercourse or with insertion of a speculum), vaginal wind is expected after these activities. However, some women describe the passage of loud air from their vagina at other times, and it is this random passage of air that is typically reported as distressing.

The first step it to understand that air normally gets into the vagina. Using data from CT scans we know that 11% of women with no symptoms have some air in the vagina. During movement or coughing the air in the vagina is forced downwards. If the muscles at the vaginal opening part slightly to allow some air to escape, a noise may result.

There are only causes two sources of the air/gas that produces vaginal flatulence:

• The normal air that gets into the vagina.
• Air that comes from the bowel. This implies a fistula, a connection between the bowel and the vagina, allowing gas (and sometimes fecal matter) to pass from the bowel into the vagina.

Contrary to popular belief among gynecologists, a vaginal infection does not cause vaginal wind. While there is gas forming bacteria, these are not typically vaginal pathogens and the gas they produce is in the actual tissues of the body, so it wouldn’t escape via the vagina.

What is the treatment? Ruling out a fistula. This may take a trip to a colorectal surgeon, a CT scan, or special x-rays depending on where the fistula is suspected (small bowel, large bowel, or low down at the anus). Women with inflammatory bowel disease, previous surgery in the area, diverticulitis (a type of bowel infection), and radiation treatment are at highest risk for a fistula, but it can also happen after a vaginal delivery. If it is a fistula, the treatment is surgery.

If it’s not a fistula, is there anything that can be done as the air is a normal biological phenomenon? Some suggest physical therapy for the pelvic floor muscles (there are no randomized trials, but if the vagina is lacking support from the pelvic floor muscles it is possible more air is entering, so strengthening the muscles may help). The other option is a pessary, which prevents the vagina from fully collapsing at rest. While this doesn’t prevent the air from entering, it may prevent the noise as the air leaves the vagina. In one very small study a third of patients found a pessary helpful.