What are vaginal changes?
During the menopausal transition, the state of the vagina often changes. Vaginal dryness and pain are symptoms of vaginal atropy (atrophic vaginitis) that occur as a result of lowered estrogen levels. The tissues in the vagina weaken, get thinner, dryer, and may get inflamed, causing pain, burning, or discharge.
Changes to the vagina usually occur at the same time as changes in the urinary tract, so they have recently been combined into a single category – genitourinary syndrome of menopause (GSM). GSM covers a variety of changes to the genitourinary tract – particularly the urethra and vagina. Vaginal atrophy and urinary incontinence (UI) are the most common symptoms of GSM, affecting 40-50% of midlife and aging women.
Women may be very reluctant to speak up and act on vaginal issues due to embarrassment and negative feelings about aging. However, these are conditions that can be treated at home or with the help of a medical practitioner.
Self-care for dry and weakened vaginas
To address vaginal atrophy at home, you can:
- Use over-the-counter lubricants to hydrate the walls of your vagina. This can also help reduce vaginal infections.
- Stimulate the muscles of and increase the blood flow to the vaginal wall with vaginal sex and masturbation, as this helps keep your vaginal tissues healthy.
- Avoid vaginal intercourse when experiencing pain and dryness, as this can result in tearing delicate tissues and may lead to infections.
- Seek medical care if self-care doesn’t help.
Therapies for vaginal dryness and urine leakage
At age 40 find a reliable, educated primary care provider familiar with recognizing and treating the symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.
You can try over the counter vaginal moisturizers and lubricants to help increase the moisture in the vagina. If you are using a lubricant, which is typically applied just before intercourse and reduces vaginal pain, check to see if the product contains any petroleum (like petroleum jelly). If you are in the menopausal transition there is still a chance of pregnancy, and petroleum based products can break down latex used in condoms.
Topically (locally) applied hormone therapy (HT) with estrogen is safe and often effective for reducing dryness in the vaginal lining and improving strength of the vaginal wall. Topical HT comes in the form of creams to apply inside the vagina or tablets and rings that can be placed inside the vagina. Locally applied estrogen can also help to reduce the incidence of urinary tract infection.
The Science
Vaginas are part of a woman’s sexuality and reproduction and can be healthy throughout life.
The walls of a vagina are muscular, and with stimulation and estrogen support, can remain strong and thick. The vaginal lining secretes mucus, which makes the walls slippery. Mucus also protects against bacteria and yeast overgrowth.
The effects of menopause-related vaginal thinning and dryness can be mitigated with over-the-counter products, gentle Kegel exercises and safe and effective HT with estrogen.
Statistics
Postmenopausal European women with symptoms of vaginal atrophy
Patients with vaginal atrophy who receive adequate therapy
Vaginal Changes and the Menopausal Transition
FALSE
Vaginal healthy aging can be had by using non-prescription lubes, HT with estrogen, and regular exercise with masturbation and intercourse.
FALSE
No, there are many safe and effective non- prescription medications that can be used to lubricate your vagina. A vagina is a muscle, and it needs exercise.
FALSE
Oh, please.
Compiled References
1. Baber, R. J., Panay, N., Fenton, A., & IMS Writing Group (2016). 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric : the Journal of the International Menopause Society, 19(2), 109–150. https://doi.org/10.3109/13697137.2015.1129166
2. Bulan, S. E. (2019). Physiology and Pathology of the Female Reproductive Axis. In Melmed, S., Koenig, R., Rosen, C., Auchus, R. & F. Goldfine (Eds.), Williams Textbook of Endocrinology (14th ed., pp. 574-641). Elsevier.
3. Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. The Cochrane Database of Systematic Reviews, 10(10), CD005654. https://doi.org/10.1002/14651858.CD005654.pub4
4. Minkin M. J. (2019). Menopause: Hormones, Lifestyle, and Optimizing Aging. Obstetrics and Gynecology Clinics of North America, 46(3), 501–514. https://doi.org/10.1016/j.ogc.2019.04.008
5. Kołodyńska, G., Zalewski, M., & Rożek-Piechura, K. (2019). Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Przeglad menopauzalny = Menopause review, 18(1), 46–50. https://doi.org/10.5114/pm.2019.84157
6. The North American Menopause Society. (n.d.). Changes in the Vagina and Vulva. Retrieved July 11, 2021, from https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
7. Santoro N. (2016). Perimenopause: From Research to Practice. Journal of Women’s Health, 25(4), 332–339. https://doi.org/10.1089/jwh.2015.5556
8. Krause, M., Wheeler, T. L., 2nd, Richter, H. E., & Snyder, T. E. (2010). Systemic effects of vaginally administered estrogen therapy: a review. Female pelvic medicine & reconstructive surgery, 16(3), 188–195. https://doi.org/10.1097/SPV.0b013e3181d7e86e