How Menopause Affects Your Vulva and Vagina

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Are things looking and feeling differently down under? It’s entirely normal to experience changes to your vulva and vagina with menopause and age. They’re caused by shifting levels of hormones—estrogen in particular.1 Here’s what you can expect, along with some tips on what you can do about it.

Changes on the Outside

Let’s start with the external female genitals: the vulva. The lips on your face aren’t the only ones that become less plump with age. The tissues of the vulva and labia also get thinner.2 3 And after years of grooming your southern coif, you may notice you’re going full frontal these days with less hair below. The loss of pubic hair happens because of declining testosterone levels.4 5

Changes on the Inside

1. Higher pH

Inside your vagina, lower estrogen levels increase its pH and make the vagina less acidic.6 This means that the amount of good bacteria called lactobacilli, which help protect the vagina, can decrease and other bacteria can multiply—putting you at higher risk for yeast infections.7 It’s best to avoid irritants that can disrupt the healthy balance of bacteria, such as perfumed soaps, gels, and douches.8

2. Vaginal Dryness

Does your vagina feel drier? Declining estrogen is the culprit, causing decreased lubrication.9 Don’t let dryness come between you and your partner staying connected. Local estrogen therapy is an option for treating vaginal dryness. It works by releasing small doses of estrogen into the vaginal tissue and is available by prescription only in various forms, including vaginal rings, tablets, and creams.10 For those looking for a simpler solution, a personal lubricant can be your best friend in easing dryness and discomfort. Our go-to is K-Y® lubricants, which have a range of intimacy products including some that have a natural feel during sex.

3. Thinner and Less Elastic

After menopause, the lining of the vagina is thinner and has fewer folds, so it’s less stretchy and flexible.11 In addition, your vagina can become shorter and narrower without regular vaginal sexual activity.12 It’s important to continue having intercourse. Just like your other body parts, your vagina can become sore and stiff without enough exercise.13 Not only does sex increase blood flow to the genital area,14 it helps the vagina maintain its stretchiness and moisture. If your vagina has become so shortened and narrowed that it can’t accommodate an erect penis, exercises with vaginal dilators can help.15 These are plastic or rubbery round-tipped cylinders that come in sets with different diameters. They stretch and relax the vaginal muscles so that intercourse is more comfortable.16

It’s not surprising that all these changes inside the vagina can make intercourse uncomfortable, even downright painful for some women. Vaginal thinning and dryness are normal and cited as the most common cause of uncomfortable sex in women over the age of 50.17 Again, we turn to K-Y personal lubricants to help ease dryness and discomfort. K-Y is the brand most trusted by couples and the #1 brand recommended by doctors.18 And don’t forget to do your Kegel exercises, which help to improve the tone of your pelvic floor muscles, reduce pain during sex, and increase the strength and awareness of the muscles involved in pleasurable sexual sensations.19

1 The North American Menopause Society (NAMS), “Changes in the Vagina and Vulva,” http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
2 The North American Menopause Society (NAMS), “Changes in the Vagina and Vulva,” http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
3 American Nurse Today, “The True Effects of Menopause,” https://americannursetoday.com/blog/the-true-effects-of-menopause/
4 American Nurse Today, “The True Effects of Menopause,” https://americannursetoday.com/blog/the-true-effects-of-menopause/
Christiane Northrup M.D. The Perimenopause Transition. http://www.drnorthrup.com/perimenopause-transition/
6 The North American Menopause Society (NAMS), “Changes in the Vagina and Vulva,” http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
7 NHS, “Keeping Your Vagina Clean and Healthy,” http://www.nhs.uk/Livewell/vagina-health/Pages/keep-vagina-clean.aspx
NHS, “Keeping Your Vagina Clean and Healthy,” http://www.nhs.uk/Livewell/vagina-health/Pages/keep-vagina-clean.aspx
9 The North American Menopause Society (NAMS), “Changes in the Vagina and Vulva,” http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
10 The American College of Obstetricians and Gynecologists, “The Menopause Years: Frequently Asked Questions,” https://www.acog.org/-/media/For-Patients/faq047.pdf?dmc=1&ts=20160714T1329449605
11 The North American Menopause Society (NAMS), “Changes in the Vagina and Vulva,” http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
12 The North American Menopause Society (NAMS), “Menopause and the Volatile Vagina,” https://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2012/09/27/menopause-and-the-volatile-vagina
13 The North American Menopause Society (NAMS), “Weight Loss, Exercise, and Healthy Living,” http://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/weight-loss-exercise-and-healthy-living
14 The Society of Obstetricians and Gynaecologists of Canada, “Sexuality Fact Sheet,” http://menopauseandu.ca/factsheets/Sexuality08.pdf
15 The North American Menopause Society (NAMS), “Menopause and the Volatile Vagina,” https://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2012/09/27/menopause-and-the-volatile-vagina
16 The North American Menopause Society (NAMS), “Sexual Devices,” http://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/sexual-devices
17 The North American Menopause Society (NAMS), “Pain with Penetration,” http://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/pain-with-penetration
18 Wolters Kluwers Quarterly Survey 2009.
19 The North American Menopause Society (NAMS), “Yoga, Kegel Exercises, Pelvic Floor Physical Therapy,” http://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/yoga-kegel-exercises-pelvic-floor-physical-therapy