As if puberty and childbirth weren’t enough, your vagina—and the surrounding area—are in for many more changes as you get older, especially after menopause strikes. Sadly, these changes aren't oft-discussed topics, meaning we’re typically uninformed and woefully unprepared for the realities of our aging lady flowers.
No longer. Read on to discover exactly how your vagina transforms and adjusts to maturing, as well as tips from experts on keeping it healthy and yes, active.
The hair down there
Perhaps the most noticeable change in your vaginal area is the greying, thinning, and loss of pubic hair. "Usually you don’t lose the hair entirely, but a lot can be lost," says Dr. Yael Swica, practitioner at Village Women’s Health in New York City and Clinical Assistant Professor of Family Medicine at the Center for Family and Community Medicine at Columbia University. Your scalp, leg, and underarm hair may thin, as well, especially after menopause.
On the bright side, this means you’ll need to shave less as you get older. On the not-so-bright side, hair begins to appear elsewhere. "There are women who gain hair on their face [and other] places they don’t want," says Dr. Margery Gass, board-certified gynecologist and Executive Director of The North American Menopause Society. Fortunately, there are ways to combat this, like creams and laser treatments, which are discreet and fairly inexpensive.
Your changing vulva
First thing’s first: While closely connected, your vulva and vagina are two different things. "The vulva is the outside, and the vagina is the canal," says Dr. Swica. "Often, women talk about their vagina, and what they really mean is their vulva, the lips, the clitoris, the labia majora, the labia minora, and even the urethra."
Your vulva remains largely unchanged from your late teens to your 40s, and even into your 50s. At some point, however, we can begin to experience Vulvovaginal Atrophy (VVA) (a.k.a. Genitourinary Syndrome of Menopause, or GSM) resulting from the gradual loss of estrogen that comes with perimenopause and menopause. That means, "the tissue can become more pale and smoother, the labia can become less distinct, and the vulva will lose its fullness."
While cosmetic surgeons have seen a jump in labiaplasty procedures in recent years, this natural process is nothing to freak out about. "I don’t think women need to be that concerned about it," says Dr. Gass. Simply wash the area gently with water and move on.
The vagina itself
VVA affects the vagina as well as the vulva. "The loss of our sex hormone (estrogen) can result in dramatic changes in the appearance and function of the vagina," says Dr. Swica. "The vaginal opening can shrink, and the length of the vagina can shrink. You can also get irritation."
That irritation occurs because the vaginal walls become thinner, losing elasticity and especially moisture. "Anywhere from 20 to 50 percent of women start to have this complaint of burning, itching—and these are chronic sensations," says Dr. Swica. "With sex, it becomes more pronounced. And that’s when they’ll really notice it, because it’s painful."
And while sex is the main instigator of itchiness, Dr. Gass adds, "There are some people who notice it other times, maybe when they’re walking or doing exercise."
Scratching that itch
Fortunately, there’s both long-term and temporary relief for the discomfort that comes with VVA.
- "Moisturizers are something you use twice a week, to keep the vagina moist," says Dr. Swica. "Moisturizers like Replens and Luvena eliminate the feeling of dryness."
- "Lubricants are what you use when you need much more moisture, during sex. There’s silicone, water, and oil-based lubricants. You can use olive oil or coconut oil, as well, and it’s a little messy, but it works." If you’re unsure of a potential reaction, Dr. Swica suggests, "Try it on your forearm before using it on your vagina."
- Used to restore moisture, Local Estrogen Therapy is a low-dose of hormones administered via pill, cream, or ring, and can be done by, "anyone who does any kind of gynecological care."
- "If women value their sexual life, it’s better to stay sexually active on a regular basis," says Dr. Gass, since regular intercourse helps the vagina remain moist and flexible.
Dr. Gass also recommends against using douches ("unless it’s treating a specific problem"), soap, and anti-cling products or fabric softeners on underwear. "In the past, we used to say to go with cotton underwear [as well], but I think that’s something women have to experiment for themselves."
The infection connection
The good news: Aging doesn’t necessarily mean more yeast infections.
The bad news: Aging could mean more of those other infections.
"Without estrogen, the flora of the vagina changes and the tissue around the urethra is thinner, so we become more prone to urinary tract infections," says Dr. Swica. "The epithelium becomes thinner, so we’re more vulnerable to sexually transmitted infections and HIV. You’re more prone to bacterial vaginosis, as well, which can give women an unpleasant kind of wetness accompanied by an unpleasant odor."
Local estrogen therapy can thwart the onset of these diseases, since it helps restore your flora. Moisturizing, lubricating, and sex are also helpful, as they keep vaginal tissue supple and less disposed to small tears. Dr. Gass cautions against using scented or flavored lubricants, however, as, "It could predispose women to yeast infections."
Sex drive
Your sex drive may change as you get older. Then again, it might not. Libido depends on a range of factors, from hormones to your emotional state to physical limitations, and every woman is different. Either way, you can make sex a more enjoyable experience—and keep your vagina lubricated, pliable, and healthier—by staying in practice. "In terms of how sex is affected with the vagina, if you don’t use it, you lose it," says Dr. Swica. "It’s important to keep having sex."
Dr. Gass agrees. "Truly, a key part is to be regular. You might think of it as an exercise or a sport. If you didn’t play your favorite sport for six months, and then expect to have a great time, you might walk off sore. So, be regular about the activities. It doesn’t have to be tied to a schedule, but a regular pattern of sexual activity, it will work better for you than having long abstinences."
There’s no reason to worry if you’re flying solo, either: "There are things women can use—lots of dilators and vibrators —that can be of use for women who don’t have a partner."
Let's talk about prolapse
If you haven’t experienced it first-hand, you’ve probably heard of prolapse, which occurs when organs start slipping out of position due to weakened pelvic floor muscles. "Thirty to forty percent of women have some degree of prolapse," says Dr. Gass, "but there are many different kinds—bladder, uterus, the top of the vagina, the urethra." While it may not hurt, prolapse can be alarming, and may require surgery to put things back in place. Among those more likely to experience the condition: smokers and women who've had lots of children.
To help prevent prolapse, you have to keep your pelvic floor in shape—a process that should begin after childbirth and continue throughout your life. Kegel exercises, in which you flex those pelvic floor muscles, are the best way to accomplish this. (See here for instructions.) Happily, orgasms are another option. "The contractions a woman has while she’s orgasming? That’s the ideal kegel," says Dr. Swica.
When to see a doctor
To maintain your vaginal health as you age, Dr. Gass recommends an annual gynecological exam, which doesn’t necessarily have to include pap smears or a pelvic workup each year. You should make an appointment if you note any changes or unusual symptoms, however. "Chronic itching, pain, discharge, very bad odor, bleeding, of course—all of those would be things to see a gynecologist or health care provider about, and have a pelvic exam," she says.
Above all, remember to voice your concerns, "Don’t be afraid to speak to your OB/GYN or physician about what’s going on," says Dr. Swica. "Even though we know somewhere between 25 and 45 percent experience symptoms, only about a quarter of women bring it up with a healthcare professional. And doctors don’t bring it up with women. Women think this is part of aging, because no one talks about it. Don’t let it go and let it get worse, because all this is treatable—very treatable."
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