Andrew Siegel MD 1/14/2016
The vagina and vulva of a young healthy adult has a different appearance (as well as functional ability) than that of a female after menopause. After menopause—with its dramatic reduction in estrogen production—the female genital tissues no longer have the availability of the hormone that keeps the genital tissues vital. Age-related changes of the vulva and vagina occur on the basis of the ravages of time and lack of estrogen-stimulation following menopause. The vagina becomes thinner, dryer, and less elastic with diminished length and width, lubrication potential and expansive ability. This can give rise to symptoms including vaginal dryness, irritation, burning with urination and pain and bleeding with sexual intercourse. All in all this adds up to diminished quality of life.
Menopause is a significant risk factor for the occurrence of anatomical and functional changes that result from reduced levels of the female hormone estrogen. The vestibule (plate of tissue upon which open the vagina and urethra), vagina, urethra and base of the urinary bladder have abundant estrogen receptors that are no longer stimulated, resulting in diminished tissue elasticity and integrity. The labia become less robust, the vaginal opening retracts and the vaginal walls thin and lose the “tread”(rugae) that is typical of youth. The skin of the vulva becomes paler, thinner and more fragile. Because of this array of changes, the aging vagina can have difficulty lubricating and in accommodating a penis, resulting in painful sexual intercourse, a situation that affects more than two-thirds of post-menopausal women.
Often accompanying the physical changes of menopause are diminished sexual desire, arousal and ability to achieve orgasm. Pain, burning, itching and irritation of the vulva and vagina—particularly after sexual intercourse—are common. Urinary changes include burning with urination, frequency and urgency and recurrent urinary infections. Prior to menopause, healthy bacteria reside in the vagina. After menopause, this vaginal bacterial ecosystem changes, which can predispose one to urinary tract infections.
Considering that nature’s ultimate “purpose” of sex is for reproduction, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect the anatomy and function of the sexual apparatus.
The aging vagina was at one time referred to with disparaging terms including “atrophic vaginitis,” “vulvar and vaginal atrophy,” and “senile atrophy.” There are many such hurtful and cruel labels for female issues, including “frigid” for women who have difficulty in achieving sexual climax as opposed to the clinical term “anorgasmic.” A much kinder, although technical term for the aging vagina is “genitourinary syndrome of menopause” (GSM).
6 Ways To Keep Your Vagina Youthful:
- Stay Sexually Active Regular sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Vaginal penetration increases pelvic and vaginal blood flow, which optimizes lubrication and elasticity. Orgasms tone and strengthen the pelvic floor muscles that support vaginal function. “Use it or lose it” is the rule. Be sure to use plenty of lubrication if vaginal dryness is an issue.
- Pelvic Floor Exercises Pelvic floor muscles play a vital role with respect to sexual, urinary and bowel function as well as the support of the pelvic organs. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) to help maintain pelvic blood flow, sexual function, pelvic support and urinary/bowel control. The pelvic floor muscles play a vital role with respect to all aspects of sexual function, including arousal, lubrication, clitoral and vulvar engorgement and sexual climax.
- Consider Topical Estrogen Replacement This is a means of achieving the advantages that estrogen provides to the genital issues using a cream formulation that is applied locally. There is minimal absorption and it therefore avoids the vast majority of adverse effects that can occur from oral hormone replacement therapy. A small dab of Premarin or Estrace cream placed in the vagina three or four nights per week prior to sleep can restore vaginal suppleness and increase tissue integrity. This will help improve lubrication, pain with intercourse, urinary control issues and can help prevent urinary infections.
- See Your Gynecologist You bring your car in for annual preventive maintenance to a mechanic, so do the same for your lady parts.! Your gynecologist is on your team with a goal of keeping you and your vagina healthy. Gynecologists have some new tools at their disposal to combat GSM, including lasers that can be applied to the vestibule for purposes of skin resurfacing and restoration.
- Healthy Lifestyle It is desirable to keep every cell and tissue in your body healthy via intelligent lifestyle choices. These include: smart eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.
- Avoid Excessive Time In The Saddle Bicycle riding, as well as any other activity that places prolonged pressure on the “saddle” of the body (including motorcycle, moped, and horseback riding), are potential causes of impaired genital function. Although this is rarely a problem for the casual or recreational cyclist, it can be a real issue for women who spend many hours weekly in the saddle. When cycling, intense pressure is applied to the perineum (area between vulva and anus), the area of the body that can be considered to be “the heart” of the blood and nerve supply to the vagina and pelvic floor muscles.
Bottom Line: All things eventually get old, including vaginas and vulvas. We are not in control of the aging process and sooner or later Father Time reigns supreme. However, by adhering to some commonsense advice you can maintain vaginal youth and vitality for many years.
Wishing you the best of health,
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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.
Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com
Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com