The main areas impacted by menopause are the vulva and vagina. Since the vagina is a central part of female anatomy and the reproductive system, it’s no surprise that the tissues change as female hormones change.
To better understand these changes, it’s helpful to know what is normal pre-menopause. The vulva (outer structures including the labia minora, majora, and the clitoris) and the vagina (internal structure leading to the cervix and uterus) are very estrogen-sensitive areas. Estrogen causes the tissue in these areas to be moist, stretchy, thick, and supple. Normally, the vagina is acidic, meaning of a low pH. This is thanks to the healthy balance of bacteria supported by the presence of estrogen and its effects on the tissue.As estrogen decreases, the vaginal lining becomes thinner, drier, and less elastic. This causes an increase in the pH. This combination of changes leads to increased itching and discomfort, more frequent UTI’s and vaginal infections, and pain during sex. These changes, overall, are referred to as the Genitourinary Syndrome of Menopause, or GSM.
Happily, effective treatments are available and are safe for use by almost everyone!
Changes during intercourse
More than half of women in post-menopause are affected by GSM.. This can make sex uncomfortable and even painful. Penetration can cause burning, itching, pain, and sometimes, tearing of the vaginal wall. And naturally, a great disincentive to having sex at all!
These changes aren’t isolated to your sex life, though.
Changes in urination
GSM can also cause painful urination, leaking urine, and frequent bladder infections. The tissues that line the urethra (the tube that connects your bladder to the outside) and your bladder are also very sensitive to estrogen.
Changes in appearance
Menopause can cause the vagina to feel and look different. The vaginal walls become thin, which isn’t something you can see since it’s internal. But you can see your labia minora and majora, which are part of the vulva, become thinner and flatter. The skin may look paler in color and seem more taught/tight. While it’s perfectly normal for your vagina to change in size and shape throughout puberty, childbirth, and menopause, pain is never normal and treatment is available!
Treatment for vaginal changes
Here are a few ways to manage symptoms, decrease irritation, and increase enjoyment of sex when you’re experiencing GSM.
- Lubricant can work wonders for vaginal dryness during intercourse
- Over the counter vaginal moisturizing products are available and can be used every few days to provide moisture and lubrication.
- Low-dose estrogen cream is a prescription treatment that acts locally to restore elasticity and moisture as well as reduce the frequency of vaginal and bladder infections.
- Similarly, DHEA (a hormone that converts to estrogen in the vaginal cells) can be used vaginally to manage symptoms and reduce infections.
- Another prescription medication called ospemifene acts on estrogen receptors to help manage symptoms effectively as well.
- All of the above prescription medications are safe for use by most people and do not increase the risk of blood clots or cancers as they act locally and do not increase your blood level of estrogen.
- Wear breathable cotton underwear to reduce irritation.
Reviewed by the Ovia Health Clinical Team
Sources
Gandi, Jason. “Genitourinary syndrome of menopause.” American Journal of Obstetrics and Gynecology. 215(6):704-711. Web. December 2016.
“New Solutions for Menopause-Related Chronic Urinary Tract Infections.” Women’s Healthcare of Princeton. Women’s Healthcare of Princeton. https://www.princetongyn.com/blog/new-solutions-for-menopause-related-chronic-urinary-tract-infections
American Urological Association: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
