Here's EXACTLY what to expect.
By Sarah Klein
If you're not the kind of woman who regularly examines herself south of the border, you might not realize that, just like the rest of your body, your vagina is getting older.
It's not that your vagina is celebrating your exact birthday. After all, "your body doesn't know that the calendar is changing," says Alyssa Dweck, MD, an assistant clinical professor of obstetrics and gynecology at the Ichan School of Medicine at Mount Sinai in New York and a practicing gynecologist in Westchester County. But genitals undoubtedly change as time goes on, and knowing these changes are totally normal—and that the unpleasant ones can often be managed—at least offers a little comfort.
Women using birth control pills in this decade (or before, or after!) might find themselves with a little vaginal dryness, Dweck says, possibly because the pill stops ovulation, which might limit natural lubrication around that time each month.
Another cause is complicated and a bit controversial, says Stephanie S. Faubion, MD, director of the Office of Women's Health at Mayo Clinic and author of Mayo Clinic—The Menopause Solution. "We think some women may get more vulvar dryness with birth control pills because the pills are blocking male sex hormones called androgens, and the vulva has androgen receptors." It's unclear, she says, why some women on the pill feel these effects and others don't.
Of course, other women may decide during this decade that it's time to populate the planet. Obviously, pregnancy (and childbirth) has a major impact on the vulva and vagina, but some of the changes common to the miracle of life are a little more surprising.
For example, some women will find themselves with varicose veins down there—yes, really—due to the heavy weight of their uterus while pregnant, Dweck says. These engorged blood vessels are more common late in pregnancy and right after delivery, she says. Pregnancy hormones might also change the color of your vulva, so don't worry too much about a darker hue appearing, she adds.
Luckily, "the vagina is a very forgiving place," Dweck says. Due to its elastic nature and rich blood supply, things tend to go back to normal shortly after giving birth. "It's still amazing to me even after all these years in practice," she says.
However, muscle and nerve damage can also occur due to the amount of force put on the pelvic floor muscles during pregnancy and labor, Faubion says. "Some physical therapists argue we should all get a little bit of instruction after having a baby," she says, to help rehab your way back to optimal pelvic health. For some women, pelvic floor exercises can help prevent incontinence down the road and keep sex sexy.
If you've been a slave to pubic hair removal, you might start to notice the effects of constant waxing or shaving in the form of pigment or skin changes, Dweck says. Your hair down there might also start to thin around this decade, possibly as a natural consequence of getting older or due to declining estrogen.
That estrogen drop signals the perimenopausal transition that's likely to begin in this decade, as most women usually reach menopause somewhere between the ages of 50 and 52. You might notice the beginnings of vaginal dryness or changes in elasticity.
Menopause brings with it the most noticeable vaginal and vulvar changes, not to mention the ones women are most likely to bring to the attention of their doctors, Faubion says. Dwindling estrogen leads to thinner, less elastic, drier vulvar and vaginal tissue, which can make sex feel like using sandpaper and cause irritation that makes you feel like you need to pee.
Recently, some medical experts have been campaigning for these changes to be formally referred to as genitourinary syndrome of menopause, or GSM, Faubion says. The name change (many used to refer to it as vaginal atrophy, which just sounds icky) isn't supposed to make you feel like you have a capital "S" syndrome, necessarily, but to draw attention to the fact that this cluster of vaginal, vulvar, and urinary symptoms accompanies menopause regularly. It's a reminder to women and their health care providers that there are ways to treat these symptoms, Faubion says. (More on treatment later!)
If you were to gaze at your privates with the help of a hand mirror, you might notice some obvious changes to the look of your vulva in this decade, as women lose fat and collagen that was there when estrogen was aplenty. "I tell women this is the one place on your body you want wrinkles and folds and the one place on your body you lose wrinkles and folds with menopause," Faubion says, as the thinner, less elastic skin can cause the whole area to, in a sense, shrink.
When estrogen leaves the building, so do certain bacteria that make their home in the vagina, which changes its pH. When the vagina becomes more acidic, it might become more vulnerable to infection, Faubion says, but the loss of elasticity may also be to blame. Tiny tears can form more easily in a less lubricated, less flexible vagina, Dweck explains, making it easier to catch something.
Hot flashes and night sweats can linger for several years, but they will eventually get better; vaginal changes from menopause only get worse, Faubion says. Around 50 to 60% of women report problems with vaginal dryness, she says, and if you're not taking steps to remedy those problems, you might find yourself in a vicious cycle.
"When sex hurts for women after menopause, there's this involuntary reaction," she explains. "You anticipate having painful sex, and then your pelvic floor muscles spasm to protect you. Your brain is saying, 'This is going to hurt,' "—and then it most certainly does. Believe it or not, while many of us are busy Kegel-ing away, some women might need physical therapy to loosen pelvic floor muscles, Faubion says.
If looseness is your problem, though, some postmenopausal women are at risk for a serious change called prolapse, which is when the connective tissues holding the uterus, cervix, or even the bowels loosens, allowing those body parts to…droop. This can be unnoticeable, Faubion says, or so severe that parts actually protrude out of the vagina. In some cases, women may need surgery to repair the damage.
So what should you do?
At any age, if any of these changes concern you or are making you physically uncomfortable, don't shy away from talking about it, whether you broach the topic with your ob-gyn, your regular doc, or a nurse practitioner. "Women need to be their own advocate," Faubion says. "If it doesn't sound like a medical provider wants to talk about this or feels comfortable with it, go see someone else."
If your discomfort is mild, it makes sense to start with good old-fashioned lube during sex. Stay away from anything with gimmicks like warming or tingling features, which can burn the vulva, Faubion warns. Remember that oil-based lube doesn't play well with condoms, and silicone-based lube can degrade your expensive silicone-based vibrators.
You might also try vaginal moisturizers, "the face cream for the vagina," Faubion says. "They work by binding to vaginal cells and holding water," she explains. Your body naturally sloughs off those cells every 2 or 3 days, meaning you have to reapply regularly.
If those options don't work, a prescription for vaginal estrogen may be the answer. Your doc can help you decide if estrogen in a cream, a tablet, or a ring is right for you; all three deliver vaginal and vulvar benefits in a low dose without the risks you've probably heard come with taking systemic hormone therapy. Not only does this treatment improve vaginal discomfort, it's also "dramatically effective," Faubion says, at reducing infections.
This article was originally published at Prevention. Reprinted with permission from the author.