What Happens When Your Vagina Gets Old?

If you’ve finished menopause and notice that your labia are no longer plump, your vagina is itchy or your libido is MIA, you’re not alone.

Those symptoms and others have an official name: genitourinary syndrome of menopause, or GSM. Everyone’s symptoms are different. Yet it’s common enough that the American Urological Association issued guidelines for doctors meant to help women identify their challenges and find relief.

You’re Not Alone

You might have noticed that your genitals look and feel different and that urination is suddenly hard to control. It’s not something that most women talk about. About 50 percent to 80 percent of post-menopausal women have similar symptoms, but no more than a quarter discuss it with a medical provider. It all falls within the GSM spectrum, encompassing your vulva, vagina and lower urinary tract.

Low estrogen is the culprit. Your body makes less of the female hormone once you stop menstruating. Then the changes begin. These are common symptoms:

• Labia (vaginal lips) shrink or disappear
• Painful intercourse
• Dry and/or itchy vagina
• Bleeding after intercourse due to vaginal dryness
• Lack of bladder control
• Frequent urinary tract infections
• Labia and/or clitoris less sensitive
• No desire to have sex
• Vagina narrows

The medical community used to refer to this condition as vaginal atrophy, but the name has changed to represent all the possible effects. You might also hear the term vulvovaginal menopause.

Big and Small Workarounds

You can handle GSM in any number of ways. If nothing bothers you much, you might just accept your body’s evolution and give it little thought.

If you find one or two symptoms disturbing, you can take action. Here are examples:

• Moisturize. We moisturize our faces, so why not our vaginas? Try a nonhormonal vaginal cream, tablet or ovule capsule.
• Lubricate. Use a water-, oil- or silicone-based lubricant when having sexual intercourse. It will ease the way just as your natural lubrication used to.
• Stimulate yourself. With a partner, your fingers or a vibrator, stimulate your genitals to keep blood and lubrication flowing.
• Add hormones. If that’s not enough, ask your doctor about a vaginal estrogen topical product. Creams are best for targeted treatment; if your urethra is dry — the part urine comes out of, which is common — you can rub some directly onto it. These products are very low in estrogen and are not tied to causing breast cancer or stroke.
• Try testosterone. This is controversial, but testosterone supplements might up your sensation of well-being, increase your desire to have sex and even plump up your labia. It also might make your voice deep or your face hairy and could cause heart issues. This is best done with menopause specialists and with blood-level monitoring.
• Stretch your vagina. Ask a doctor or pelvic floor physical therapist about vaginal dilators.
• Keep up with kegels. Pelvic floor exercises similar to those you did during pregnancy can keep your muscles strong. Work with a specialist to find the movements that will help and not harm.
• Stay healthy. Medical conditions like diabetes, hypertension and vascular disease can dull sensation in your labia and clitoris. Controlling these issues might make a difference.

None of these steps is likely to make your vulva, vagina and urinary tract as they were when you were younger, but they are likely to make you more comfortable and improve your quality of life.

Speak Up

While the hot flashes you experience during menopause may eventually stop, GSM symptoms will likely worsen over time.

Still, as with all medical situations, you must be your own advocate. Arrive at your well-women doctor’s appointment with a list of specific questions related to your GSM symptoms. If the medical provider skims past your questions, persist; insist on getting a referral to a specialist such as a urogynecologist or find a new practitioner.

Take steps to make your older, different body perform the way you want it to, within limits. The right professional will guide you to the best steps.