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The Truth About What Happens to Your Vagina During & After Menopause

Dr. Elizabeth Yuko is the Health Editor at SheKnows. She is a bioethicist and writer specializing in sexual and reproductive health and the intersection of bioethics and popular culture. She is an adjunct professor of ethics at Fordham ...

Is your vagina really 'use-it-or-lose-it' when it comes to sex after menopause?

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For some people, having a tight vagina is a desirable trait — and they may even decide to undergo a surgical procedure to get one. But for others — particularly those who are menopausal and postmenopausal — vaginal tightness can be part of a larger painful condition called vaginal atrophy.

Among the rumors floating around regarding what causes it, one is that not having sex during and after menopause could result in your vagina closing up. But is that true? Is your vagina really use-it-or-lose it, like your health savings account at the end of the year?

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In short, kinda. A lack of sexual activity may result in the contracting of the vaginal opening, making it smaller, particularly for those with vaginal atrophy. But it’s more complex than that.

Vaginal atrophy is characterized by dryness, inflammation and thinning of the lining of the vagina. Symptoms include the vaginal area appearing pale, shiny, dry and smooth, filled with little red dots and easily irritable. The vagina can also shorten and narrow, and as a result, may bleed easily.

So, what causes vaginal atrophy?

According to Dr. Yen Tran, an OB-GYN at Orange Coast Memorial Medical Center in Fountain Valley, California, it’s a drop in estrogen concentration in women, which may be worsened by the normal aging process, and usually develops gradually over a period of years. Additionally, the thinning of the vaginal skin makes it more susceptible to trauma, potentially leading to bleeding, ulceration and infection as well as painful intercourse.

Factors other than low estrogen levels can also impact the degree of atrophy, Tran told SheKnows, including stopping sexual activity, never having delivered babies vaginally, multiple prior vaginal surgeries, previous radiation to the area and/or being a smoker.

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Let's talk about sex

Speaking of sexual activity, Tran said that it does help preserve the vaginal area, presumably by increasing blood flow and tissue elasticity from mechanical stretching and exercise of vaginal tissue.

“Women who are sexually active with a partner or through masturbation or the use of vaginal dilators have fewer symptoms related to vaginal atrophy, including less urinary tract infection frequency,” she added.

For people who don’t have partners or have partners who can no longer have intercourse, the use of vaginal dilators (available in sets of graduated sizes) and masturbation with moisturizers may help maintain a healthy vagina.

But what if sexual activity is painful because of vaginal atrophy? This catch-22 situation is exacerbated by the fact that up to 70 percent of women with symptoms of vaginal atrophy do not discuss their condition with a health care provider, according to Tran.

“Cultural, religious and societal beliefs may play a role in making women feel uncomfortable discussing such concerns,” she added. “That is why it is important to find a gynecologist that you feel comfortable in sharing your intimate problems with.”

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It's not an open-and-shut case

If you do have vaginal atrophy, there are ways to treat it, including tablets, rings, oral medications, topical estrogen (cream or suppository) as well as a laser procedure that stimulates the vaginal lining to develop normalizing thickness, followed by stretching using a dilator or resuming intercourse.

As far as the frequency of sexual activity, Tran said that the ideal is two to three times per week, if possible (although there’s no “official recommendation”). If not, she suggests mechanical stretching exercises like masturbation with moisturizers or usage of vaginal dilators.

“A healthy sex life after menopause looks a lot like a healthy sex life before menopause,” Dr. Marc Winter, an OB-GYN at Saddleback Memorial Medical Center in Laguna Hills, California added. “Things may take a little longer (response to stimulation may be longer) and help may be needed (treating atrophy in women and erectile dysfunction in men), but many women are able to continue to enjoy an active sex life as they age.”

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