How menopause affects the vagina and vulva?

 

Transitioning into the last day of your final period can feel a lot like getting your first period; many women get confused, scared, they experience all kind of changes in their body and the information that they stumble upon regarding this subject is not necessarily clear and often times is filled with tons of speculations and myths and not nearly enough scientific data.

Finding a good source of information  is one of the key steps towards understanding your menopause journey and seeing how it might affect your vagina, vulva and everything else above and below it.

Many women experience changes in their vagina and they don’t know nor understand why.  Needless to say, they do not know what to do about it.

The book that speaks specifically about our vagina is “The Vagina Bible” by Jen Gunter.

Written by someone who actually has a medical degree and vast experience in this specific area of gynecology , Dr Jen Gunter  explains the changes our vagina and vulva experience throughout our lifetime, including menopause; to stay true to providing only best, most accurate information to you, we are using quotes from her book to try and better capture the effects that menopause has on the vagina and vulva.

 

Genitourinary Symptoms of Menopause

 

Menopause or GSM – the genitourinary syndrome of menopause is a term that is describing the various menopausal symptoms and signs that are associated with several different physiological changes of the vagina, vulva and the lower urinary tract.

The symptoms of menopause may include: vaginal dryness, decreased lubrication during sexual activity, post-coital bleeding, discomfort even pain during sexual activity, decreased arousal, orgasm, and desire for sex, irritation, burning or itching of the vulva or vagina, dysuria, urinary frequency, incontinence and urgency.

From these, as Dr Gutner puts, “vaginal dryness is the number one symptom” and it often times is followed with many of the other symptoms like “sandpaper feeling in the vagina, vaginal irritation, change in discharge, pain with sex, bleeding after sex, burning on urination, increased urgency and bladder infections.”

What is really frustrating is that most women who experience these symptoms actually do very little to recognize them and try to diagnose and treat them. Some women are ashamed, others wait for it to go away, and third simply believe that this is how it goes as you get older. In fact, as Dr Gunter  points out, “most women do not attribute their symptoms to menopause – in one study, only 4 percent thought they could be menopause-related.”

For women, often times  aging symptoms and menopause symptoms are intertwined and therefore ignored. However, this is not healthy and this behavior should not be spread.

Ignoring the symptoms and waiting for them to ‘get bored’ and ‘go away on its own’ won’t help. In fact, it will only make the situation much worse in the future; as Jen states, while 15% of women report symptoms during perimenopause, this number drastically increases to 50% of women experiencing different GSM symptoms after 3 years of menopause. That’s why, it is important to note the changes occurring during this turbulent period, note all your symptoms and don’t be afraid to discuss them with your doctor.

Following a treatment prescribed by a specialist of GSM will ease the process of menopause and help you restore certain control and power over your own body.

How the vulva/vagina changes during GSM?

 

The first thing we need to mention and point out is that all of our bodies are different and react differently to various stages of menopause; while some may not experience any major changes during menopause, a good percentage of woman, “approximately 50 percent of women” will experience tissue changes during their GSM.

During menopause, your vagina and vulva experience changes: simply put, Dr Gunter claims that “the vaginal tissues become thinner and the ability to stretch is reduced”. This occurrence used to be called vaginal atrophy; when this occurs, the tissue shrinks, which furthermore leads to changes in the size-width of the vagina – making it shorter. Combined with reduced discharge, this oftentimes leads to microtrauma and in some cases even visible trauma with sexual activity.

Nowadays, this terminology – vaginal atrophy, although medically accurate, is avoided due to the fact that these changes affect more than the vagina; it also affects the vulva and the urinary tract, leading to the new term, we previously explained – GSM.

As the level of estrogen drops during menopause, the skin of the vulva and the vagina become thinner since they lose elasticity and show the symptoms of GSM. Additionally, since estrogen is also responsible for maintaining the bacteria colonies of the vagina when its levels lower down, some women may also experience a change in the type of bacteria they have – which further results in a change of their typical vagina smell. This means changes in the smell can be another result of GSM.

Some of the changes that occur during GSM are on a microscopic level. Outside factors, such as smoking can also influence the symptoms of GSM and microscopic changes as they lower the estrogen levels. Nevertheless, it is important to know that the level of microscopic changes are not parallel and don’t necessarily mean fewer or more GSM symptoms; in fact, as Dr Gutner explains in the book, “Some women will have several symptoms of GSM and minimal microscopic changes, and some will not be bothered by symptoms and yet have severe microscopic changes.”

The changes that occur on the vulva and vagina during GSM often times are analyzed from a sexual perspective, meaning how they influence the sex drive, libido as well as whether or not they are to be held accountable for decreased sexual activity. One of the most frequently asked questions regarding menopause is focused on the relationship between sex and the changes that occur on the vulva/vagina during GSM, which leads us to:

Sex Lies and Libido

 

The number of myths related to the correlation between sex and menopause is always astonishing and definitely requires special attention. Dr. Gunter has her own views which is different from some of her peers. But this happens all the time in healthcare. Drs don’t always agree on what happening with their patient. 3 doctors, 3 different opinions.

Many theories claim that women experience pain or even GSM due to lower sexual activity, some claim that regular sexual intercourse will help lower the pain and symptoms and protect from the GSM symptoms, but the truth is much more complex than that.

Myth: “If you don’t use it, you lose it” – one of the most pretentious, stupid myths that unfortunately is widespread and used against women is the myth of “if you don’t use it, you lose it.” Basically, this theory as Jen wittingly puts, spreads “the mythology that a penis is a cure for everything” which one can’t help but laugh at.

Having sex does not mean your vagina will magically be cured of GSM and you will preserve it. It doesn’t mean that you will/will not experience GSM symptoms. That is not how our body works. The truth is, even if you are sexually active after menopause, you still can experience vaginal changes.

Having sex after menopause won’t lower the symptoms; when people spread this myth, they rely on the main theory that “the local trauma of sex keeps the tissues healthy, possibly due to increased blood flow” adding that the “repetitive pressure can stretch the tissue.” But this is not true, and as Dr Gunter points out from both her experience as a gynecologist and her own personal experience, that having ‘intercourse offers no protection.”

Numerous studies had confirmed that including the one Dr Gutner describes as “a more recent (2017) study looking at over 800 women and the net effect of menopause on the cells of the vagina found no difference in cellular changes between women having sex and those who were not. If sex were tissue-protective, women who were having sex would have fewer changes.” However, that is not the case, which completely debunks the entire myth.

In medicine, every treatment should be approached differently as each body is its own system which functions on its own and fights different types of issues. That’s why some women may experience severe GSM symptoms and others may not. Some women who are in GSM may experience decreased sexual libido as well, others may not. Even women who have no GSM symptoms can suffer from decreased sexual libido.

The truth is, each case is unique and different and should be approached as such.

The changes in the sexual libido, on one hand, can be explained and be related to GSM, but not necessarily. While it is true that “vaginal symptoms of menopause lead to sexual difficulties for many women, but certainly it’s not all.” Some women will experience pain during intercourse that will result in their GSM symptoms which will further make them avoid sex to protect themselves from that pain.

Yet, that is not the case with all women and certainly is not the solution. Searching help and treatment for GSM symptoms and trying to understand your own body will definitely help more in both saving your health and reducing pain and having a healthy sex life.

On the other hand, one should also not neglect the psychological and social aspect that influences the sex drive of older women. While yes, as we said, GSM might be the reason for some women choosing to avoid sex that may not be true for all.

We live in a society that shames women for being sexual creatures and oftentimes, sex in older women is seen as something shameful, something that is not ‘appropriate’ anymore, and this, of course, can also influence how sexually active older women want to be. Another reason for lowered sexual libido in older women that is completely unrelated to the GSM is the perception women have of themselves; they may feel like they are no longer attractive, or even uncomfortable in their own skin due to aging. This can also result in less sexual activity.

The point is, GSM or lowered estrogen levels are not the only reason for the loss of sexual desire among menopausal women. However, they may contribute to pain during sex. Because of this, as well as all the other issues that GSM causes, the symptoms of GSM should be taken seriously as well as experiencing decreased sexual desire after menopause.

Final Thoughts

 

Honest and open conversation with both your doctor who can give you a proper diagnose and therapy and your partner who can be aware of your feelings is the right solution and it is the only way to help you overcome any difficulties you may experience, regardless if they are GSM or sex-related.

For more information on all thing vagina, you can purchase your come of Dr Gutner’s book here.