Your Vagina, Vulva and Menopause

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In this extract from the brilliantly frank and informative The Vagina Bible, a gynaecologist explains exactly what is happening to your body in the menopause years

No woman has ever benefitted by learning less about her body.

The vulva is the ultimate multitasker. It is the most important organ for sexual pleasure, it protects the tissues at the vaginal opening, it is built to handle the irritation of urine and faeces, and it can deliver a baby and heal as if nothing happened. And do it all again.

The vulva is the ultimate multitasker

Oh yeah – and multiple orgasms.

The penis and scrotum have nothing on the vulva.

The problem? The vulva is often neglected. A lot of this vulvar neglect is a result of a patriarchal society’s lack of investment in and fear of female sexual pleasure. When we exclude the vulva from conversations about women’s bodies and sexuality, we erase the organ responsible for female orgasm.

The most important basic anatomic point of the lower genitals tract: the vulva is the outside (where your clothes touch your skin) and the vagina is the inside. The transition zone between the vulva and vagina is called the vestibule.

The penis and scrotum have nothing on the vulva.

How menopause affects the vulva

Oestrogen increases blood flow to the tissues and helps maintain tissue strength and elasticity. As levels drop, the tissues can become more fragile and lose the ability to stretch. The skin can also become thinner and feel dry, and there can be redistribution of fatty tissue.

The labia majora can shrink or change shape. The labia minora can reduce in size, and the ability of the vaginal opening (vestibule) to stretch can become impaired. The amount of erectile tissue in the clitoris also decreases with age. Whether this is an oestrogen-related phenomenon or simply part of normal ageing (muscle fibres shrink with age) is not known. We also do not know if the loss in clitoral volume has a role in the sexual difficulties some women experience during and after menopause.

How menopause affects the vagina

The lack of oestrogen affects glycogen deposition in the vaginal mucosa. The cells lose volume and there is less glycogen to feed lactobacilli, so they begin to die and different populations of bacteria can be established. Consequently, some women may notice a change in vaginal odour.

There is also a reduction in cervical mucus and less transudate (fluid that leaks from blood vessels into the vagina). Given the change in bacteria, cervical mucus and transudate, the vagina can feel drier and lubrication during arousal is reduced. The vaginal tissues become thinner and the ability to stretch is reduced.

For some women, the size of the vagina, especially the width, can shrink. Over time, some women can experience a shortening of their vagina. The combination of reduced discharge and thinner, less elastic tissues can lead to micro trauma and even visible trauma with sexual activity. 

The Vagina Bible by Dr Jen Gunter is published now. 

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