Get those pearls ready to clutch!

Ready to dive into all things vulva and vag?

As a reminder, we’re tackling this topic without even a smidgeon of shame. No gasping or clutching of pearls allowed, got it?

Sure, we’re talking about unpleasant changes to your most intimate body parts, but can you imagine how much better off we’d all be if we talked about this stuff openly with each other and our care providers?

When it comes to menopause impacts to the vulva and vagina, there is no reason to suffer in silence because there are safe, effective ways to alleviate discomfort. But you have to be willing to communicate what’s going on to have your needs met, and that starts here and now.

With that out of the way, let’s get started!

First, can you review some anatomy?

Yep! The vulva refers to your outside body parts between the base of the pubic bone to just before the anus: the clitoris, the urethra, labia majora and minora (i.e. the outer and inner lips), and the vaginal opening, etc.

The vagina refers to the inside fibromuscular tube that connects the vulva with the uterus.

Also, remind me why changes happen?

Both the vulva and vagina rely on estrogen to keep tissues healthy, plump, lubricated and strong. As estrogen declines during the menopause transition, both the tissue and the microbiome in those areas change, regardless of the severity of other menopause symptoms. When these changes occur, it’s called Genitourinary Syndrome of Menopause (GUSM or GSM).

Give it to me straight. What changes should I expect?

The most common symptom of GUSM is vaginal dryness but other common symptoms include:

Vaginal and vulvar itching, burning, irritation, bleeding, pain
Pain with vaginal penetration (many women refer to this as “sandpaper sex”)
Irritation of the skin after wiping
Clitoral pain and/or shrinkage, and difficulty reaching orgasm
The labia minor can resorb (dissolve) leaving the urethra and vagina unprotected and more vulnerable to trauma and chronic infections.
Changes in smell and discharge

Without vaginal estrogen therapy, vulvovaginal atrophy will occur in 50-80% of menopausal women. Some menopause experts believe these changes occur to some degree in all women as estrogen declines and continues to stay low post menopause.

The good news is that vaginal estrogen therapy (prescription medicine formulated as a cream, tab or ring that stays in the vaginal area) is super safe for all women, and a great option for restoring vaginal and vulvar tissues.

Systemic hormone therapy (prescription hormone therapy that circulates through your whole body) can also be helpful, but isn’t an option for women at risk for breast cancer or blood clots.

Some women will need both MHT and vaginal estrogen therapy to treat their GUSM symptoms, so be sure to bring it up with your care provider if your symptoms aren't managed with just one or the other.

What else can I do to take care of fragile vulvar and vaginal tissue?

So many things! Here are some ideas:

• Find a lube you love and make it non-negotiable during sex. Silicone and oil based lubes work great (*please note: latex condoms are NOT compatible with oil based lube). Water based lube is more likely to be irritating, so unless you want to do some research and spend time looking at ingredient lists, I’d find a silicone or oil based lube that you like the feel of. Some women also use straight up coconut or olive oil, which is fine. Bonus: women who use lube are more likely to orgasm - how’s that for incentive!
• Moisturize! Moisturize! Moisturize! There are lots of great over-the-counter vaginal moisturizer options. Especially vaginal moisturizers containing hyaluronic acid, which is a large molecule found in and around skin cells that lubricates and hydrates cells. Avoid anything with fragrance, as it can be irritating.
• Switch from soap to cleanser. The vagina and vulva are basically a self-cleaning oven and don't need any product to stay clean. But if the idea of washing up with just water makes you uncomfortable, use an unscented cleanser which will keep the protective layer of the skin intact. CeraVe or Cetaphil cleansers work great, and you can get a foaming cleanser from either brand if you still want something that suds.
• Change your wiping strategies. Blot yourself clean instead of wiping after peeing, and avoid wet wipes as most wipes contain ingredients that will irritate delicate vulvar skin.
• Leave a landing strip. Pubic hair helps trap moisture against the vulva which is important as estrogen declines and vulvar skin thins and dries out. Removing pubic hair (by waxing or shaving) also damages the top layer of the delicate skin and leaves it vulnerable to irritation and infections.
   

Anything else I should know?

Always (haha).

First, a note about vaginal rejuvenation lasers and radio frequency devices. While these therapies show promise, neither the American College of Obstetricians and Gynecologists nor the North American Menopause Society recommends them for GUSM. Good data on safety and efficacy isn’t available yet, and these treatments come with risks. In plain english: they are experimental procedures so proceed cautiously.

And last, a quick reminder that most doctors, nurse practitioners and PA’s didn’t receive adequate medical training about menopause and don’t know how to treat GUSM. You can look up a menopause-trained doctor in your area (gynecologists and urologists both specialize in the pelvic area) or book a telemedicine appointment with a menopause specialist through companies like Midi Health, Evernow or Alloy.

Next post, we’ll dive into the urinary tract, pelvic floor and bladder impacts of menopause - I bet you can’t wait, lol.

In the meantime, I’m sending you lots of love and well wishes for a healthy, happy, plump, moisturized vulva and vag today, tomorrow and forever.

xo, Rebecca