Reading: 5 Things You Need to Know About Your Midlife Vagina

We boomers received a funny kind of sex-education. At least many of us did. While our moms were pretty circumspect about sex, the book Our Bodies, Ourselves filled in a whole lot of blanks about sexual health. As teens we compared notes with our girlfriends and learned firsthand about menstruation; in our 20s we talked about pregnancy and childbirth, but for the most part left miscarriage and infertility out of the conversation, discussing instead the gory details of screaming and pooping during delivery; and now, 30 or 40 years later, we’ve clammed up as we head into (or are well into) menopause. Why aren’t we talking about the changes taking place with our bodies? Why are we limiting the conversation to bad jokes about hot flashes? The fact is, there’s a lot going on down there, just as there was when we were turning into “women,” and then again when we were producing offspring, and then again when we hit our 40s and were finally truly comfortable with how our bodies work. So, let’s talk about “it” —  the aging vagina.

Vaginal dryness is one of the most common issues women over 50 experience. Like hot flashes, vaginal dryness results from declining hormone levels. It can make sex vaguely uncomfortable or excruciatingly painful. And it can lead to a downward spiral: that is, sex is uncomfortable, so we postpone it. And then, because we aren’t providing those tissues any attention to boost their circulation, the dryness gets worse — so we put off sex some more. Mom didn’t mention lubricants, either, or vaginal moisturizers, which are the easiest way to make intercourse not only comfortable but pleasurable, even with a dry vagina.

Lower hormone levels also mean shrinking vaginal tissues. A young vagina is like a pleated skirt (with what we doctors call rugae); that’s how it accommodates babies as well as penises of various sizes. As we lose hormones, that pleated skirt is remade into a pencil skirt. Like a pencil skirt that’s straight and tight, older vaginas lack elasticity.

Add a newly un-elastic vagina to dry fragile tissues, and the cause of discomfort is very clear.

So, what to do:

If you are perimenopausal: Since keeping vaginal tissues healthy is easier than restoring them to health, start a moisturizing routine now.

If you’re post-menopausal: Talk to your healthcare provider about localized estrogen or other prescription options (Osphena and Intrarosa are two choices) that aid in vaginal health.

The Big O becomes evasive:

In keeping with the clothing analogy … While our vaginas go from pleated to pencil, the clitoris goes from maxi to mini. We experience what men often call shrinkage; but, unlike for men, clitoral shrinkage is a permanent condition that has nothing to do with being cold. The clitoris — the entire genital area, actually — atrophies, losing 80 percent of its volume. In updated lingo, doctors call this  “genitourinary syndrome of menopause,” replacing the prior term vulvovaginal atrophy.

A smaller clitoris, less sensitive tissue, and lower testosterone can add up to “evasive orgasms.” The good news is that we can delay and decrease clitoral shrinkage and evasive orgasms by increasing stimulation. That means more foreplay, more masturbation, and the addition of vibrators and warming lubricants. Another solution is to be more direct with our partners, explaining what we need to get there. Remember, since the clitoris benefits from use, the more stimulation it receives, the more responsive you’ll be.

That’s all well and good, except for this final, added twist:

After menopause, we lose up to 80 percent of our testosterone production. With less of this “hormone of desire,” you’ll need a strategy to keep the home fires burning. Consider marking time for sex on your calendar. While it doesn’t seem romantic, if you don’t use it, you’ll lose it. You’d be surprised how many women I see in my practice who’ve just realized they haven’t had sex in a year.

“I feel betrayed by my body,” a patient experiencing vaginal dryness told me. And that’s why knowing and understanding is key. Being prepared can help us age not only gracefully but with greater empowerment.

And don’t forget to tell your daughters. Please.