The vagina, an internal organ in the female reproductive system, is not just a simple tube. It is a complex ecosystem influenced by hormonal changes that occur throughout a woman’s life, including puberty, pregnancy, breastfeeding, and menopause. As women age, the vagina undergoes several normal changes in the growth and function of its cells, as well as alterations in its microbiome – the groups of bacteria that reside within it. While many women may not notice these changes, they can occasionally lead to symptoms. In this article, we delve into the intricacies of the aging vagina and shed light on what happens as women grow older.
The vagina, like many other organs in the body, is sensitive to fluctuations in female sex steroid hormones. Puberty, pregnancy, and menopause are significant periods when these hormone levels change. Menopause, in particular, brings about a decline in circulating estrogen concentrations and an end to progesterone production. Such hormonal changes have profound effects on the vagina and its ecosystem. Some of the effects that may occur during menopause include reduced vaginal secretions, resulting in potential dryness, decreased growth of vaginal surface cells leading to a thinning of vaginal lining, alterations to the connective tissue supporting the vagina causing decreased elasticity and increased narrowing, a decrease in blood vessels surrounding the vagina, and a shift in the type and balance of vaginal bacteria, leading to changes in vaginal acidity.
Interestingly, many women do not observe any bothersome vaginal changes as they age. Furthermore, there is little evidence indicating that these changes lead to vaginal symptoms such as infection or bleeding in menopausal women. While some women may experience vaginal dryness after menopause, it remains uncertain how much of this dryness is directly linked to menopause itself, as younger women also commonly report this symptom. Studies suggest that approximately 47% of sexually active postmenopausal women experience vaginal dryness, along with around 20% of premenopausal women.
Notably, the changes in hormone levels after menopause do not solely affect the vagina. Other nearby organs, such as the bladder and urethra, also experience impact. Consequently, some women may encounter recurrent urinary tract infections, leading to pain and discomfort that is not solely originating from the vagina but is related to urinary tract changes.
It is important to recognize that every woman’s experience with vaginal changes and their level of concern may differ. Some women with vaginal dryness may not notice a change in vaginal secretions if they are not sexually active. Conversely, some women may experience severe dryness that significantly impacts their daily functioning and activities. Researchers worldwide are increasingly focusing on women’s experiences of menopause to guide future research. This includes prioritizing symptoms that matter most to women, such as vaginal dryness, discomfort, irritation, and pain during sex. While these symptoms can be distressing, the good news is that they are generally manageable.
Various strategies can be employed to alleviate vaginal symptoms and enhance comfort. Lubricants are frequently used to reduce pain during sexual intercourse, while vaginal moisturizers can combat dryness. These products are readily available over the counter at local pharmacies. However, it is crucial to note that although there are numerous clinical trials on individual products, their effectiveness in improving vaginal symptoms is yet to be definitively established. In contrast, there is strong evidence supporting the efficacy of vaginal estrogen in treating vaginal dryness, reducing pain during sex, and minimizing the risk of urinary tract infections. If considering this option, it is advisable to consult with a healthcare professional for a prescription. Typically, vaginal estrogen is applied using an applicator two to three times a week. The risk of systemic absorption is minimal, making it generally safe. However, longer-term trials are necessary to confirm its safety with prolonged use exceeding one year. Women with a history of breast cancer should consult with their oncologists to determine the suitability of estrogen therapy.
While hormonal treatments like vaginal estrogen are currently available, there is a growing need for more non-hormonal options. Researchers are actively exploring novel treatments for vaginal dryness. One avenue of investigation revolves around understanding how the vaginal microbiome adapts to changes in hormone concentrations. Some reports have suggested that combining vaginal probiotics with low-dose vaginal estrogen can improve vaginal symptoms. However, further evidence is needed before this approach is widely recommended.
The aging process and menopause bring about changes in the vagina. While most women do not experience troublesome vaginal symptoms during and after menopause, some may encounter discomfort or distress. Hormonal treatments, such as vaginal estrogen, have demonstrated effectiveness in managing these symptoms. Nevertheless, the need for more non-hormonal treatment options persists. With ongoing research and a better understanding of women’s experiences, we can hope for innovative solutions that cater to the unique needs of each woman as she experiences the ever-changing vagina.