A healthy vagina is lubricated, supple, and elastic.
It’s supposed to be able to stretch (for obvious reasons, like both penetrative sex and childbirth), but then it’s also supposed to go back into place afterwards.
It’s supposed to get lubricated and stay at least a little moist pretty much most of the time, with extra lubrication when you’re sexually excited (and at certain times during your cycle).
The skin of the vulva and your inner and outer lips, when you’re younger, doesn’t droop and it doesn’t tend to sag. I don’t know what the right adjective is–taut seems wrong–but the skin of the vulva forms a consistent shape.
But that doesn’t mean that the vagina is always like this. Different things can interfere with the lubrication and suppleness of the vagina, and that can impact sex.
We’re spending some time Fact Checking some common beliefs about sex this month, and I want to spend a few posts looking particularly at the idea:
Does orgasm stop after menopause?
I’ve heard this from so many women, and I’ve talked to a bunch of OB-GYNs about it, and looked at the literature, and so I’d like to explore it further in a few posts. Today I want to talk about maintaining the health of the vagina, and next week I’ll talk about why orgasm may be more elusive after menopause (though it isn’t for many women!).
I’ve written about this a bit before, and I’ll revisit some of those posts, because I’ve had a lot of requests for posts on menopause, and I haven’t addressed it in a while.
But even if you’re not in menopause, it’s good to know this stuff beforehand.
When Rebecca and I were speaking at Calvin University in Michigan last weekend, one of the questions we got while on a panel was about menopause. There are so many misconceptions out there, and knowing what to expect, even when you’re years away from menopause, is helpful.
So, let’s get back to the vagina.
It’s mostly the hormone estrogen that keeps the vagina functioning smoothly.
Estrogen increases blood flow to the genitalia to keep it moist, taut (for lack of a better word), and supple. Estrogen keeps everything moving nicely.
But what happens when estrogen starts to diminish?
Women in their 40s and 50s and beyond have less estrogen in their bodies, and this impacts the vagina in a variety of ways–general comfort, and, of course, sex!
1. Less estrogen can cause vaginal dryness
A healthy, young, post-pubertal vagina tends to be at least a little moist. Not like a mouth moist, but it’s similar. That makes basic movement easier, and it creates a healthier and more comfortable environment for all kinds of things (including sex).
But a normal, menopausal vagina is a lot dryer. That can cause a bit of daily discomfort, as moving around when things ar dry can become uncomfortable, but it can especially show up in the bedroom when your mind may be raring to go, but your vagina and vulva haven’t gotten with the program.
At older ages, you can even have breakthrough bleeding which can look like a mini-period, even decades after menopause. If this happens, please see a doctor immediately. But it doesn’t always mean something like cancer. You can just get “all dried up”! And that’s why finding other ways to keep lubricated can help.
2. The vagina can also experience thinning, sensitivity, and tearing
With less estrogen, the vaginal tissues start to get thinner. And we already know they get less lubricated.
So picture tissue that is thinning and more fragile, and that is dry, and then imagine what thrusting against that tissue would feel like.
Yep.
Lots of women get tearing and microfissures of the vagina from sex after menopause.
3. The vagina can also experience shortening and tightening
As the vagina gets less lubricated, it can also start to “shrink”, causing penetration to feel quite tight, and even causing the vagina to shorten (so the length from the opening to the cervix becomes shorter).
4. Less estrogen can also increase the chances of infections
Finally, the lubrication that women get due to increased estrogen is also largely responsible for the good bacteria in our vaginas. When the lubrication goes away, some of that good bacteria can as well, causing some women to have more frequent UTIs (urinary tract infections) after menopause.
So what should you do to help your vagina–before and after menopause?
Before menopause, your vagina will thank you if you:
Learn how to do Kegel exercises
Keep your pelvic floor muscles in great health to help prevent prolapse (where organs push in and down the vagina), incontinence, and more when you’re older. (Here’s a post from the Mayo Clinic on how to do this.)
Figure out how to make sex great for you!
Figure out now, before menopausal changes come, how to experience real pleasure. Learning how to get turned on will help you later when sex starts to pose some special challenges.
Get help with painful sex or postpartum pain
If you’re experiencing pain during intercourse, or if you’re not healing as well as you’d like to postpartum and sex has now become difficult or feels different, please see a pelvic floor physiotherapist, or talk to your general health provider. When we don’t get things checked, we can actually make things worse. You shouldn’t have to live with pain, or with loss of sensation.
During and after menopause, your vagina will thank you if you:
Have lots of sex–that is actually pleasurable for you!
Intercourse without pleasure or orgasm will not help you. But intercourse where there is lubrication (even if it’s bought), and where you do orgasm, can really help! It can prevent shortening of the vagina; it can help maintain elasticity; and it can help you with muscle control.
Get help to stay lubricated
You are not less sexual when you hit menopause. You can want sex just as much and enjoy sex just as much (more on that next week!) But you just may need some help getting lubricated.
Introducing Femallay’s Vaginal Melts
A few years ago, Femallay sponsored this blog, and I tried out their products and was really impressed. So I still recommend them heartily (and I’ll use Amazon affiliate links to point you to them!).
We’re used to thinking of “lubrication” as something that the husband puts on his penis that helps him thrust without discomfort for either of you.
That’s great–and it can help tremendously. But all it really does is help you temporarily feel more comfortable during sex.
What I like about Femallay is that they’re a women’s wellness company that’s focused on products that actually help YOU. Instead of a typical lubricant, Femallay’s vaginal melts are specially formulated to help address the many different challenges that our vaginas face as we age!
Femallay’s vaginal melts are suppositories made with botanical oils and butters, enriched with Vitamins A and E, that give your vagina the TLC it needs!
And they’re available in a wide variety of flavours (that’s fun!) with a wide variety of essential oils (and some that are completely unscented). And you can even order small sample packages to see which ones you like best.
The melts are soy-free, gluten-free, glycerin-free, paraben-free, hormone-free, and naturally antimicrobial. Made with vitamin E and other natural, luscious ingredients, they’re focused on nourishing the tissues so you don’t get the dryness and the tightness, and so that microfissures are much less likely.
Their melts come with a super easy applicator. You can use one daily to relieve dryness and minor irritation, or insert right before sex for some quick lubrication right when you want it! If you spend a lot of time swimming or in hot tubs, you can also insert one AFTER you get out (please not before!), because chlorine and hot tubs have a habit of drying us out even more. (Although you should wait until the evening to use them, so everything stays where you want it while you’re lying down and doesn’t leak out!).
What about younger women who also need some TLC?
Everyone is different, and some of you may need some help with elasticity even earlier–especially after childbirth! You may need some help with healing, or just to get back on track (check with your medical provider if you’re using them postpartum!)
If you’ve been struggling with sexual pain, these can also help once you’ve done the pelvic floor physiotherapy and retrained your muscles (please do that work too!).
We often don’t think about our vaginas much until something goes wrong.
We pay attention during our periods, but other than that–they don’t affect us much. They tend to be self-cleaning. They tend to regulate bacteria and yeast pretty well on their own. And that’s how we’re made! That’s a good thing.
But if we can pay attention earlier, we can find that we breeze through a lot of the changes that come with childbirth, menopause, hormonal changes, and more.
Your vagina is an awfully important part of you. So give it the TLC it deserves! (They also come in 3 packs which reduces the price dramatically).
Have you experienced changes in your vagina, or challenges? Let’s talk in the comments!
Fact Checked It For You Series
- Are Blue Balls Real?
- The 72 Hour Rule: How Evangelicals Convinced Women Men Need Sex Every 72 Hours
- Does Sex Hurt the First Time?
- How Does the Vagina Change After Menopause?
- Can You Still Orgasm After Menopause?
- Are Teen Girls Asexual?
- What if Your Small Child is Masturbating? (coming soon)
Doc said I have rectocele prolapse but I’m afraid a specialist will recommend surgery. Other options?
Find a pelvic floor physiotherapist. I’m sure it depends on how severe your rectocele is but a pelvic floor physiotherapist can help evaluate the severity and help you learn exercises to help compensate for the rectocele. Perhaps you can avoid surgery.
I have seen a pelvic floor therapist for a couple of issues over the years. They are kind, gentle, professional and very helpful. I had significant relief within days although I saw them for a few visits to make sure my issues resolved.
I just went through physical therapy this past year for rectocele and cystocele with fantastic improvement. The initial consult with the gun said I’d require surgery but I insisted on physical therapy because of my teen daughters’ success with their pelvic floor therapist (to help recovery from endometriosis surgeries).
Thank you for addressing this topic, and for the recommendation about product to use. My gyn has me on estrogen replacement and it has helped some, but I’d be very happy to give it a little more help! General, everyday discomfort from menopause and lichen sclerosis has been a thing for so long that I’ve almost forgotten what feels “normal!”
Just one more way that women are taught that sex will hurt so they should just accept it (and of course still have as much sex as their husbands demand). 🙄
And thank you for pointing out that a dry vagina and vulva can be uncomfortable if not downright painful just going about ordinary activities, like sitting in a chair or walking around or peeing.
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To other women who are suffering, i cannot stress strongly enough that you need to be your own advocate when the doctors you see don’t treat your pain and other symptoms seriously. Tell them to put it in your chart that they are not interested in helping you return to maximum health, then watch them to make sure they do. Then ask for a hardcopy printout of the visit notes so that you have a permanent record if they alter the notes after you leave. Bottom line, don’t take no for an answer.
(I’m imagining a forthcoming visit with my own GI specialist who will likely tell me there’s nothing he can do. I think I’ll simply assume a male voice and posture from the get-go, describe my ongoing symptoms and issues in the somewhat crude terms a man would use, then see if it all hits him any differently—and prompts him to dig deeper for treatment. I will not, however, hold my breath.)
Anyone else have a ‘time lapse’ with natural lubrication? Every time, I hope my body will kick in and produce its own, but it doesn’t, so I have to resort to the tube. And about 2 hours after, my body seems to wake up to the fact that it’s meant to be doing something and I have lots of natural lubrication when it’s too late to be any use!!! It’s not a huge issue as the artificial stuff works ok, but I’d just love to know what causes the delay.
I’d add to the other things the importance of checking your vaginal area so that you know what is normal and can get any weird lumps or colour changes checked out.
This article came at the right time. I’m going to get married in less than 2 months. I’m 47 and have been celibate for over 20 years, so I am not sure how sex is supposed to feel at my age. I’m going through perimenopuase. Oh, the joy of dealing with PMS symptoms such as bloating, cramping, moodiness along with menopause symptoms like night sweats and occasional hot flashes. I don’t know if I need lubrication at this point.
It’s likely not a bad idea, Laura! I mean, don’t rely on it INSTEAD of arousal, but it can make things easier and more fun!
Definitely keep some lubrication by you – I got married at 45, and I think I’ve managed once or maybe twice without using the artificial stuff. I’d also recommend applying it once or twice BEFORE your honeymoon, just to check that you don’t have any reaction/irritation to it, rather than finding out that it’s an issue once you are on your honeymoon! (I use one called Yes which has Aloe vera in it)
The best lube I ever used was coconut oil. I don’t know what it is about that stuff, but it was better than even olive oil — whole different feel. Highly recommend!
This page has information – and links to published, peer-reviewed studies – about the pros / cons / considerations for using coconut oil as a lube. https://www.health.com/condition/sexual-health/coconut-oil-lube
Ditto to the coconut oil. Smells good, not sticky, can be used everywhere. A simple massage becomes quite fun! No embarrassment buying it and feel so soft everywhere the next day.
Fabulous post – thank you!!
As someone still in the process of separating from an emotionally and sexually toxic partner, another relationship has been the furthest thing from my mind.
But being in the menopausal range I’m grateful to know that everyday changes are ahead and what those could look and feel like. I’ve never heard this conversation before.
I really do appreciate you so much.
Funny thing — I read your comment as “menopausal rage” for a second. And this is about how I feel about it, lol!
😂🤣😂
I’m not sure how I feel about it all yet. Nothing seems normal at this point. It seems I’m just along for a weird ride in my body!!
Feeling for you!!
Are the Femally Vaginal Melts FDA- approved or reviewed?
AFAIK Personal lubricants are regulated (I believe Class II in the USA).
Are there any peer-reviewed studies, clinical trials, or real world data supporting the claims in the post – about addressing dryness and tightness? Any studies showing the ingredients are safe, or appropriate for use in the vagina?
The Menopause Manifesto: Own Your Health with Facts and Feminism by Dr. Jen Gunter is really informative and helpful!
I’m in perimenopause. The best thing I’ve found for vaginal dryness and avoiding those micro tears was getting a vaginal estrogen cream prescription from my doctor. It’s great to supplement with otc solutions if you find that helpful but the body really needs the estrogen.
I follow @vaginarehabdoctor on tiktok and Instagram and her podcast. She’s a pelvic floor therapist providing education and coaching and teaches exercises to help with pelvic floor dysfunction. She has talked about how kegels can make you too tight and cause pelvic floor dysfunction, urinary incontinence, etc. so please talk to your gyno first. It’s not the right solution for everyone!
Dr. Mary Claire Haver @drmaryclaire on Instagram has been a good account to follow as well for menopause education.
Thank you, good information!
YES …. To all of the above 👆!!
Thank you for starting this series! Menopause is actually something that I’m a little bit scared of. I’m 39 this year, and I’ve had a lot of setbacks in my sex life over the years. I was a virgin at marriage only to discover I had vaginismus. We struggled with that and then three subsequent pregnancies, tons of moves/job changes (stress), low testosterone, and my autoimmune disease. Last year I found answers to a lot of health issues, dropped weight, and we no longer have the chaotic moves in our life anymore. Sex is finally going really well after all of these years! I’m just scared that it will not last that long and that menopause will steal something important to me away. I appreciate your generally positive and proactive outlook on things so I’m looking forward to what you have to say.
Prescription vaginal estrogen cream helps with all the functioning and all the infections.
Kelly Casperson is another good urologist that I follow for a lot of perimenopause and menopause-related education. Her work is inspiring me to take charge with my OB/GYN as I approach that range. And she presents a lot of the current research as well as tells which of the old stuff isn’t relevant anymore. She also addresses that much research is needed in this area because for so long most urologists and OB/GYNs were male and didn’t understand. Even the current females were largely trained by men. I found her on IG – https://www.instagram.com/kellycaspersonmd/#