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The 411 on Vaginal Changes After 40
Let’s be honest – there are some things that many women are still reluctant to talk about. Like the way our bodies change during perimenopause and menopause – and how those changes can affect not just our hormones, cognitive function and energy, but our most intimate areas too.
If you have noticed more dryness, itching, or discomfort in your vulvo-vaginal region, you are probably not imagining it, and you are definitely not alone. You may be experiencing something called ‘vulvo-vaginal atrophy’ (VVA), so let’s talk a little more about what that is. We’ll discuss what VVA is, why it happens and how you can find real soothing relief.
What is Vulvo-Vaginal Atrophy (VVA)?
Vulvo-vaginal atrophy was the older medical term used to describe the thinning, drying, and inflammation of the vulvar and vaginal tissues. VVA is typically linked to the decline in estrogen during perimenopause and menopause. Estrogen plays a key role in keeping vulvar and vaginal tissues hydrated, flexible and healthy. When levels drop, these tissues can become more thin, fragile and sensitive – leading to many local pelvic and genital symptoms women may experience through the menopause transition.
Today, this condition is more accurately described and referred to under the broader, more inclusive term of Genitourinary Syndrome of Menopause (GSM). GSM recognizes that these changes don’t just affect the vaginal and vulvar tissues, but they also impact urinary health and sexual wellness.
Common Symptoms of VVA
If you are wondering if you might be dealing with VVA, here are some common signs and symptoms to look out for:
- Vaginal or vulvar dryness
- Burning or itching around the vulva
- Discomfort or pain during intercourse
- Increased urinary urgency or frequency
- Recurring urinary tract infections (UTIs)
If any of this sounds familiar, it may be worthwhile to bring it up with your doctor, pelvic physiotherapist, or gynaecologist. These are possible symptoms of VVA; however it is important that you and your healthcare provider rule out any other medical conditions that may present with similar symptoms such as any active gynaecologic or urologic infection, or dermatology concern at play.
Finding Relief: What are your Options to Help Manage VVA?
The good news is VVA is very treatable. Depending on your needs and preferences, you may explore:
- Vulvo-vaginal Moisturizers:
- May be used for regular hydration on an ongoing basis
- Specifically created to help hydrate the vulvo-vaginal tissues
- May also include non-hormonal balms such as FemmeSense Balm which helps with daily vulvar hydration
- Vaginal Lubricants:
- Used for comfort during intimacy and sexual play
- Different from moisturizers as they are fast-acting, but not long-lasting
- Great to improve slide and glide during sexual activity but are not made to necessarily help maintain tissue health in the longer term like a moisturizer does
- Hormonal Treatment:
- Medications that come in a variety of forms (tablets, suppositories, creams, gels, etc.) and include hormones such as estrogen, progesterone, testosterone, and others
- Local hormones used in the vulvo-vaginal area can significantly improve VVA symptoms
- Pelvic Floor Physiotherapy:
- A form of treatment that can help guide women to better support their tissue health, mobility, and circulation
- Can help guide an individual who is having pain or difficulty with intimacy or penetration, and it is also considered first line treatment for those struggling with bladder urgency, frequency, or incontinence
- Avoiding the use of harsh chemicals, soaps and fragrances
- Ease symptoms of dryness, irritation and inflammation
These options may be used individually or in conjunction with one another – it all depends on what choice(s) feel right for you. Sometimes there may be some trial and error when sorting through which treatment(s) and dose(s) work best, but with some patience and perseverance, the right combination will come to light.
Let’s End the Silence
Vulvo-vaginal atrophy affects nearly 50% of postmenopausal women, yet it’s still whispered about. This needs to end and we are now at a tipping point, as menopause is certainly having a moment! So, let’s continue this conversation as you deserve to be educated, feel supported and informed about your body. Now that you have some insight in ways to manage VVA, I urge you to not delay and get treatment today!
References:
S Faubion, S Kingsberg, J Shifren, C Mitchell, A Kaunitz, L Larkin, S Kellogg Spadt, A Clark, J Simon (2020). The 2020 Genitourinary Syndrome of Menopause Position Statement of the North American Menopause Society. Menopause. 2020 Sep;27(9):976-992
S Johnston MD, C Bouchard MD, M Fortier MD, W Wolfman, MD (2021). Guideline No. 422b: Menopause and Genitourinary Health. JOGC. Volume 43, Issue 11, p1301-1307.
Angelique Montano-Bresolin, Reg. PT, BSc. PT, HBA Kin is an educator, practicing pelvic health physiotherapist, founder of Proactive Pelvic Health Centre, founder of Pelvic Health Hub and creator of FemmeSense Vulvar Balm.
