Vaginal Changes After Menopause

You’ve survived the hot flashes, sleeplessness and irritability of menopause. No more periods, no worries about birth control—this should be “prime time” for the two of you. Then you discover that sex has become increasingly uncom-fortable and that you’re more susceptible to vaginal irritations and infections. What’s going on?

“After puberty, estrogen helps keep a woman’s vaginal walls smooth, moist and firm,” says Patrice Weiss, M.D., director of medical education for obstetrics/gynecology at Lehigh Valley Hospital and Health Network. “After menopause, most women have noticeable changes in the vagina caused by the decrease in estrogen. The vaginal lining be-comes drier and thinner, the vagina narrows, and vaginal muscles begin to lose elasticity and tone.”

These changes can make intercourse really painful, she says. Even if you’re not sexually active, vaginal dryness can lead to itchiness, infection and bleeding.

What can you do?

Lubricate. You’ll find a variety of vaginal lubricants at the drugstore, including KY Jelly, Replens and Astroglide. (Water-based ones without fragrance are best.) These products make intercourse more comfortable, but they don’t resolve the underlying issues caused by lack of estrogen.

Use estrogen. Hormone replacement pills are no longer recommended for most women because of increased heart disease risk. But estrogen is also available in three low-dose topical forms—vaginal cream, vaginal tablet and timed-release vaginal ring. These require a prescription. Talk to your doctor or nurse practitioner about which would be best for you.

Exercise. Just like any other muscle, the vagina keeps its tone better when it’s used. Regular intercourse is an effective exercise. Kegel exercises (in which you tense and release pelvic-area muscles) help, too.

Communicate. Talk with your partner about your concerns rather than suffer in silence. It could be the beginning of a new level of closeness in your relationship.

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