How Your Vagina Changes As You Get Older

Hot flashes and night sweats can linger for several years, but they will eventually get better; vaginal changes from menopause only get worse, Faubion says. Around 50 to 60% of women report problems with vaginal dryness, she says, and if you're not taking steps to remedy those problems, you might find yourself in a vicious cycle.

"When sex hurts for women after menopause, there's this involuntary reaction," she explains. "You anticipate having painful sex, and then your pelvic floor muscles spasm to protect you. Your brain is saying, 'This is going to hurt,' "—and then it most certainly does. Believe it or not, while many of us are busy Kegel-ing away, some women might need physical therapy to loosen pelvic floor muscles, Faubion says.

If looseness is your problem, though, some postmenopausal women are at risk for a serious change called prolapse, which is when the connective tissues holding the uterus, cervix, or even the bowels loosens, allowing those body parts to…droop. This can be unnoticeable, Faubion says, or so severe that parts actually protrude out of the vagina. In some cases, women may need surgery to repair the damage.

So what should you do?

At any age, if any of these changes concern you or are making you physically uncomfortable, don't shy away from talking about it, whether you broach the topic with your ob-gyn, your regular doc, or a nurse practitioner. "Women need to be their own advocate," Faubion says. "If it doesn't sound like a medical provider wants to talk about this or feels comfortable with it, go see someone else."

If your discomfort is mild, it makes sense to start with good old-fashioned lube during sex. Stay away from anything with gimmicks like warming or tingling features, which can burn the vulva, Faubion warns. Remember that oil-based lube doesn't play well with condoms, and silicone-based lube can degrade your expensive silicone-based vibrators.

You might also try vaginal moisturizers, "the face cream for the vagina," Faubion says. "They work by binding to vaginal cells and holding water," she explains. Your body naturally sloughs off those cells every 2 or 3 days, meaning you have to reapply regularly.

If those options don't work, a prescription for vaginal estrogen may be the answer. Your doc can help you decide if estrogen in a cream, a tablet, or a ring is right for you; all three deliver vaginal and vulvar benefits in a low dose without the risks you've probably heard come with taking systemic hormone therapy. Not only does this treatment improve vaginal discomfort, it's also "dramatically effective," Faubion says, at reducing infections.