Vaginal Atrophy—Yep, We’re Talking About It (Because We Need To!)

Do you have a vagina? Then I'm talking to you. Yes, YOU!

A quick note on school…I start in less than a month. My first day at school is April 4th!

---

Welcome to the kind of information that I hope to share a lot more of in the future! If the title of this article makes you feel a little squirmy, that’s why I’m writing it.

Only three months into my 40s and I feel like I haven’t stopped talking about vaginal atrophy for at least two of those months and I can assure you no matter how many times I say it, the term doesn’t get any less abrasive. I think it’s time for a rebrand and along with that rebrand some education that starts going out to people with vaginas in their twenties! (Ok so it kinda did get a rebrand, as genitourinary syndrome of menopause, or GSM, but that is definitely not solving the ick problem).

Here’s what I’m talking about when I say vaginal atrophy:

Vaginal atrophy happens when lower estrogen levels cause the vaginal walls to become thinner, drier, and less elastic.

askabigailnpcnm

A post shared by @askabigailnpcnm

In the image above you can see more clearly what I’m talking about. Vaginal atrophy does not mean your vagina will just shrivel up like a prune but it does mean things are not as plump, soft, and elastic as they once were.

Alright so here is what I wish I had known years ago:

It’s Not Just About Dryness

Vaginal atrophy can cause itching, burning, painful sex, and even urinary symptoms like urgency and frequent UTIs. While dryness seems to be the only thing ever really discussed in regard vaginal health in perimenopause and menopause, vaginal atrophy is one thing that I am on a war path about because I learned this fact….just wait for…

87% OF WOMEN EXPERIENCE VAGINAL ATROPHY

I’m shouting. Can you hear me shouting? Eighty freaking seven percent of people with vaginas will experience vaginal atrophy within their lifetimes and NO ONE is talking about it. Not our grandmas, moms, aunties, OR OUR DOCTORS…no one. A handful of years ago, when I had first heard about VA, I thought it was relegated to only elderly women and it was exclusively about dryness. I was so so so wrong. This is not reserved for the geriatric people in our lives, instead, it can hit even in early perimenopause, and that can hit in your 30s. This is no longer a future us problem, friends with vaginas. This is a “could happen just about anytime” past 30 years of age problem.

And I want to be clear here, that when I mentioned burning or painful sex above, I mean anywhere from some discomfort all the way to “absolutely not, get out of me” pain. Vaginal atrophy can take a perfectly healthy sex life and body slam it like a WWE showdown. Please do not discount early symptoms of dryness or discomfort.*

It Can Start Sooner Than You Think

Many people assume vaginal atrophy only happens post-menopause, but it can start during perimenopause (or even sooner with certain medical conditions, medications, or after childbirth).

If you’ve even heard the term vaginal atrophy, it’s likely that you also cringed (because why does it have to sound so aggressive?!) but you again thought, it’s probably only a menopause thing.

Also, a fun tip because we’re here to educate:

Menopause is when a woman’s menstrual cycles permanently stop, marking the end of her reproductive years. It officially happens when she has gone 12 months without a period and is caused by a natural decline in estrogen and other hormones.

Perimenopause is the transition period before menopause when hormone levels start to fluctuate, causing symptoms like irregular periods, hot flashes, mood swings, and sleep issues. It can last a few months to over 10 years and usually starts in your 40s (but sometimes earlier).

Most of what we were taught as young adults that was identified as “menopause” is actually perimenopause, which again, can start in your 30s. So if menopause marks the complete end of your cycle, that means perimenopause is the roller coaster of hormones before menopause and this is where you can start to experience vaginal atrophy.

Lube Alone Isn’t Enough

While lubricants help during sex (and everyone should be using them all the time regardless of their age or status), they don’t treat the underlying issue and you’ll know pretty quickly if the lube alone is not solving your problems. If you’re using copious amounts of lube and it still feels like you’re having sex with a broken Coors Light bottle…it’s not the lube. It’s not dryness. It could be pelvic floor dysfunction, but it could also be vaginal atrophy. If you’re younger than 30, I recommend talking to your doctor about both pelvic floor therapy and the possibility of VA because they are treated differently. Additionally, if you’re doing pelvic floor therapy and nothing is changing and even the dilators are causing pain, it may be time to dive into VA as a potential cause of your pain.

Additionally, if you can tell me whether you were a Backstreet Boys fan or a N’Sync fan…it’s time to talk about vaginal moisturizers. Sorry to break it to you babe, but it’s not just your face that needs some moisture.

Vaginal moisturizers are a thing but because Estée Lauder doesn’t make one, we don’t talk about them. Many brands and different options are available, most of which can be purchased without a prescription. You’ll apply this moisturizer mostly to the outer labia and clitoral region, and sometimes right at the vaginal opening itself. As you age, and lose moisture from your body, you will notice that your inner and outer labia may change**. You might feel like they’re shriveling up…and they kind of are but fear not! This is where the moisturizers come in and on the market, there are some with and without hormones, there are also some that are a combo lube and moisturizer, which is a nice little twofer.

It Doesn’t Just Go Away on Its Own

Unlike a temporary hormonal shift, vaginal atrophy is progressive without treatment. Vaginal atrophy cannot be reversed but it can be slowed. DO NOT LET THIS SCARE YOU! There are many products and prescriptions on the market to support you if you are experiencing VA including moisturizers like I mentioned, estrogen cream, and even laser procedures. But it’s most important to remember that it’s tough to restore tissues that have been atrophying for a long time, so do not wait to talk to your doctor if you are experiencing any of the symptoms I have mentioned!

If You Don’t Use It, You’ll Lose It

I think about all the people I know who have had babies that were hard on their bodies, managing their postpartum lives, trying to reconnect with their partners while parenting, or even just managing their partner’s sexual expectations…it’s easy to see why many marriages suffer to engage in meaningful and pleasurable sexual connections. This is not reserved just for parents either, many child-free people also experience deep lulls in their sexual connections. I think lack of sex leads to resentment, the same way being pressured to have sex can lead to resentment. The Kinsey Institute reports that adults over 40, have sex on average about 1.3 times per week, and considering our modern-day lives where people are busy, stressed, and always on the brink of burnout it’s no wonder our sex lives are lacking the care and effort they deserve.

This is the fact that hit me the hardest: the longer you go without inserting something into your vagina, whether that be vaginal dilators, or regular sexual activity (solo or partnered), the more likely and severely your vagina will begin to atrophy. When estrogen levels drop, the vaginal walls become thinner, less elastic, and drier. Without regular stretching or stimulation—whether through sex, dilators, or even self-exploration—the tissues can shrink and tighten over time, making penetration increasingly difficult and even painful.

So if you’re someone who is struggling to make time, energy, and effort for your sex life I understand your dilemma. I also now bear the weight of telling you that will likely make your sex life worse in the long run, which frankly just doesn’t seem fair at all.

*Doctors Don’t Always Bring It Up—So You Have To!

Many doctors don’t ask about vaginal health unless you bring it up and/or are still far behind the curve on these symptoms and how to treat them or what they even mean. It’s important to remember that you have to advocate for yourself fiercely. If your doctor is blowing off your concerns, see a new one. And if it happens again…see a new one again and again and you keep going until someone starts listening and taking action.

** Yes, your Labial Folds Could Be Fusing Together

I am so sorry to break this to you because again, it shocked the shit out of me but yes, Labial fusion (or labial adhesion) can happen when the inner and outer labia stick together due to thinning, dry, and fragile tissue—often caused by low estrogen levels.

It all goes back to that moisture. When estrogen levels drop during perimenopause and menopause your inner and outer labia also lose their moisture and elasticity. This can lead to small, tiny tears in the tissues; when they heal they can slowly grow together over a long period.

Labial fusion is discussed EVEN LESS than vaginal atrophy but it can be treated though it cannot be fully reversed. What are the treatments? Good news, if you’ve made it this far you already know.

1. Vaginal moisturizers

2. Estrogen creams

3. Staying sexually active

So this is your cue to run, not walk to your next gyne appointment to tell them EVERYTHING. Everything that feels embarrassing or weird or scary. The things you think are not a big deal, or can’t possibly happen to you. You’re gonna walk in there next time and spill ALL the tea about your vagina because that is the best way you can keep your bits and bobs healthy, happy, plump, and functional!