When menopause strikes, topics about sexuality and vaginal changes are oftentimes hushed convos. Many women are not only uneducated but pitifully unprepared for what is coming down the pike with regards to the changes ‘down there.’
Obvious vaginal changes like graying, loss of pubic hair, dryness, thinning, opening and length shrinkage, and penetration irritation are pretty commonplace. The vagina also becomes more prone to not only urinary tract infections and bacterial vaginosis (discharge, itching, odor), but STD’s and HIV as well.
50BOLD spoke to Barbara DePree, M.D., a gynecologist, menopause care specialist and author of Fearless Menopause: A Body-Positive Guide to Navigating Midlife Changes to discuss a few of the sexual and vaginal changes that come with the ‘Big M.’
50BOLD: Does the vagina change after menopause? If so, what are the changes that take place?
Dr. DePree: When your estrogen supply begins to diminish your skin and other tissues lose collagen—the substance that keeps skin supple and youthful-looking. Loss of collagen causes vaginal and genital tissue to become thin and dry. You may also notice that your vagina no longer lubricates well when you become aroused. This is called vaginal atrophy and it can make sex very uncomfortable. Vulvovaginal atrophy can also exacerbate urinary tract infections and cause burning, itchy genitals.
50BOLD: What happens to a woman’s libido after menopause?
Dr. DePree: As we enter menopause and our hormone levels drop, spontaneous thoughts about sex and responsiveness to opportunities for sex diminish for most of us. That’s natural and normal. You say you find your partner attractive, you have a good relationship, and your gynecologist gives you a clean bill of health. And yet, you’re having trouble getting aroused. There is an FDA-approved hand-held device called Eros Clitoral Therapy that uses a vacuum system to help engorge the clitoris and increase arousal, lubrication, and overall sexual satisfaction in women.
50BOLD: Can testosterone cream really boost sexual interest and activity? Is it safe, and has it been tested especially with regards to breast cancer and heart disease?
Dr. DePree: Testosterone has been called the “hormone of desire” for women. In many studies over the years, replacing testosterone has been linked to greater sexual desire, more intense orgasm, and improved sexual performance in women. Yet, it’s still only available “off-label,” meaning that there’s no pharmaceutical brand approved by the FDA. Testosterone, in the form of injections, patches, pills, or creams, can be prescribed by using the male FDA-approved products in lower doses.
However, testosterone therapy remains controversial. Unlike in men, there’s no direct relationship between libido and blood testosterone levels in women. Additionally, appropriate levels of testosterone for women have been hard to establish since we produce so little of it. Before beginning testosterone therapy, it’s important to address other causes of loss of libido such as depression, medications, painful intercourse, lack of emotional intimacy, or even chronic stress.
For some women, testosterone is a game-changer and for others, not so much. Since the potential benefit is so positive and the detriment is minimal, in my opinion, testosterone therapy is a solid treatment option. Always consult with your healthcare provider to discuss available therapies.
50BOLD: What is your ‘vaginal maintenance plan?’
Dr. DePree: Generally, a maintenance plan for a healthy vagina and pelvic floor involves:
- Moisturizers. Use vaginal moisturizers like Replens, regularly—two or three times a week. Vaginal moisturizers help hydrate vaginal walls and maintain a normal pH balance. Your doctor might also prescribe a topical estrogen, which restores vaginal tissue to pre-menopausal condition without being absorbed into your system.
- Lubricants. Apply lavishly before and during sex to ease discomfort and add an element of fun.
- Kegels. These muscle-tightening exercises will tone your pelvic floor, which keeps your internal organs in place, makes orgasm more powerful, and reduces incontinence which we’ll discuss later.
50BOLD: Why do menopausal women have vaginal pain and dryness? Can women still orgasm after menopause?
Dr. DePree: The truth is that vaginal dryness does not end the intimacy you have with your partner or the afterglow you experience yourself after sex. Yes, it’s likely hormones. As estrogen levels decline, the vaginal lining changes. It becomes more delicate and less stretchy. There’s less lubrication and less circulation.
Vaginal dryness is a typical first sign of vaginal atrophy when vaginal tissues shorten and tighten, it’s common, you aren’t alone, and you aren’t deficient.
If you are just noticing some discomfort, you can take the easy step of adding a long-lasting silicone lubricant to your foreplay, like Replens Silky Smooth or Wet Platinum. Next, you can add a vaginal moisturizer. While lubricants provide temporary comfort and reduce friction during sex, vaginal moisturizers such as Replens, work to “feed” and strengthen vaginal tissues around the clock. I recommend an application of at least two to three times a week.
Menopause isn’t the end; it’s only a transition, which we as women have a lot of practice with. Take heart and take charge!
50BOLD: Will doing Kegels help with incontinence?
Dr. DePree: Bladder misbehavior in the form of incontinence and urinary tract infections (UTIs) is a common female complaint, and it tends to become more common and more troublesome as we age. This is because decreasing estrogen affects genital tissue and muscles in unhelpful ways.
This critical exercise for strengthening and toning your pelvic floor is your first line of defense for any weakening, sagging, or leakage. In several studies, Kegels were the one non-surgical treatment for incontinence that actually seemed to make a difference.
One way to challenge yourself and to ensure you’re exercising the right muscles is with Kegel weights or balls. Firm up those pelvic floor muscles, and you’ll help all those downtown organs stay where they belong. Kegels may not completely end all your incontinence issues, but they’re the place to start.