Menopause brings a host of changes to a woman’s body, many of which can be unexpected and challenging. Here, Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University, discusses the physical changes the vagina undergoes due to decreased estrogen levels, and the significant impacts of those changes on women’s genital health.* 

Thinning, Drying, and Pain

During the menopausal transition, the thick wall of the vagina, characterized by folds that allow it to expand, becomes thinner and less flexible. This can lead to painful penetration during intercourse, even if arousal is present. 

In severe cases, inflamed red patches near the vaginal opening can cause “stabbing” or “fiery” pain. 

Over-the-counter vaginal lubricants or moisturizers can alleviate some of this discomfort, but in more persistent cases, Streicher says, vaginal estrogen may be necessary.

UTIs, and What’s Going on With Your Vulva

The tissues lining the vagina and urethra both contain estrogen receptors, making them vulnerable to drying out as estrogen levels drop. This dryness can lead to urinary tract infections (UTIs) due to the proliferation of harmful bacteria. 

According to Streicher, you can help prevent bacteria from sticking to the walls of your bladder through:

• Good hydration, 
• Regular urination, and 
• Cranberry supplements.

Menopause also affects the vulva, leading to a thinning and flattening of the labia minora, the folds of skin protecting the vagina and urethra. 

In some cases, Streicher says, menopausal women may lose their labia minora entirely. These changes can complicate penetration, underscoring the importance of addressing both internal and external genital health during medical consultations.

Vaginal Flora and Pelvic Floor Health

Another little-known fact Streicher shares is that menopause can alter your vaginal pH, changing the makeup of your vaginal flora (aka vaginal microbiome). This shift can heighten your risk of vaginal infections. 

Bacterial infection caused by vaginal pH imbalance can lead to inflammation and irritation of your pelvic floor muscles. This can cause them to weaken, resulting in urinary incontinence.

What You Can Do

Vaginal estrogen treatment, says Streicher, while primarily used for other menopause-related symptoms, can help restore a healthy pH balance and promote beneficial bacteria, and strengthening your pelvic floor through specialized exercises, often guided by a physical therapist, can help manage these symptoms and improve bladder control.

In Short

Ultimately, navigating menopause involves understanding and addressing various physical and hormonal changes. By recognizing these issues and seeking appropriate treatments, you can manage your symptoms effectively and maintain your quality of life during and after this transition.

*Migala, J. (2024, January 1). 5 Changes That Happen to Your Vagina During Menopause. Everyday Health. https://www.everydayhealth.com/menopause/vaginal-changes-occur-during-menopause/ 

Responsum Health closely vets all sources to ensure that we always provide you with high-quality, reliable information. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, or procedure discussed within.