Perimenopause is a transitional stage characterized by fluctuating estrogen levels. We have estrogen receptors all over our bodies, so it is not surprising that every organ system can be affected. When it comes to the vulva and vagina, these areas can be particularly affected by perimenopause because they are highly sensitive to estrogen. Here is a glimpse into what changes you can expect to see and how you can best care for your intimate skin.
One of the first changes you will notice is that your tissues are not as moist. Likely, you will have less of your own natural lubrication, which may first become evident during intercourse. Estrogen stimulates glands in your vagina to produce secretions, helping maintain your pH balance, prevent infection, and keep you comfortable overall. You may also notice dryness on your vulva, which can make the skin feel easily irritated and sensitive.
Vaginal atrophy is where the tissue in your vagina becomes thin, dry, and inflamed. Aside from lower estrogen levels, one of the reasons this occurs is because there is less blood flow to the area once you enter menopause. Atrophy can lead to discomfort in your everyday activities (like working out, chores, and even walking). It can also cause distressing urinary symptoms, like frequent UTIs. Often, women are diagnosed with GSM, or “Genitourinary Syndrome of Menopause.”
Changes to the labia
We usually focus on the changes occurring inside our vaginas, but there are also significant changes on the outside. And this is an area we can actually visualize. The perry team sat down with Dr. Staci Tanouye, M.D., FACOG, to talk about what happens to your labia during perimenopause and beyond. Here is what we learned from Dr. Tanouye:
“Estrogen is what keeps our skin thick, supple, and with a good amount of lubrication… Initially, during perimenopause, you can get some hyperpigmentation or darkening of the skin but over time as your transition through menopause and later menopausal years, this actually changes and the area becomes a little more pale.”
In addition to that, you lose elasticity not only in the vaginal area but also in the external labia vulvar area as well. Collagen decreases, elastin decreases, so the skin support of that area decreases as well just like the rest of our skin as we age. Over time, with the lack of estrogen the labia can also kind of fuse to each other so you can lose the skin folds in that area due to the lack of estrogen.”
Habits To Implement In Caring for Your Intimate Skin
Changes are inevitable, but with daily care and some well-deserved attention, you can prevent discomfort.
Gentle hygienic practices - If you were an avid user of heavily perfumed soaps, now is the time to opt for a gentler cleanser. Many OB/GYNs recommend using even a mild, unscented baby soap with a soft washcloth to help remove dead skin cells, sweat, and excess oils.
Wear breathable underwear - Cotton is the best fabric for allowing your skin to breathe. Women of all ages should opt for cotton underwear most of the time. Oh, and speaking of breathability, bedtime is the perfect opportunity to let your intimate skin feel free.
Be careful with hair removal techniques - Hair removal like waxing, chemical removers, and shaving are more likely to irritate and tear the skin once you enter perimenopause. Be extra cautious when using these methods.
Focus on your strength - When you enter your 40s and 50s, you may notice your pelvic floor strength decreases. Yet, we need a strong pelvic floor to help maintain the structure and position of our pelvic organs, including the bladder, uterus, vagina, and rectum. Women who have had vaginal deliveries are even more likely to experience decreased pelvic floor strength, as are women who are overweight.
Surprisingly, strengthening your pelvic floor muscles can have a positive effect on your vulvar and vaginal skin. We all lose muscle tone and strength as we get older, but strengthening exercises can give more structure to your skin. Incidentally, pelvic floor exercises also draw more blood flow to the area, providing more oxygen and nutrients to your tissues.
Exercises that focus on pelvic floor toning, like yoga and pilates, can help decrease vaginal or uterine prolapse and urine leakage.
Sex - Women often experience a decreased libido in perimenopause and menopause. However, sexual arousal can do wonders for your tissues because it brings blood flow to your vagina and vulva. As we get older, the vagina can become shorter and narrower with more fragile tissues. Having regular sex can help delay these changes from occurring.
However, you don’t have to have intercourse to reap the benefits of arousal, which is good news for women who struggle with dryness. Focus on clitoral stimulation by incorporating a vibrator or using a gentle oil to help stimulate this area.
Use a moisturizer - Dryness is the main culprit behind most of the discomforts women experience in this area. When it comes to your vulva, use Rosebud Woman's Honor Everyday Balm, specifically formulated for this purpose, Even though your vulva is external, it still deserves a product that will not increase your risk for infection or irritation.
Julia Walker, RN, BSN is a women’s health nurse and advocate. She is a member of the perry team. perry is a social network for women in perimenopause - connecting & supporting like-minded warriors in the same stage of life. The community offers a safe space for women to feel understood, unite and tap into knowledge and resources from menopause experts.
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.