Vaginal Health and Menopause: Everything You Want to Know But Didn’t Want to Ask

Do you ever get the feeling during menopause that your body has made decisions without you? Like, when did you give your vajayjay permission to become the Sahara Desert of the South Pole? Never, right? When vaginal symptoms like dryness and incontinence pop up during menopause, they can be disconcerting. You might wonder if such symptoms are caused by menopause or something else. We’ve got the low-down on vaginal health and sexual health problems you might experience during menopause and what you can do about them. Basically, we give you the answers that your body isn’t telling you.

vaginal health and menopause

Possible Common Vaginal Health Problems During Menopause

While the particular mixture of menopausal vaginal problems varies, the most common tend to fall into these categories:

  • Vaginal dryness caused by atrophy
  • Urinary incontinence
  • Recurrent urinary tract infections (UTIs)
  • Painful or uncomfortable sex

Let’s talk about symptoms first, then causes, then what you can do about them. Because you can do plenty! You’re not at menopause’s mercy, even if it sometimes feels like it.

Vaginal Dryness and Atrophy

Vaginal atrophy is the thinning, drying, and inflammation of the vaginal walls, caused by decreased estrogen. It occurs in one of every three people going through menopause. It’s not very fun. But, you can handle it with these do’s and don’ts! 

Ways to Improve Vaginal Dryness

  • Don’t use bubble baths, dryer sheets, moistened wipes, perfumes, and other irritants.
  • Do use vaginal lubricants during sex.
  • Do use vaginal moisturizers made with hyaluronic acid regularly. 
  • Do consult your healthcare practitioner if neither of the above steps work. The North American Menopause Society recommends consulting your doctor. Specifically, ask for a prescription of estradiol, estriol, conjugated estrogens, or promestriene gels, creams, ovules, tablets, or rings.

Urinary Incontinence

Urinary incontinence is a nice way of describing those not-so-nice moments when you accidentally pee your pants a bit when you sneeze, cough, or laugh. Isn’t that fun? Not! 

Types of Involuntary Urination

A few types of incontinence exist related to menopause, depending on which part of your plumbing isn’t working right:

  • Stress Incontinence. This is the most common type of incontinence. Imagine the muscles that keep your urine where it’s supposed to be as ticket takers at a concert. Picture them being all over the age of 60 and bombarded with a million young concert-goers. This is stress incontinence when the physical changes caused by menopause weaken your gate-keeper muscles so that they can’t always control the flow.
  • Urge Incontinence. Sometimes your bladder muscles are to blame, rather than your “pee muscles.” Those bladder muscles might squeeze incorrectly, causing leakage.
  • Overflow Incontinence. Sometimes, your bladder muscle might just be tired, or “underactive.” This can cause continuous urine dribbling. 

Ways to Decrease or Treat Urinary Incontinence During Menopause

Two types of bladder leakage treatment exist. First, those things you can do at home. Second, treatments only a doctor can prescribe or help you with. In general, experts suggest:

  • Modifying your fluid intake: Decrease the amount of caffeine-containing liquids (because caffeine irritates the bladder), carbonated drinks, and alcohol. Instead, increase the amount of more beneficial fluids like water, cranberry juice to at least 48 oz. a day. These fluids dilute too-concentrated urine, which can also irritate the bladder.
  • Training your bladder: According to Merck Manuals, bladder training involves “Having a person follow a fixed schedule for urination while awake. The doctor works with the person to establish a schedule of urinating every 2 to 3 hours and suppressing the urge to urinate at other times (for example, by relaxing and breathing deeply). As the person becomes better able to suppress the urge to urinate, the interval is gradually lengthened.”
  • Doing Kegel exercises: These are especially helpful if you’re suffering from stress incontinence. However, you have to make sure you’re exercising the right muscles for them to be effective. For one to two seconds, squeeze the muscles around the urethra and rectum that stop the flow of urine. Then relax them for 10 seconds. Repeat this exercise about 10 times three times a day. You should be able to gradually increase the squeeze time to about 10 seconds each time. If you can’t identify the right muscles to squeeze, or the exercises don’t seem to work, your doctor can help. 
  • Seeing your doctor: If your symptoms of urinary incontinence are bothersome or interfere with daily life, consult a doctor. They have a variety of tests for determining the exact cause of your urinary incontinence and the appropriate course of action. You would want to start by asking your primary care physician. He or she may refer you to a urologist, who focuses on urinary tract issues. Or, a urogynecologist, who is more versed in female bladder problems.

Chronic Bladder Infections

Urinary tract infections (UTIs) are the most common bacterial infection in women, according to a 2017 study. About half of all women who were assigned female at birth will get one sometime in their life. Furthermore, they’re more likely to get them during the menopause transition. Although some biological women can have UTIs and show no symptoms, others may experience any or all of these symptoms:

  • Pain or burning during urination
  • Urge to urinate often
  • Pain in the lower abdomen
  • Urine that is cloudy or smells bad

UTIs aren’t usually serious if treated promptly. They’re also more likely to recur during and after the stages of menopause. This is because your urinary tract, like many other parts of your body, doesn’t like that it’s getting less estrogen. Estrogen gave it strength, after all. So, the same thing that causes UTIs during the menopause journey also contributes to ongoing incontinence.

Ways to Prevent, Resolve, or Treat Recurrent Urinary Tract Infections

Studies show that probiotics, cranberry extracts, and supplementation with d-mannose (a kind of sugar found in many fruits) can reduce the risk of urinary tract infections. If they aren’t effective for you, estrogens delivered directly to the vagina also reduce the number of urinary tract infections.

Ways to Prevent, Resolve, or Treat Recurrent Urinary Tract Infections

Studies show that probiotics, cranberry extracts, and supplementation with d-mannose (a kind of sugar found in many fruits) can reduce the risk of urinary tract infections. If they aren’t effective for you, estrogens delivered directly to the vagina also reduce the number of urinary tract infections.

Painful Sex During the Menopause Transition

Painful sex during menopause can really put a kibosh on intimacy. People who experience this type of pain usually say it happens during penetrative sex and describe it as a feeling of dryness or “sandpaper” to severe pain. 

The Causes of Painful Sex During the Stages of Menopause

Things like vaginal thinning and dryness—trademarks of menopause—are usually to blame for painful penetrative sex during menopause. Additionally, the Mayo Clinic and Healthline report that these other factors can come into play:

  • Injury or trauma
  • Scarring from pelvic surgery
  • Eczema
  • Lichen sclerosus (thin, white patches of skin, usually in the genital area)
  • Vaginismus (automatic reaction to the fear of vaginal penetration)
  • Certain medications, which can contribute to vaginal dryness
  • Pelvic floor dysfunction
  • Endometriosis
  • Uterine fibroids
  • Vaginal atrophy

Ways to Make Sex After Menopause Less Painful 

These options may help you reduce painful penetrative sex:

  • Vaginal lubricants and moisturizers
  • Pelvic floor exercises with lubricated dilator
  • Low-dose vaginal estrogen cream, vaginal tablet, flexible vaginal ring, or prasterone
  • Medication (e.g., Ospemifene)
  • Seeing a counselor or sex therapist

Again, you can do a variety of things on your own. If they’re not effective, then you can involve a professional.

Check out our comprehensive list with tips to rock your sex life during menopause.

Less Common Vaginal Health Problems Associated With Menopause

Not every menopausal maven going through menopause will experience one or more of the above common vaginal health problems. Fewer still will experience these less common vaginal health problems. However, you’ll want to be aware of them so that if you do experience them, you can know what to do.

Yeast Infections 

Suzane Somers, author of I’m Too Young for This: The Natural Hormone Solution to Enjoy Menopause, says, “With overuse of antibiotics, many women upon reaching perimenopause find themselves with recurring yeast infections.” 

What Causes Yeast Infections

Antibiotics taken by mouth tend to kill the bacteria that normally reside in the vagina, which prevent yeast from growing. So if you get a yeast infection during menopause, which isn’t likely, it’s probably because the “flora” of your vagina has changed (did you know you had flora down there?). And that can be caused by the double-whammy of overuse of antibiotics and the loss of estrogen.

Ways to Remedy Yeast Infections

Whatever the cause of a yeast infection, the remedy is the same:

  • Reduce carbohydrate and sugar intake.
  • Take a pharmaceutical-grade caprylic acid or grapefruit seed extract.
  • Lower your stress levels.
  • Take omega-3 fish oil, probiotics, possibly digestive enzymes. [source]

Genitourinary Syndrome of Menopause (GSM)

GSM is a less-common vaginal health problem whose symptoms are a round-up of the common vaginal health problems caused by menopause. Unlike other menopausal symptoms, though, GSM tends to stick around and even worsen after menopause. Estimates of how many women experience it range from 27 percent to 84 percent, so whether it’s “less common” is debatable. Regardless, you’ve got a variety of options that start with ones you can do on your own. However, you’re usually better off getting your doctor involved sooner rather than later on this one.

What to Do About GSM

Remedies for GSM are similar to remedies for painful sex and urinary incontinence and usually take care of its milder symptoms. There are some variations, though, and, again, steps you should take if the at-home ones don’t work:

  • Vaginal lubricants and moisturizers
  • Low-dose vaginal estrogens 
  • Vaginal DHEA supplementation
  • Systemic estrogen therapy 
  • Medication with Ospemifene 

Discomfort Not Directly Related to Menopause

The North American Menopause Society says that there are some vaginal health problems not directly related to menopause. These might include vaginal discomfort, not necessarily during penis-in-vagina (PIV) sex, and they can and do occur during the phases of perimenopause and post-menopause. 

Vaginitis

Defined as inflammation of the vagina, vaginitis can be caused by:

  • Estrogen-related vaginal atrophy
  • Yeast or bacterial infection
  • Irritation from soap or hygiene products

Symptoms can include:

  • Vaginal discharge
  • Itching
  • Burning
  • Swelling of the vagina and vulva
  • Pain during urination

Once the exact cause is determined, relief can be obtained with medication and/or stopping use of the irritating product. As much as we hate to say it, you might have to dump those wonderfully-smelling perfumed soaps for the sake of your hoo hah! But your vagina will thank you for it.

Vaginismus

If the muscles at your vaginal opening or in the perineum (the area between the vagina and the anus) involuntary spasm or contract, this is vaginismus. It tends to make sex difficult or impossible and can be caused by:

  • Trauma related to past sexual abuse
  • Fear of sex, maybe as a response to painful intercourses caused by estrogen deficiency
  • Lack of sexual experience

Treatment once again depends on the causes and can include:

  • Cognitive-behavioral therapy
  • Physical therapy
  • Relaxation exercises
  • Vaginal dilators
  • Biofeedback
  • Medications

Other Urinary Tract Conditions

In addition to recurrent infections, these other conditions can include:

  • Irritable bladder syndrome
  • Urethritis
  • Sensitivity to latex condoms
  • Prolapsed bladder

To determine the best treatment for any of these urinary tract conditions as well as for vaginitis or vaginismus, consult your healthcare providers.

Assembling Your Menopause Healthcare Team

Speaking of healthcare providers… after reading about all the many ways that things can go south with your southern parts, you might wonder if your regular doctor will really be able to identify your specific problems, let alone their root causes and treatments. Or you might hope that all you have to do is talk to your primary care physician and he or she will be able to magically prescribe the exact right pill or cream to make your problem go away immediately. My advice? First, get educated, like you’re doing already by reading this article (yay you!). Next, adjust your expectations. Then, put together a menopause healthcare team. You have so many options for professionals who can rally around you and provide you with the support you need.

Paying Attention to the Feels

If you’re mad at estrogen for leaving you with any of these possible vaginal health problems, we get it. If you’re sad that your brain and body parts don’t get that you want to join the conversation, totally understandable. Would you laugh at us if we told you that sometimes the best way to handle those feelings is to move through them? Feeling the feels and letting them all hang out, but not obsessing over them, can often help you cope. You can grieve your passing youth, but realize that there are better days to come.

Communicating With Your Partner About Vaginal Issues and Sexual Health

On top of working through any of these vaginal health problems and the emotions that might come with them, you might be worried about your partner. Because both of you will have similar but different feelings about your sexual relationship, including your sexual activity and sex drive, listening, validating, and showing empathy is key. 

How to Communicate With Your Partner

As difficult as it may be, communicating with your partner is critical to moving through menopausal changes. Specifically, consider doing the following: 

  • Describe your symptoms and feelings to help your partner better understand you. 
  • Allow them to share their feelings.
  • Listen as they open up to you. 
  • Ask questions to clarify and gain more understanding. 
  • Acknowledge and validate whatever frustrations they convey with empathy. 
  • Emphasize your focus on proactivity and resolution, for both your sake and theirs. Communication—especially healthy communication—should be a key component of your “I’m-going-to-survive-and-thrive” menopause plan.

Consider couple’s therapy if you and your partner struggle to listen to, validate, or show empathy for each other.  

It’s a Wrap!

Vaginal health problems during menopause can show up in a number of common and less-common ways, including:

  • Urinary incontinence
  • Painful sex
  • Vaginal dryness
  • Recurrent UTIs
  • Yeast infections
  • GSM

Each of these come with their own set of symptoms and troubles. But, plenty of ways exist to improve your vaginal health and your sexual health during menopause, including:

  • Taking care of the physical symptoms, on your own or with your healthcare team’s support
  • Paying attention to your feelings
  • Communicating with your partner

Altogether, you’ve got lots of options.

Sources

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