If you’ve noticed that your vulva looks or feels different these days — thinner, for example, or more easily irritated — it may be due to perimenopause. Falling levels of estrogen during and after menopause are associated with thinning tissue and less moisture in the entire vulvovaginal area.
What exactly is the vulva?
The vulva refers to all of the external sex organs in your genital area, including:
- The labia majora (the outer folds of skin)
- The labia minora (the inner folds of skin)
- The vestibule (which the vagina and urethra open into)
- The Skene glands (located on either side of the opening to the urethra)
- The Bartholin glands (located on either side of the opening to the vagina)
- The clitoris (located at the top of the labia minora and covered by the clitoral hood)
- The perineum (the area between the vagina and the anus)
Issues associated with vulvar changes
When the tissue in the vulvovaginal area begins to lose moisture and elasticity, it can lead to a number of issues, including soreness, itching, burning, redness, rashes, and an increased risk of infections. Your body also makes less collagen after menopause, which can lead to a loss of fat tissue in the area. Urinary incontinence, which is also common, can increase the risk of some of these symptoms.
You may notice that your clitoris, which typically looks like a tiny, soft bump, has actually gotten smaller due to this loss of fat, fluid, and blood flow. As a result, the same touching, rubbing, and other clitoral stimulation that once led to pleasurable feelings may now sometimes cause pain, soreness, or oversensitivity.
Treatment options
To start, there are some tried and true ways to decrease general irritation and increase moisture. Start by keeping your vulva protected from urine leakage by using incontinence products, not menstrual pads. Many experts also recommend avoiding any wet wipes, scented products, sprays, or douches. These can all further irritate and damage your vulva’s more sensitive skin.
Other potential treatments may include over-the-counter vaginal moisturizers (again avoiding any scents), which can help with dryness and itching, and topical estrogen, which can help make vulvovaginal tissue more flexible and supple.
Localized hormone therapy is both very effective and very safe for the vast majority of women. Topical estrogen is prescribed either as a cream or as a tablet or ring you insert into the vagina. Similarly, DHEA suppositories are prescribed for the same purpose as DHEA is a hormone that changes to estrogen within the vulvovaginal cells. Both increase the estrogen in the vulvovaginal tissues and can be life changing! Neither increase the risk of cancer or blood clots. So they are different from systemic hormone therapy in that regard.
Most importantly, don’t hesitate to bring up issues like these to your healthcare provider. Most women don’t get treatment because they never mention they are experiencing these symptoms. But treatment is available. So advocate for yourself, you are worth it!
Reviewed by the Ovia Health Clinical Team
Sources
American Urological Association: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
