Dealing with vulvar changes during menopause

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 fluid and mucus 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 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. Topical estrogen is prescribed either as a cream or as a tablet or ring you insert into the vagina. 

Lastly, talk to your healthcare provider about the benefits and risks of hormone replacement therapy (HRT), which may relieve vulvar as well as vaginal irritation by increasing your estrogen levels. HRT has also been shown to be effective in treating hot flashes, insomnia, and mood disorders in menopausal women.

Reviewed by the Ovia Health Clinical Team

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