You’ve likely noticed some of the drawbacks of aging—wrinkles, a decreased metabolism, and memory loss, to name a few—but your vagina doesn’t deal too well with old age, either. In fact, there are a whole host of changes that occur down there, starting in your 40s. While most of the aging-related differences you’ll notice in your lady parts (like an increase in dryness and yeast infections) are just simply annoying, others can be serious. Here’s the deal:
Your Uterus Can Fall Into Your Vagina
One age-related condition that can occur down below is prolapse (a.k.a. the dropping of the uterus, bladder, or rectum into the vagina), says Timothy Ryntz, M.D., assistant clinical professor of gynecologic surgery and urogynecology at Columbia University. For women with mild prolapse, Kegel exercises can be helpful. As far as treatments go, that depends on the health of the patient—but one option is having a supportive pessary (a removable device) inserted into the vagina to keep things in place. Another option is surgery, including cystocele repair (tucking up the bladder), rectocele (tucking up the rectum), and hysterectomy (removal of the uterus and possibly the cervix), says Alyssa Dweck, M.D., assistant clinical professor in the department of obstetrics, gynecology, and reproductive science at the Mount Sinai School of Medicine and co-author of V is for Vagina.
Your Vagina Actually Starts To Look Older
As you age, your skin loses elasticity, and wrinkles become more pronounced. Something similar happens to your vagina. Estrogen helps to keep skin plump and more elastic. Consequently, hormonal decreases as a result of aging mean a loss in elasticity of the vagina. This is known as vulvo-vaginal atrophy, or VVR. The vaginal walls thin out and can become dry and inflamed. Kegel exercises probably won’t help, but any kind of activity that simulates and invigorates the area might, including sexual arousal. A doctor might even recommend a vaginalmoisturizer or prescribe a topical or oral estrogen.
Your Uterus and Entrance To Your Vagina Might Shrink
In response to dropping estrogen levels, the uterus can actually change size. “As women get older, the uterus itself tends to get smaller,” says May Hsieh Blanchard, M.D., associate professor in the department of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine. Makes sense since you’re no longer in your childbearing years.
Similarly, the vaginal entrance can narrow with age. “All of the tissue tends to constrict, particularly if it isn’t being used,” says Blanchard. According to a report from Harvard Medical School, this narrowing can lead to irritation, dryness, and sometimes, inflammation of the vaginal wall—a condition called atrophic vaginitis. Left untreated, atrophic vaginitis can cause bleeding and painful sex and pelvic exams. That being said, maintaining a certain level of sexual activity can offset some narrowing—although there isn’t any kind of externally mandated level of how often you should be getting busy. “It needs to be what’s satisfying and comfortable for the woman and her partner,” says Blanchard. Estrogen treatments can also help.
You May Not Be Able to Control Your Bladder
As time goes on, musculature and ligaments supporting the pelvic floor start to relax. In some cases, the urethra may actually move in relation to the bladder, which can cause leaking. For stress-related incontinence—when you pee a little after coughing or sneezing—surgical treatment may be required. But other, non-surgical remedies like Kegels and biofeedback (a monitor actually shows when your pelvic floor muscles contract) can do some good. Blanchard also recommends considering a pessary, which can be placed in the vagina to support the bladder neck.
You May Experience More Urinary Tract Infections
UTIs may become more frequent when you’re older due to more delicate genital tissue, says Dweck, adding that an unrecognized or untreated UTI can progress to a kidney infection and then develop into systemic infection. This can actually cause behavioral changes, such as confusion. Small micro-abrasions can also occur and lead to bladder infection. What helps? Cranberry juice or a vaginalprobiotic like RepHresh Pro-B and vaginal estrogen can be preventative. Meanwhile, Blanchard says that women may experience UTI symptoms (irritation, increased frequency of urination, burning with urination) simply due to decreased hormone levels and inelasticity without having an actual infection. In that case, estrogen therapy is an option.