Should I be worried about vaginal atrophy?

Last week I wrote a post about how the Bot Ad Overlords and my friends crowdsourced me a new anxiety: incontinence. I alluded to another worry that’s coming close on its heels: vaginal atrophy.

Or, as the New York Times recently called it, “the incredible shrinking vagina.”

What exactly is vaginal atrophy?

Essentially, as your estrogen levels drop during menopause, the “skin of the vulva and vagina become thinner with a loss of elasticity.” Labia minora can also shrink. And all of this is commonly accompanied by dryness, or, other symptoms during sex, “loss of lubrication, an uncomfortable sandpaper-like sensation, pain, difficulties achieving orgasm and even tearing of the vagina or vulva. There is also an increased risk of urinary tract infections.” Oh — and also according to the NYT — “as estrogen is crucial to maintaining the bacterial colonies of the vagina, there can also be a change in the type of bacteria, which can lead some women to notice a change in their typical smell.” This delightful array of symptoms is formally known as “genitourinary syndrome of menopause” — or GSM.

I think I speak for all of us when I say:

So what to do? What to do?

That link to the NYT piece has some basic suggestions, including obvious things like unscented soap, lube and vaginal moisturizers. But these are about managing symptoms — to try to do any prevention, you need to explore with your doctor about whether different pharmaceutical options, like vaginal estrogen creams etc., are a possibility.

This is where the feminist piece comes in for me: short of asking me “are you still having periods?” my doctor has never raised or mentioned anything about peri-menopause, my aging uterus or dwindling hormones — let alone my shrinking vagina. (I’m working hard here not to start to mentally distance myself from my discomfort here by using terminology like “my petrifying pussy” or “languishing ladygarden.” I never use those kinds of terms, but my inner voices are all like, eek must make this a joke!) It’s one of those not-talked-about things.

We were talking about this NYT piece the other day and Susan pointed out that if things are going to shrivel, by the time you become symptomatic enough for a doc to treat it as a thing, things are already shrunken, and you’re managing symptoms, not preventing anything.

So this is my little feminist rant for this: older vagina-having people are sexual beings, and it’s a perfectly reasonable thing to want to preserve your juiciness. Docs aren’t going to offer anything until it’s a problem. Topical estrogen seems to be a (relatively, of course) safe option to prevent shrinkage. Seize your own destiny on this.

What’s up next in the “Icky Things my genitals might do” series?