Why the Vagina Shrinks After Menopause

The vagina is a remarkable organ. It's so much more than a tube between the outside world and your cervix which is the entrance to the internal world of your body. The vagina allows menstrual blood to flow through it without absorbing any. It is small enough to fit a man's penis within it and caress it so that both partners experience pleasure. And it is large enough to let a baby pass through it.


The vagina is able to do that by being extremely elastic. Like the ribbing of a sock allows your foot to pass into it and then it collapses back on your ankle, your vagina is really a potential space. It is closed until something enters it and then it opens wide enough to let that something in and gently hold it.

The vagina does this because estrogen causes the lining of the vagina to be corrugated. The folds inside the vagina contain elastic tissue that can stretch and return. Estrogen also causes the lining cells of the vagina to shed and with it, lie like fallen leaves inside the vagina. The cells contain glycogen; a sugar that is broken down into glucose. The Lactobacillus bacteria in the vagina use the glucose for food and break it down into lactic acid which as the name implies is an acid pH, which keeps the balance of bacteria in the vagina in perfect balance. Estrogen also allows blood vessels to provide rich nutrition to the vagina and appear pink in color.

With stimulation, the interstitial fluid around the blood vessels "sweats" through the vaginal walls to provide lubrication.

It is a system that works well until menopause. As menopause approaches and estrogen levels decline, the amount of cells that shed are reduced and as a result, the "good" bacteria of the vagina begin to reduce in number.

The folds, called rugae (ROO-guy), that keep the vagina elastic also reduce until over time, the vaginal walls become flat and thin. Over time, without estrogen, the vagina can shorten and narrow.

Also with menopause, the color fades from pink to pale and the moisture "dries up" causing some women to say their vagina feels like the Sahara. That can lead to discomfort or even pain with intercourse and painful sex puts a damper on intimacy that can stress relationships. The medical term of vaginal atrophy caused many women to say it made them feel "shrivelled up." The new term for it is urogenital syndrome of menopause.

There are many ways to improve this situation. Since lower estrogen levels is the cause of the problem, taking estrogen can be a solution. Estrogen can be taken by mouth or through the skin (transdermally) so that it goes to the entire body, including the vagina, or it can be taken only locally by placing an estrogen tablet, cream or ring into the vagina. Local estrogen mostly stays in the vagina, but some can get into the bloodstream. Usually it is only a small amount. The local estrogen works for about as long as it is used. Once it is stopped, the vaginal tissue return to the way it was before estrogen was used over the next weeks and months.

If estrogen is something you do not want to take there are other choices. Some women use over the counter moisturizers such as Replens. That product contains a substance called polycarbophil, which causes the interstitial fluid from around the vagina to come into the vagina. Moisturizers should be used twice weekly to get the maximum benefit. Lubricants can be used if needed to add additional lubrication.

A new medication that is a non-estrogen prescription has recently been approved by the FDA. It is called Osphena It is a class of medicines called SERMs or Selective Estrogen Receptor Modulator.

Medications like Tamoxifen and Raloxifene are other medications in this general category that you might have heard of. Osphena may be a good alternative for women who have breast cancer and don't want to or can't use an estrogen.

Talk with your doctor about what might be best for you and when you notice symptoms of vaginal change, ask for help. There are lots of things that can be done.

Continue Reading