So, you’ve made it through the hot flashes that make you feel like your body is on fire from the inside, made it through night sweats that require a change of pajamas and sheets, made it through mood swings caused by changing hormone levels, and you’re thinking, “Hey, this whole no period thing is pretty great.” You’re feeling like the wise, mature woman you are, and you’re wondering why menopause isn’t celebrated in the U.S. like it is in some countries (and, well, it should be).
Then comes a day when your vagina, more precisely your labia, hurts after a run, a workout, or just a normal day of activity. Everything feels sort of raw like your underwear rubbed in the wrong places. This comes and goes, and you don’t think too much about it because you’re blaming those $%#@ing underwear for that chafed feeling. After a while, however, you start noticing that sex isn’t feeling fabulous. Penetration might be uncomfortable or pretty difficult to accomplish. If you CAN successfully have sex, your vagina may be sore afterward. Like you went horseback riding for a couple of days without a break, kind of sore. For some, sex might be downright impossible. It’s like your vagina has shut down for business. Now you’re asking yourself, “What The $%#@ Happened To My Vagina?”
Everything mentioned above is very common post-menopause and is primarily due to a complete lack of estrogen. Let’s talk estrogen for a minute. Your body’s estrogen needs are different from your vagina’s estrogen needs. Without estrogen, the labia can actually shrink. The skin becomes thin, delicate, and sensitive to shear forces (like rubbing underwear or skin rubbing on skin). Ouch! The muscles of the pelvic floor (the muscles that keep us continent – that is – keep us from leaking urine or feces) can become tense, tender, and dry (as in, it feels like the Sahara Desert has set up shop in your vagina, kind of dry). The medical term for these changes is vaginal atrophy. Yuck. It doesn’t paint a pretty picture.
Post-menopause, you could also experience urinary changes such as increased frequency (oh my gosh, I just peed 15 minutes ago, but I need to go again), increased urgency to urinate (yikes, I’m not sure I’m going to make it to the bathroom without leaking), urine leakage with urge (nope, didn’t make it to the bathroom – totally peed my pants), or urine leakage doing the things you do in everyday life (like walking, bending, sneezing).
Pelvic organ prolapse also happens more frequently in menopause. Your uterus and/or bladder can begin to droop down further into the vagina (and sometimes even outside of the vagina – what on earth is that thing that looks like a red balloon?). Prolapse can cause discomfort and increased risk of UTIs.
Even though these changes can be a normal part of menopause, they don’t have to be. That’s right. I said they don’t have to be. Pelvic floor therapy can help the post-menopausal vagina. A pelvic floor therapist can help to release tight muscles in the pelvic floor, teach patients how to keep urinary urgency under control, and make recommendations on how to manage symptoms (which could include seeing a gynecologist or primary care physician to get a prescription for topical estrogen). A pelvic floor therapist can recommend lubricants and devices that can help keep the vaginal opening more relaxed. If you have pelvic organ prolapse, a pelvic floor therapist can teach you how to properly strengthen your pelvic floor and manage your symptoms.
Don’t suffer in silence. Talk to your physician or Google “Pelvic Floor Therapy” to start getting the help you need.
Leanne Johnston is a Doctor of Physical Therapy and has been treating pelvic floor dysfunction since 2007. She treats both women and men and is very passionate about helping her patients overcome issues that impact their quality of life.
