Postmenopause Vulva and Vagina Changes (part one)

The structure and function of women’s genitalia are highly dependent on the sex steroid hormonal milieu. As a woman ages or a young woman is exposed to medicines that interfere with the hormonal milieu (eg oral contraceptives, tamoxifene), her supply of sex steroid hormones (estradiol, testosterone and progesterone) diminishes significantly. During menopause, ovarian estradiol production ceases. However, estrogen does continue to be synthesized in the periphery (eg, skin, adipose tissue, bone, muscle) in postmenopausal women through conversion of androstenedione to estrone and testosterone to estradiol; the amount of estradiol synthesized depends, in part, on the enzymatic activity of aromatase.

Estrogens and androgens are required for genital tissue structure and function. These hormones act on estrogen and androgen receptors, respectively, which exist in high numbers in genital tissues, including the epithelial/endothelial cells and smooth muscle cells of the vagina, vulva, vestibule, labia, and urethra. Diminished estrogen production renders women’s genital tissues highly susceptible to atrophy (thin, fragile structure).

Physical examination of the postmenopausal woman’s genitalia shows clitoral atrophy, *phimosis, and nearly absent labia minora. The appearance of a woman’s labia minora mirrors her level of estrogen (estradiol), because these labia are exquisitely sensitive to estrogen (estradiol).

The urogenital area termed the vestibule is very important in female sexual function because it contains organs that are sensitive to both estrogen and androgen. For example, the clitoral tissues and prepuce (the hood that covers the clitoris) are androgen sensitive. The minor vestibular glands, which are located in the labial-hymenal junction are also androgen dependent. The glands of Littre are located on the anterior (front) surface of the urethra.

A host of structural changes and cellular dysfunctions can occur in women’s genital tissues as a result of low estrogen. For example, estrogen deficiency specifically in the vagina leads to vaginal atrophy. One consequence is an alteration in the normally acidic vaginal pH that discourages the growth of pathogenic bacteria. The change to an alkaline pH value in the atrophic vagina leads to a shift in the vaginal flora, increasing the likelihood of discharge and odor. In an estrogen-rich environment, glycogen from sloughed epithelial cells is hydrolyzed into glucose and then metabolized to lactic acid by normal vaginal flora. In postmenopausal women, however, epithelial thinning of the vaginal tissue reduces the available glycogen.

In addition to vaginal atrophy and a reduction in organ size, other signs of a decline in sex hormones in women include: vaginal dryness; no secretions or lubrication; pale or inflamed tissue; petechiae; epithelial/mucosal thinning; organ prolapse; changes in external genitalia; decreased tissue elasticity and loss of smooth muscle. Symptoms of women’s sexual health concerns that  a clinician may elicit when taking a history in a menopausal woman are: dyspareunia, vaginismus, coital anorgasmia, vaginal and/or urinary tract infections (pH imbalance), overactive bladder/incontinence.

 The vulva is a woman’s external genital area. It includes two hair covered folds of skin called the labia majora, which surround two thin inner folds called the labia minora. The labia majora and labia minora surround the clitoris, the opening of the vagina and the urethra, the tube through which urine is passed.

Phimosis is when the clitoral hood does not retract limiting exposure to the glans of the clitoris. Petechiae are tiny pinpoint like, round spots that appear on the skin as a result of bleeding under the skin.

* Estrogen deficiency also interferes with many physiologic responses associated with sexual arousal, including smooth muscle relaxation, vasocongestion, and vaginal lubrication.

 

Sourced From:
BIOLOGY OF FEMALE SEXUAL DYSFUNCTION
Copyright © 2007 San Diego Sexual Medicine
San Diego, California 92120

DISCLAIMER: Kátha Soma does not provide medical advice, diagnosis or treatment. The information provided is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.