The vulva (external genital area) and vagina (internal) contain the largest tissue concentration of estrogen receptors in the female body. As a girl goes through puberty, the ovaries start producing estrogen. The vulva labia majora and labia minora thicken and develop, the mons pubis elevates, and internal genital organs develop. The vagina matures and develops a multilayered epithelium with rugae, or folds of tissue facilitating distention during sex/intercourse.
The pH of the vagina becomes acidic, around 3.5 or lower, indicating the presence of hydrogen peroxide producing lactobacilli. Lactobacillus is a healthy bacterium normally found in the mouth, intestinal tract, and vagina. These protective bacteria keep pathogens at bay, ensuring the healthy vaginal microflora. Normal vaginal secretions are relatively odor free, thin, and non irritating.
After menopause (no menstrual period for 1 year), estrogen levels decline significantly. As a result of low estrogen, the labia minora (inner folds) lose fullness and become thin. The vaginal opening (introitus) can become less flexible and more narrow, making intercourse painful (dyspareunia). The vaginal lining (epithelium) also becomes thin and fragile. Rugation (folds of tissue) decrease, making the vagina shorter and narrower . . . another contributor to dyspareunia.
Additionally, for postmenopausal women the vagina pH increases, as lactobacilli decrease due to diminished estrogen production. Consequences may include vaginitis from flora and Escherichia coli colonization of the urethra, placing postmenopausal women at higher risk of urinary tract infections: bacteria overgrowth in the urethra and/or bladder. Maintaining optimum lactobacillus levels reduces vulnerability to urinary & bladder infections because the lactobacillus naturally neutralize bacteria overgrowth.
Cystitis (inflammation of the bladder wall), and Interstitial Cystitis (same symptoms as an urinary infection but involves chronic bladder inflammation not related to bladder infection) are also conditions that post menopausal women are more vulnerable to as a consequence of diminished estrogen production. Prior to menopause estrogen had supported the structure and function of the bladder.
Unlike hot flashes, and heart palpitations which tend to ease during the menopause transition, vulva and/or vaginal atrophy does not lessen over time. This is because the vulva and vaginal structure have changed with age as a direct result of diminished ovarian estrogen production.
It is helpful to distinguish the vulva from the vagina because these genital areas have different tissue structure and function. Vagina discomfort is felt with penetration . . . during intercourse. Labia dryness, vulva discomfort can be felt throughout the day.
Keirá is a non hormonal feminine ointment that supports labia moisture and vulva tissue to address symptoms of vulva atrophy (dry, thin fragile tissue). For post menopause women daily use of Keirá Feminine Ointment helps replace labia moisture (better comfort) and also supports clitoris tissues to enhance sensitivity: arousal and pleasure. To learn more about Keirá Feminine click here. Self care is the essence of self compassion.
Note: Low estrogen due to menopause can diminish physiologic responses associated with sexual arousal including smooth muscle relaxation, vasocongestion (blood pooling creates the warmth/heat sensation during arousal and orgasm), and vulva vaginal lubrication (milky like secretion). As helpful to know, the amount of vaginal lubrication in not necessarily indicative of the level of sexual arousal. The intensity of an orgasm does not diminish with age.
Dyspareunia is a medical term for pain with sexual intercourse.
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