Prevention Explains Normal and Serious Vaginal Changes

Vaginal and vulvar changes can come from aging, childbirth, perimenopause, menopause, breastfeeding, and shifting hormone levels. Lower estrogen can make tissue thinner, drier, paler, and less flexible. That may cause discomfort during sex or everyday activities. Breastfeeding-related dryness often improves after nursing ends, while changes linked with perimenopause or menopause are less likely to resolve without treatment.

Other expected changes include reduced fullness or firmness of the labial skin as collagen, elastin, fat, and volume decline. Pubic hair may also become sparser, shorter, finer, or less pigmented because follicles spend more time between growth periods. Lower estrogen can also reduce the cells and glycogen that support helpful vaginal bacteria, increasing susceptibility to vaginal or urinary infections. Vaginal moisturizers, hyaluronic acid suppositories, prescription vaginal estrogen, and hormone therapy are discussed as treatments for some of these changes.

Three developments deserve prompt medical attention: bleeding after menopause, especially when it is heavy, prolonged, or irregular; unusual lumps, bumps, or sores; and infections that are not properly treated. Even one episode of postmenopausal bleeding calls for a healthcare visit, physical examination, and pelvic ultrasound to determine the cause. Most causes are benign, but vaginal or uterine problems need to be ruled out.