Human bodies are constantly changing as we age. Even if you somehow still got carded when you order a glass of wine, your body may be aging in sneaky ways that you might not notice right away. This is definitely the case with the vagina and vulva — a beautiful and beloved part of our bodies that we aren’t always fully briefed on.
They sort-of prepare us for puberty in school — letting us know that we’re going to start sprouting pubic hair and bleeding once a month — but after that, we’re basically left to guess what’s going to happen next. Well, you’re in luck, because we spoke with several OB-GYNs about how your vagina and vulva change as you age. (Spoiler: it’s more than you think.)
Although the vagina and vulva are two distinct body parts (and don’t trust anyone who tells you otherwise), they “work as a contiguous unit throughout the life cycle,” Dr. Kecia Gaither, MD, OB-GYN and Director of Perinatal Services for NYC Health+Hospitals/Lincoln, tells SheKnows. In other words, these intimate body parts age at the same rate, in roughly the same ways as hormones change. Here’s how it tends to go.
The Early Years: Your Vulva in your 20s
By our 20s, many of us are acquainted with our vagina and vulva and how the parts work. Given that people in their 20s (and 30s and early 40s) typically have normal estrogen levels, their vaginas and vulvas should be “elastic, thick and lubricated,” Dr. Sharyn Lewin, MD, gynecologic oncologist at Holy Name Medical Center in Teaneck, New Jersey tells SheKnows.
This is also a decade where many people become sexually active and get more comfortable with their bodies. According to Dr. Sherry Ross, MD, an OB-GYN in Santa Monica, California and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period, with new and more sexual partners the vagina may be prone to infections, human papillomavirus (HPV) and other sexually transmitted infections (STIs) — so using condoms and choosing partners carefully is important. The HPV vaccine is also available for people ages 9 to 45.
Even in our 20s, our vulvar skin can be sensitive. Dr. Mary Jane Minkin, MD, OB-GYN and clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale University School of Medicine says that sitting in a bubble bath, for example, may leave you with something that looks and feels like a yeast infection. This could mean experiencing itching and redness of the vulva, even when your baseline tissue is quite healthy.
If you find this is the case for you, don’t worry — there’s a solution. “Try to use very gentle washes to the vulva,” Minkin tells SheKnows. “And you want to be using pH balanced products when washing.”
During and After Childbirth
Though many people end up having children in their 30s and 40s, the average age of giving birth in the United States is 26.3 years-old, and regardless of when — or if — you want kids, it’s helpful to know what the process does to your vagina and vulva. According to Ross, 30 percent of people who have a vaginal birth will have some form of trauma to the tissue and muscles in the vagina and pelvic floor.
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“The vagina and all its elastic glory can only stretch so much during childbirth,” she explains. “With each vaginal delivery, there is a little more stretch — similar to what happens to the elastic band found on pants. The muscles stretch, distend and tear in the vagina to allow the head to come through this tight space and never completely recover.”
Vaginal tearing or an episiotomy during a vaginal birth can and does happen for many women. But never fear, your vagina does heal. Recovery time really depends on the person and how they delivered. The traditional healing period is six to 12 weeks — during that time, doctors typically tell you to avoid having penetrative sex — but for some people, recovery can last longer.
The pelvic floor can weaken during pregnancy and childbirth, too, which can cause incontinence. To rebuild your pelvic floor, you can start with some pelvic floor exercises, which you can do on your own at home. If, after trying these, you’re still experiencing incontinence or a weak pelvic floor, this is definitely something to bring up to your doctor. They may recommend pelvic floor physical therapy to strengthen the muscles in the area.
As the vagina heals from childbirth, sexual dysfunction issues can arise. As you re-enter sexual activity, you can curb discomfort by using a sexual lubricant and clearly communicating with your partner. “Being patient and knowing what is happening with your body helps both you and your partner understand this is a normal challenge for new parents,” Ross says.
In your 30s
Regardless of whether or not you’ve given birth, Ross says you should start doing Kegel exercises in your 30s, if you haven’t already. (And really, the earlier the better.) “Kegel exercises strengthen the pelvic floor muscles, which support the vagina, uterus, bladder and bowel,” she explains. “If Kegels are done correctly and repeatedly, over time, you can avoid symptoms such as stress and urge incontinence caused by childbirth, aging and obesity. A bonus is Kegel exercises can also make sexual intercourse more enjoyable for you and your partner.”
In addition, 30-something women using birth control pills may notice vaginal dryness with sex. “There are many different brands of birth control pills, each varying in the types and doses of two key hormones,” Ross explains. “Some women are more sensitive to one or both of these hormones exacerbating side effects such a vaginal dryness. One size does not fit all when it comes to the pill. Finding the right brand may take some time and patience.”
If you’re experiencing vaginal dryness in your 30s, OB-GYN Dr. Jessica Grossman MD suggests using FDA-approved lubricants and vaginal moisturizers and, if the issue persists, speaking with your healthcare provider.
In your 40s
Perimenopause can set in as early as your mid-30s, but more commonly begins some time in your 40s, and typically lasts between four and eight years. Perimenopause refers to those years in the reproductive life cycle where the ovarian production of estrogen becomes irregular and erratic, Ross explains. Symptoms — including dryness and an increased risk of vaginal infections — can begin to crop up in your 40s.
“Some women will go on a low dose birth control pill, or hormone replacement therapy to treat these disruptive symptoms of perimenopause,” Ross says. ”You need to talk to your health care provider about any symptoms that are negatively affecting normal routine, especially in the bedroom.”
Again (and you’re probably sensing a theme here), if vaginal and/or vulvar dryness is an issue, you can always use FDA-approved lubricants or moisturizers (both internal and external) to help deal with it. Minkin recommends using Replens vaginal gel, which comes in both an internal vaginal moisturizer and an external comfort gel.
In your 50s
The average age for menopause to start is 51. Menopause is a time when your ovaries stop producing estrogen and your female hormone reserves are depleted, says Ross. Some choose hormone replacement therapy to replace the estrogen and combat some menopausal symptoms. If you don’t take hormone replacement therapy, your vagina may become progressively more dry and dehydrated, she adds.
“With the loss of estrogen nourishing and hydrating the vagina, the tissue can become dry, pale, itchy and dehydrated,” Ross says. “The natural vaginal discharge created by a woman’s sex hormones is gone. The medical term for this is vulva-vaginal atrophy (VVA). As a result, intercourse and other forms of vaginal contact become painful, if not impossible.”
Minkin notes that the skin on both your vagina and vulva can end up having dryness issues.
The good news is that non-prescriptive remedies include lubricants — like gels, moisturizers and oils — and can ease and minimize the discomforts related to VVA. “For women with more severe symptoms, localized estrogen treatment can reverse this condition,” Ross notes. “Prescriptive remedies that have the best results include a recent non-hormonal prescription, Osphena, and oral orvaginal estrogen creams, tablets and the Estring.” For this, Minkin recommends using Replens gel for this as well.
Even though your vagina and vulva can experience some pretty big changes throughout your life, know that there are usually ways to navigate problems and changes that come up — or at least make you more comfortable along the way.
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