Posts Tagged ‘estrogen’

5 Ways to Maintain A Vibrant, Vigorous and Vital Vagina

February 15, 2020

Andrew Siegel MD   2/15/2020

Aging can be cruel and does not spare any body part, including the vagina. The vulva and vagina are particularly susceptible since menopause depletes estrogen, which can be thought of as vaginal rocket fuel. As a result of this estrogen decline, the vagina can wither. Considering that nature’s ultimate purpose of sex is for reproductive purposes, perhaps it is not surprising that when the body is no longer capable of producing offspring, changes occur that affect genital anatomy and function. The good news is that many unwanted changes associated with aging can be managed readily and the bloom of vaginal youth maintained.  Read on!


Image by Josch13 from Pixabay

Suddenly the seven dwarfs of menopause arrived at my door without warning: itchy, bitchy, sweaty, sleepy, bloated, forgetful, and all-dried-up.“…Suzanne Somers

The estrogen-deprived vagina and vulva of an older female have a very different appearance from that of the estrogen-enriched vagina and vulva of a younger adult. The vestibule (area where vaginal and urethral openings are), vagina, urethra and base of the urinary bladder are rich in estrogen receptors that are no longer stimulated after menopause, resulting in diminished tissue elasticity and dryer, thinner and more brittle tissues. The labia and underlying fatty tissues tend to lose suppleness and the vulvar skin often becomes paler and more fragile, sometimes resulting in burning, itching, irritation and pain.

As the  vaginal wall thins, the natural ruffles and ridges (similar to tread on a tire) become less prominent, vaginal length and width diminish, and the vaginal opening tends to become relaxed and less toned. The vaginal environment morphs into a dryer form of itself (more of a desert than an oasis) and the natural microflora that reside within change from healthy lactobacillus to the type of bacteria that reside in the colon.  With less lubrication potential and expansive ability, sexual intercourse may be painful and achieving sexual climax more challenging.

Vaginal Lining (Left: pre-menopausal; Right: post-menopausal)  Attribution: BruceBlaus [CC BY-SA (

The urethra (urinary channel) and surrounding tissues thin as well. Urethral caruncles– benign fleshy outgrowths at the urethral opening—become more commonplace. The change in the vaginal bacterial ecosystem resulting from the more alkaline (less acidic) environment from the estrogen depletion causes increased vaginal colonization by colonic bacteria and potentially more frequent urinary infections. Overactive bladder symptoms, including urinary urgency, frequency, urgency incontinence become more prevalent as does stress urinary incontinence, urinary leakage with sneezing, coughing, exercise and exertion. Pelvic organ prolapse is another consequence.

5 Ways to Maintain Vaginal Vibrancy and Vigor

  1. Moisturizers and Lubricants

Many over-the-counter vaginal moisturizers are available to help rehydrate arid or parched vaginas.  Lubricants can be highly effective for women experiencing dryness and painful intercourse. Silicone-based lubricants seem to offer advantages over water-based lubricants.

  1. Lifestyle Modification

Pursuing a healthy lifestyle will help keep all tissues and organs–including the vagina and vulva–in optimal health.   These measures include maintaining a trim physique and a healthy BMI, a nutritious diet emphasizing plant-based proteins, fruits and vegetables and unprocessed foods, exercise (cardio-core-flexibility-resistance), sufficient quantity and quality of sleep, tobacco cessation,  alcohol moderation and stress management.

  1. Kegels (Pelvic floor muscle exercises)

Kegel exercises are vital to vaginal and pelvic health.  They are first-line management for overactive bladder, stress urinary incontinence, pelvic organ prolapse and sexual issues. Most women do not know how to properly contract their pelvic floor muscles and many fail to pursue a specific program that is geared to their specific issue.  My three-word reply: The Kegel Fix!

  1. Use it or Lose it

Sexual intercourse is often painful after menopause because of vaginal anatomical and functional changes.  This is particularly the case if one has not been sexually active on a regular basis.

FACT: Regular sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Vaginal penetration and the changes that result from sexual activity increase pelvic and vaginal blood flow and optimize lubrication and tissue elasticity. The pelvic floor muscles that are so vital for vaginal function are strengthened by orgasms and in fact get a good workout with sexual intercourse and particularly with sexual climax.

  1. Hormones

Systemic hormone replacement therapy– available in the form of pills, patches, sprays, creams and gels–can be effective in managing bothersome symptoms. Estrogen alone is used in women who have had a hysterectomy, whereas estrogen and progesterone in those women who have a uterus. The potential side effects of systemic therapy include an increased risk of heart disease, breast cancer and stroke.

Vaginal hormone therapy is available in creams, rings and tablets. The advantage of  this locally-applied estrogen is that it can help manage vaginal and menopausal issues with little absorption into the body and minimal potential systemic effects, as opposed to systemic hormone replacement therapy. Topical estrogen can be helpful for painful intercourse, overactive bladder, stress urinary incontinence, pelvic relaxation, and recurrent urinary tract infections. Additionally, because estrogen restores suppleness to the vaginal tissues, it can be very useful both before and after vaginal surgical procedures (most commonly for stress urinary incontinence and pelvic organ prolapse).

I commonly prescribe topical estrogen therapy, typically a small dab applied vaginally prior to sleep, three times weekly.  It has proven helpful and effective in a variety of circumstances and only requires a tiny dosage.

Bottom Line: Menopause is an inevitable part of the aging process and the absence of menstrual periods is a welcome change for many women.  However, lack of estrogen production can cause a host of symptoms and consequences, particularly affecting the vulva, vagina, bladder and urethra.  If symptoms are bothersome, there are numerous means of improving them and keeping the vagina vigorous, supple and functional. 

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health