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Real Talk From a Nurse About Below-the-Belt Changes That Happen As We Age

Even your girlfriends may not share what’s happening “down there,” but know that these 5 little surprises are common and not cause for distress. I’m in my 40s and starting to deal with them, too.

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Michelle Pereira
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It’s no secret that the body changes as we age. In my early 40s, I accept the occasional gray hair, my worsening vision and a stubborn 10 unwanted pounds. But what I didn’t expect, and what no one warned me about, were the changes in the vaginal area. And that’s because, even though we might discuss creaky joints or blood pressure within our close sister circles, it’s rarer for women to share what’s going on down there.

I’m the exception. As a reproductive and sexual health nurse, I’ve advised women about everything from their menstrual changes to treatment for sexually transmitted infections (STIs). I publish a blog about women’s health, and on Twitter, #Ispeaksexhealth. Though I am well-informed about the vagina and vulva (the external female genital area), I was totally unprepared when most of these five common changes started to take place.

To help make your experience a little less surprising, let me share them. And, of course, if you have questions, talk to your health care provider.

Loss of pelvic floor strength. I had no idea that my vaginal birth five years ago would so weaken my pelvic floor muscles, the muscles that support my bladder, uterus and bowels. I was always one hard sneeze or a belly laugh away from a urine leak. This condition is not uncommon for women. So why aren’t we talking about this?

I get it, it’s not always easy to bring up sensitive subjects, even with your health care provider, but it’s the first step toward finding a solution. After committing to a daily routine of Kegel exercises, which can help strengthen the pelvic floor, and activities that focused on my core strength, I no longer worry about the possibility of having an accident in public .

Distinct vaginal odor. Because I am a sexual health nurse, I am pretty familiar with the signs and symptoms of bacterial vaginosis (BV), a common infection with a distinctive fishy odor caused by an overgrowth of “bad” bacteria in the vagina. What I discovered is that BV infections can actually increase with age. Been there. Because aging reduces our estrogen levels, this can throw off the balance of the good and bad bacteria in the vagina and disrupt our overall pH. So if you notice a strong fishy odor, schedule an appointment with your health care provider. Oral or topical medications can treat the infection. Condom use may help limit its recurrence.

More product sensitivity. I’ve also noticed that my vulvar skin becomes irritated more easily, and I was being diagnosed with more yeast infections, so I knew it was time to take a closer look at all of the products I was using. It turns out that my laundry detergent, the same brand that I have been using for years, was causing the all too familiar itching and burning associated with a yeast infection.

Since our skin’s protective outer layer gets weaker, thinner and more easily damaged as we age, this makes it easier for irritants to penetrate and cause inflammation. So, I’ve traded in my fresh-spring-scented laundry detergent for one that is unscented and hypoallergenic. What a relief. (Editor’s note: Your health care provider can evaluate the cause of irritation, which could include yeast, allergic reactions to common products such as soaps and more.)

Variations in color of the vulva. Having to shelter in place for the past few months forced me to take grooming matters into my own hands. Hair removal revealed skin that was a lot darker than I remembered. But here’s the thing: Skin, even in the most intimate of areas, can change over time. The hormonal fluctuations I experienced during my pregnancy, in addition to the shifts related to perimenopause, has caused the skin on and around my vulva to darken.

To be honest, this darker pigmentation doesn’t bother me, and my husband certainly hasn’t complained. Vulvas actually vary in color, but if you notice any changes in your skin color where it’s redder or whiter than what’s normal for you, or if you notice any rash, warts, sores, lumps or ulcers in the vulva area, you definitely want to get this checked out.

On a related note, if you’re considering a cosmetic surgical procedure to solely change the appearance or function of your vulva or vagina, you should know that these cosmetic procedures “are not medically indicated, pose substantial risk and their safety and effectiveness have not been established,” the American College of Obstetricians and Gynecologists reports.

Thinning of the vaginal walls. It hasn’t happened yet, but I’ve been informed that I can also experience more vaginal dryness, irritation and potentially painful sex during menopause. (Side note: You can also experience these symptoms before menopause, which may be related to underlying health conditions or lifestyle factors such as breastfeeding, medication or infections.) My doctor has assured me that these symptoms can be treated, and she has encouraged me to learn more about personal lubricants and find one that is compatible with the healthy range of my vaginal pH (3.8–4.5). She also discouraged lubricants with color, flavor or heating/cooling features, since these can also cause irritation or infection. (Editor’s note: If you’re having pain during or apart from sex, talk to your health care provider or a provider who specializes in pelvic pain.)

As a woman, I feel that it’s important to be familiar with my body, including my most intimate areas. By sharing some of the age-related changes, I hope to provide insight to support and even improve your sexual health for now and for years to come.