If you’ve ever found yourself googling “is this normal?” about anything below the belt, you’re not alone. As we age, so too do our vulvas and vaginas – and yet, for something that plays such a vital role in our wellbeing, pleasure and quality of life, it’s still shrouded in a bit of mystery.
“Vaginas aren’t just about sex – though that’s definitely a key part of the picture,” says Dr Ceri Cashell, a GP specialising in women’s health and co-founder of the free online menopause community, Healthy Hormones. “They’re also essential to our everyday comfort and health.”
Whether you’re navigating dryness, itching, bladder leaks or changes in desire, now’s the time to get curious and proactive about what’s happening.
Ask your GP about vaginal hormones
As hormone levels drop during perimenopause and menopause, vaginal tissues can become thinner, drier and more prone to irritation. This condition is known as genitourinary syndrome of menopause (GSM), and it affects around half of postmenopausal women.
“GSM is the new name for vaginal atrophy or ‘senile vagina’, and it refers to all the symptoms caused by hormone deficiency in the vulvovaginal and bladder tissues: dryness, itch, pain, discomfort, urgency, frequency, incontinence, prolapse, recurrent urinary tract infections (UTIs), loss of arousal, and painful intercourse,” says Dr Cashell.
Topical (or vaginal or local) hormone therapy – either oestrogen or DHEA, which converts to oestrogen and testosterone – can be a game changer. It comes in the form of creams, pessaries or vaginal tablets and delivers oestrogen directly to the vaginal area to restore moisture, elasticity and comfort.
It has a significantly lower risk profile than traditional menopausal hormone therapy (MHT) and is considered safe for long-term use by most women, including those who may not be suitable candidates for full-body MHT.
“It doesn’t significantly enter the bloodstream,” explains Dr Cashell. “It is extremely effective at both reducing symptoms and preventing UTIs by almost 50 per cent.”
Focus on your pelvic floor
Bladder leaks when you laugh, sneeze or exercise aren’t just annoying – they can also knock your confidence.
According to the Continence Foundation of Australia, one in three women who have given birth will experience urinary incontinence, and the risk increases after menopause due to weakened pelvic floor muscles.
“Oestrogen and testosterone help maintain not just muscle tone, but also muscle mass and strength – including in the pelvic floor,” says Dr Cashell. “After menopause, declining hormone levels contribute to muscle atrophy and reduced tissue resilience, increasing the risk of bladder leaks, urgency and prolapse.”
Daily pelvic floor exercises are one of the simplest and most effective ways to strengthen the muscles that support your bladder, bowel and uterus. If you’re unsure if you’re doing them correctly, a pelvic health physio can assess your technique and tailor a plan for you.
Balance your microbiome
Your vagina has a delicate ecosystem of bacteria that keeps things running smoothly. But hormonal changes, antibiotics, fragranced soaps and even tight clothing can throw things out of whack, leading to infections like thrush or bacterial vaginosis.
“Antibiotics, hormonal shifts, douching, soaps, infections, altered bowel habit, diet, exercise, alcohol, smoking and even semen can alter the vaginal microbiome,” says Dr Cashell.
To support your vaginal microbiome, avoid douching or over-cleansing – warm water is usually enough.
“A healthy, real food diet, washing with water only, using condoms with new partners, stopping smoking, reducing alcohol, and most importantly using topical oestrogen or DHEA once your hormones drop, will all help protect it,” she adds.
You can also opt for breathable cotton underwear, change out of sweaty clothes quickly, and consider probiotics targeted at vaginal health. A 2022 review published in Frontiers found that certain strains, like Lactobacillus rhamnosus and Lactobacillus reuteri, may help reduce recurrent infections.
Embrace sex tech
Your libido doesn’t have to disappear with your oestrogen. These days, there’s a variety of women-first sex tech designed to support pleasure, intimacy and pelvic health – particularly during and after menopause.
“Hormones can really help libido, but they will not work on their own, and they cannot fix a broken relationship,” says Dr Cashell. “Sex is often the last thing a woman can face on her to-do list. It is important to focus on self-care first and then make space in your day to connect to your partner emotionally as well as physically.”
According to a 2023 study, using a vibrator was associated with better vaginal health and sexual satisfaction in postmenopausal women. So, if penetrative sex feels off the cards or you’re dealing with pain or dryness, solo or partnered play with the right tools can help reignite confidence and connection.
Reach for a lubricant
If you’re not already using lubricant, now’s the time to get on board. Vaginal dryness is one of the most common menopausal symptoms – and you don’t have to be sexually active to feel its effects. Everyday activities like walking or sitting can cause discomfort if tissues are irritated.
“Using a moisturiser regularly can keep tissues hydrated and reduce irritation day-to-day, not just during intimacy,” says Dr Cashell.
A high-quality, pH-balanced lubricant can reduce friction, protect delicate skin and make sex more pleasurable. Look for water- or silicone-based options with minimal additives, and steer clear of perfumed products that can disrupt your natural balance.
Protect yourself against STIs
Sexually transmitted infections (STIs) don’t care how old you are. Infection rates in women over 40 have been steadily rising, with recent data from the Kirby Institute showing increased cases of chlamydia, gonorrhoea and syphilis in Australia.
“Gonorrhoea has doubled in the past 10 years in Australia, and syphilis has tripled,” warns Dr Cashell.
One reason? Many postmenopausal women are no longer worried about pregnancy and stop using condoms. But STIs are still a risk – especially after divorce or when re-entering the dating scene.
“Anyone with a new partner or multiple partners should screen regularly – every six to 12 months is a good guide unless symptoms arise sooner,” she advises.
Always use protection with new partners and don’t hesitate to ask for regular STI screenings – especially if you’ve noticed unusual discharge, irritation or discomfort.
Your healthy vagina checklist
- Don’t use “feminine” sprays and deodorants
- Wipe from front to back on the toilet
- Stick to cotton underwear instead of synthetic
- Use a fresh razor each time you shave
- Skip wearing underwear to bed
- Avoid washing clothes with strong detergents
- Change out of sweaty clothes straight after a workout
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