These days, we look at our vaginas — or more correctly, vulvas — much more than women (or men) used to. And as we get older or after childbirth, many of us are shocked to find the area has changed.
So, what can you expect to happen to your vagina? What’s normal and what’s not?
First things first. Just as everyone has a different body shape, eye colour, or preference for sexual partner, there is also enormous variation in vaginas and vulvas, regardless of age.
“It’s like anything — there’s a complete spectrum of appearances of the area and they’re all usually completely normal,” Dr Yasmin Tan, a gynaecologist and laparoscopic surgeon with the Women’s Health and Research Institute of Australia (WHRIA), said.
Add the passage of time into the mix, though, and certain changes tend to be more universal.
The vagina and vulva lose thickness and the colour of the vulva can change from pink to a paler or darker hue.
The clitoris can shrink, the labia can loosen, and there may be shrinkage of some tissue, Dr Tan said. The urethral entrance may also start to “pout a little bit and look a little bit fleshy”.
“Like skin anywhere else it becomes thinner and a bit less elastic. That plumpness becomes a bit saggy,” she said.
And just like the hair on our heads, hair down there may become grey.
From puberty to menopause
The vagina and vulva will stay pretty much the same through the years from puberty to menopause, with the exception of two significant events: childbirth and breastfeeding.
Bringing a baby in to the world can be “very traumatic to the vaginal area,” Dr Tan said.
Tears or episiotomies may affect the appearance and function of the vagina and vulva in the long term, “depending on how well the tissue is put back together”.
While a vagina that has stretched during childbirth generally returns to normal with time, supporting tissues that hold vaginal structures in place can be damaged, and this may eventually lead to prolapse of the vagina walls.
The result can be bladder and bowel function problems, such as urine or faecal leakage, and a lump may protrude from the vagina. Surgery may sometimes be necessary.
Breastfeeding itself doesn’t causes problems, but the low oestrogen levels that accompany it can delay the return to normal of the vagina after pregnancy and childbirth.
This is because oestrogen is the hormone responsible for keeping the vagina and vulva lubricated and elastic. But once breastfeeding is finished, things generally go back to normal.
Sex: keep at it
For most women, menopause is when the big changes to the vaginal area start. The permanent drop in oestrogen can see dryness and tightening, which can cause a real problem in the bedroom for some women.
But there are medications (both prescription and over-the-counter) that can help when sex is uncomfortable and, as Dr Tan advises, it’s definitely helpful to keep at it.
It turns out intercourse and other sex activities that stretch the vagina can help preserve elasticity by preventing contracting and over-tightening of the tissue in the area.
She can’t put a figure on exactly how often is required but says “probably at least weekly”.
If you don’t have a partner, but might want one in the future, there are other ways to maintain the area.
Some specialist physiotherapists are trained to provide vaginal dilator therapy, which aims to stretch the vaginal muscles, she says.
Don’t suffer in silence
The good news (sort of) is that half of all women will not experience any major problems as a result of these changes, and will be able to manage any symptoms with over-the-counter medications (vaginal moisturisers and lubricants).
However, about 50 per cent of women may experience these symptoms to a level that causes serious discomfort, a condition known as vulvovaginal atrophy.
“A lot of women suffer in silence,” Dr Tan said.
“It affects their relationships, their self esteem, their sex lives. It’s an important thing to address.”
Help is at hand, and Dr Tan stresses it’s important to talk to your GP or gynaecologist if you’re experiencing discomfort during sex, or other symptoms, as there are treatments (such as oestrogen replacement or vaginal laser) available that can provide relief.