By Dr. Susan Murrmann

MacDonald Murrmann Women’s Clinic

Fifty Shades of The Graying Vagina

“Why do people say, ‘Grow some balls?’ Balls are weak and sensitive, if you wanna be tough, grow a vagina. Those things can take a pounding!”

—Betty White

YIKES!

Do our vaginas really change 50 different ways as we age? Before you panic at the notion of a mature vagina and other parts “down there”, keep in mind that “shades of gray” really means. It’s a neutral color of various shades between black and white. In other words, not cut and dried.

Like women’s health in general, nothing is either black or white. We all experience physical change at varying degrees and ages. At the stroke of midnight on your 15th birthday, you didn’t start menstruating. Nor will a bell toll to signal the dawn of hot flashes and end of blood flow.

As females we pay more attention to what we see in the mirror. As for the rest of it all, out of sight out of mind. As the old cliché “your hairdresser only knows for sure”…you can bet only your gynecologist knows for sure!

While many may complain about the writing, the poor decisions, the implausibility of it all, make no mistake the success of E.L. James and her “Fifty Shades of Gray” trilogy was because she tapped into a subject that women still seem only able to whisper about: our sexuality. Oh, come on! Everyone who owns a vibrator raise your hand! Guess what, we don’t like when a kiss happens, the music rises and the light fades to black.

The books created a new forum where women talking more and openly about sex. Ask any gynecologist, we’ll tell you, women are talking-really talking-about their sex lives. FINALLY!

So since there’s been this bright spotlight cast on lady parts, it’s time to talk about what’s going on down there as you get older.

First, we need to talk about the aesthetic world’s obsession with aging and the (millions, billions?) spent to stop the process dead in its tracks. Until now, pharmaceutical companies were the only ones that really paid attention to age-related changes to the vagina and its external counterpart-the vulva.

In fact, until women started shaving, waxing and stripping, they were oblivious to the changes that were tucked inside that dense thicket of hair. As a gynecologist, I’ll tell you. I’ve seen it all. I’ve walked my patients through various stages of their vaginal lives. We’ve been together during child birth, pap smears, menopause- you name it-if it involves a vagina and I’m your doctor, I’ve seen it.

I know the vagina pass, present and future.

And like the metaphor “Fifty Shades of Grey”, the vulva and the vagina are multifaceted organs that actually go through the same age-related changes that our faces do! Loss of fat, sagging, discoloration and yes, even some wrinkles.

Here are the far from 50 facts you should know.

Now grid your loins, the next paragraph is not for the weak or light hearted. The most common symptoms of your “vagina on age” that women complain about are dryness and painful intercourse that increases over time. The physical symptoms of hot flashes and night sweats that accompany decreasing hormone levels during menopause typically decrease, however, the dryness and painful intercourse progressively gets worse, most often resulting in a lack of sexual drive and pleasure. Not to mention the size of the vagina decreases over time contributing to the painful intercourse. The lack of sexual drive, pleasure, and painful intercourse eventually lead to decreased intimacy in the bedroom and propagate the very true cliché of “use it or lose it”.

So what are the physical changes occurring that would give rise to these symptoms?

We have blamed hormones throughout time for a whole host of problems in our society. Estrogen particularly has had a target on its back since the WHI estrogen/breast cancer scare. The fact is, we have hormone receptors throughout our bodies, and the face and the vagina are no exception. Decreasing hormone levels contribute to loss of muscle tone, blood flow, thinning of the external skin and mucosa, and loss of collagen. But wait, it does not stop there! These changes also make it difficult for the external skin and vaginal mucosa to retain water- the external labia, collectively known as vulva and once revered as the “Lotus Flower” by ancient cultures…now starts to wither. Lubrication during intercourse decreases, dryness and itching can occur.

This is sounding scary! Not to mention that when the external labia have a decreased blood supply and collagen, sagging of the skin can occur- just like the rest of your body! Women typically feel uncomfortable during intercourse and sometimes in their clothing because of the skin laxity. Discoloration can occur-the vulva become darker and the vagina becomes more smooth and pale. I know you are thinking “Please stop! This is too much information!” Now you know where the saying “I have a depressed vagina” was first heard- the show “Sex in the City” came from! Anyone would get depressed just listening to the changes!

If you are a commercial junkie like me, you should realize that anytime there is something or someone that is depressed, there are a hundred and one ways to turn it around! The pharmaceutical companies were the first to jump on board with what I now call the “vagina wars” by creating estrogen based vaginal creams to improve the above symptoms of dryness and painful intercourse. It all sounds good on paper until you throw in the estrogen/breast cancer scare and the mess of a cream in the vagina. Oral forms of estrogen can be helpful but probably do not reach the vaginal tissue as much. Don’t get me wrong, I think hormones are an important piece of the aging puzzle of our bodies but not every woman is a candidate for hormonal therapy…and that’s where the relationship gets complicated. Thankfully there are over the counter PH balancing gels and probiotics for the vagina that help to keep the same vaginal environment that we are used to. While the products do relieve some symptoms, they will not stop the age related changes from progressing during our lifetime. Even the newest pharmaceutical non-hormonal concoction designed for vaginal atrophy (can’t we find a better word?) has limited potential.

So where does that leave our pursuit of the elusive vaginal fountain of youth? Fortunately, we have learned from the technology designed to slow the aging process on our face and body and have applied it to the area ‘down there’. The energy sources used to “tighten” our face and improve tissue texture, lubrication, and increase collagen formation are now being used to do the same- aesthetically enhance the appearance of the vulva and improve the integrity of the mucosal lining of the vagina therefore enhancing lubrication and sexual satisfaction! A breakthrough for the complicated puzzle of female sexuality! We are literally “bringing sex back” to women and their relationships and enhancing the second act of their lives and improving relationships! Baby we have come a long way…finally!

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