Alright, this is probably an awkward subject, but I know from talking to some of you and from what I read in forums that our vi-jay-jays can sometimes become high maintenance in midlife.  And, the problems can be a bit vague and unpredictable which means our doctors don’t always know what to do for us.  It can be very annoying, not to mention having a negative impact on our intimate relationships.

Carol Leonard has been practicing midwifery for more than 25 years.  She has written this excellent article telling us what is happening to our vaginas during menopause, and she gives us a number of wonderful tips on what we can do about them.

After menopause the walls of the vagina become thinner and produce fewer secretions. Vaginal lubrication with sexual excitement occurs more slowly. As the amount of estrogen decreases, the vagina becomes less acidic, making women more susceptible to vaginal infections, including yeast. If changes are significant, women may have a feeling of dryness or irritation. Severe dryness can cause vaginal pain. Women are most likely to feel vaginal discomfort during or just after sexual intercourse, especially without being wet enough. Thinner, more easily injured vaginal tissue combined with decreased acidity of the vagina can lead to infections. The usual symptoms are increased vaginal discharge, itching and burning.

The disrespectful, patriarchal name for menopausal thinning and associated symptoms is Atrophic Vaginitis and Dyspareunia (painful intercourse), but this is not inevitable. These symptoms can be remedied with understanding and simple loving care. And, as with all of menopause, good solid healthy nutrition and exercise is key to preventing drying and thinning. Here are some important suggestions for self-care for a dry vagina:
 

• Take 400-600 IU of Vitamin E daily. Again, only 100 IU Vitamin E if you bleed heavily, and only 50 IU if you have diabetes, high blood pressure, or rheumatic heart murmur.

• Self-help for dry vaginas: Get Slippery! There are several "light, personal, modern lubricants" on the market today, the current favorite being Astro-Glide, probably because the name is so great. It is mostly glycerin.

• Coconut oil or cocoa butter -- smells great, tastes better, solid at room temperature, liquid at body temperature.

• Honey -- hydroscopic (water-drawing), will moisturize and heal a tender yoni. Apply directly where needed (and obviously, great tasting).

• Aloe Vera and Slippery Elm paste -- to sooth inflammations. Mix enough slippery powder into aloe vera gel (bottled or fresh) to form a paste. Apply along the labia and inside the vaginal entrance. This lubricates, heals and nourishes.

• Oil from a Vitamin E capsule -- use a capsule that has 400 or more IU's. Some women say this works as well as estrogen cream. Wheat Germ Oil is a good source of Vitamin E, cool and soothing.

• Almond oil or olive oil (cold-pressed) are nice. Apply to the fingertips and massage all around the vaginal opening and perineum.

• Look for Comfrey-based ointments with names like "Green Gold," etc. in natural food stores. Comfrey has an alkaloid called Allantion which regenerates skin tissue and will keep skin flexible and strong. I've had a long love affair with Comfrey as a midwife, using it to speed repairs of perineal tears. Comfrey could be combined with other herbs such as St. John's Wort (Hypericum, used for burns) and Calendula (Pot Marigold) for added healing. (Goldenseal will probably be too drying.)

• A commercial option is Replens, a new over-the-counter cream available in drug stores. The active ingredient, Polycarbophil, pulls water into vaginal cells and lowers the pH of the vagina, which helps prevent overgrowth of bacteria.

• For PAINFUL INTERCOURSE: Reduced estrogen levels sometimes cause the mucous membranes of the vagina to become dry, resulting in discomfort or pain during intercourse—just at a time of life when you can be more spontaneous, without fear of pregnancy. I recommend bio-identical, compounded ESTRIOL 0.2% vaginal cream (this is made by a compounding pharmacist and requires a prescription from your friendly Naturopathic Doctor.) The compound diosgenin is found in Mexican wild yam roots (Dioscorea species) but it is chemically changed in the laboratory to produce Estriol. Estriol is the weakest estrogen and when used intravaginally, is a fabulous treatment for vaginal atrophy/dryness.

• Estriol is also thought to have a cancer protective factor for women against breast, and other estrogen-driven cancers, such as ovarian and uterine cancers. Estriol may be anti-carcinogenic because it closely mimics the natural human pattern. It reduces excess blood estrogen by competing for estrogen receptor sites with a woman’s own circulating estrogen. Because the estrogen potency of Estriol is so small, it has the net effect of lowering the body’s estrogen when it binds to the receptor sites, thus reducing the risk of estrogen-driven diseases. (I am not talking about estradiol, which is the estrogen used in the allopathic Estrace and Vagifem commercial products, which is the strongest estrogen and not a good thing.)
  

• I highly recommend compounded Estriol cream for restoring youthful moistness and elasticity and, literally, putting “bees in your bonnet”. My girlfriends call this the “Marriage Saver”.

• Kegels. Remember the annoying Kegel exercises (squeezing the PC -- pubococcygeal muscle) from our child-bearing years? In the car, at every red light? Well, they are back -- and they still make the supporting muscles of the vagina stronger and healthier.

• And speaking of exercise -- of course the health of your vagina depends on stimulation like any other part of your body. It needs to be exercised regularly to keep fit. Remaining sexually active in the second half of your life, either with a partner or by self-pleasuring, is the key to maintaining a healthy vagina.

Carol Leonard, a “foremother of the modern midwifery movement,” is a New Hampshire certified midwife who has been practicing for over the last three decades. She is the author of her memoir as NH's first contemporary midwife, Lady's Hands, Lion's Heart: A Midwife's Saga, Bad Beaver Publishing, 2008. She is co-founder of the Midwives Alliance of North America (MANA), which represents all midwives in the United States, Canada, and Mexico, and served one term as its president. She is currently building a four-hundred-acre farm in Ellsworth, Maine, named Bad Beaver Farm.

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