Why does it feel like everything is shrinking and shriveling?

My “down there” seems to be changing, and not for the better. 

In part, it seems that way because things probably are. In menopause, in the absence of estrogen, the vagina narrows and becomes more thin and fragile. Even when you are lubricated enough, the tissues have likely lost elasticity and can’t comfortably stretch with intercourse.

Genitourinary syndrome of menopause (GSM) or vulvovaginal atrophy (VVA) is a very common menopause-related condition in which genital tissues atrophy. The walls of the vagina become thin, dry, and possibly even inflamed due to a decline in estrogen. (The vulva refers to your external genital organs, including the labia and clitoris.)

About half of all postmenopausal women will experience some symptoms of atrophy, which is treatable once it’s been diagnosed.

Symptoms of GSM include:

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

About half of all postmenopausal women will experience some symptoms of atrophy. But often they’ll look at these signs in isolation, not realizing that a urinary tract infection may be directly related to the discomfort they feel during intercourse—and that both might be indicative of vulvovaginal atrophy.

Treatment is readily available, but it has to be diagnosed first. And because women are often too embarrassed to talk with their doctors about vaginal problems, many try to treat it themselves, without even knowing there’s a name for it. Over- the-counter lubricants may offer some short-term relief for dryness, but vulvovaginal atrophy is chronic and requires ongoing treatment to address the underlying cause.

Typically, treatment includes estrogen therapy, either localized (applied in the vagina) or systemic (oral or transdermal), which must be prescribed by a doctor.

As soon as you feel anything unusual, lubricants don’t seem to work as well, or you begin experiencing any of the symptoms listed above, make the call to your health care provider. It’s much easier to keep healthy tissues healthy than to reverse the trend when it’s well underway (although most women can achieve some success).