The human body changes constantly as we age, even in ways that may not be immediately noticeable. As we advance through the decades, each organ in the body undergoes changes, including the skin, the ovaries, the vagina and vulva.
But despite how key the vagina and vulva are, we’re often not fully briefed on what sort of changes to expect as we age. Maybe you received some instruction about puberty in school, but after that, many women are basically left to guess what’s going to happen next.
That ends here because we spoke with several OB-GYNs about how your vagina and vulva change as you age. (Spoiler: It’s more than you think.)
Although the vagina and vulva are two distinct body parts (and don’t trust anyone who tells you otherwise), they “work as a contiguous unit throughout the life cycle,” Dr. Kecia Gaither, a double board-certified OB-GYN and director of perinatal services for NYC Health+Hospitals/Lincoln in the Bronx, says. In other words, these intimate body parts age at the same rate, in roughly the same ways as hormones change.
Before we get into key changes, Dr. Maral Malekzadeh, a board certified OB-GYN and co-owner of The Well Westlake, dispenses some important advice: Get comfortable learning about your own vagina and vulva.
“The most important habit, at every age, is understanding what’s normal for your own body,” she says. Here’s what changes to expect in each decade for your vulva and vagina.
How Your Vulva and Vagina Change in Each Decade
In Your 20s
By our 20s, many of us are acquainted with our vagina and vulva and how the parts work. Given that people in their 20s (and 30s and early 40s) typically have normal estrogen levels, their vaginas and vulvas should be “elastic, thick and lubricated,” Dr. Sharyn Lewin, a board-certified gynecologic oncologist who is director for the division of gynecologic oncology at Holy Name Medical Center in Teaneck, New Jersey, says.
This is also a decade where many people become sexually active and get more comfortable with their bodies. According to Dr. Sherry Ross, an OB-GYN and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period, with new and more sexual partners, the vagina may be prone to infections, human papillomavirus (HPV) and other sexually transmitted infections (STIs). In this decade, practicing safe sex (which likely involves some sort of birth control) is important. The HPV vaccine is also available for people ages 9 to 45.
Even in our 20s, our vulvar skin can be sensitive.
Dr. Mary Jane Minkin, a board-certified OB-GYN and clinical professor in the department of obstetrics, gynecology and reproductive sciences at the Yale University School of Medicine, says that sitting in a bubble bath, for example, may leave you with something that looks and feels like a yeast infection. This could mean experiencing itching and redness of the vulva, even when your baseline tissue is quite healthy.
If you find this is the case for you, don’t worry—there’s a solution.
“Try to use very gentle washes to the vulva,” Minkin says. Remember, the vagina is self-cleaning and fancy washes aren’t necessary. “And you want to be using pH balanced products when washing.”
During and After Childbirth
Though many people end up having children in their 30s and 40s, the average age of giving birth in the United States is 26.3 years-old, and regardless of when—or if—you want kids, it’s helpful to know what the process does to your vagina and vulva. According to Ross, 30% of people who have a vaginal birth will have some form of trauma to the tissue and muscles in the vagina and pelvic floor.
“The vagina and all its elastic glory can only stretch so much during childbirth,” she explains. “With each vaginal delivery, there is a little more stretch—similar to what happens to the elastic band found on pants. The muscles stretch, distend and tear in the vagina to allow the head to come through this tight space and never completely recover.”
Vaginal tearing or an episiotomy during a vaginal birth can, and does, happen for many women. But never fear, your vagina does heal. Recovery time really depends on the person and how they delivered. The traditional healing period is six to 12 weeks—during that time, doctors typically tell you to avoid having penetrative sex—but for some people, recovery can last longer.
The pelvic floor can weaken during pregnancy and childbirth, too, which can cause incontinence. To rebuild your pelvic floor, you can start with some pelvic floor exercises, which you can do on your own at home. If, after trying these, you’re still experiencing incontinence or a weak pelvic floor, this is definitely something to bring up to your doctor. They may recommend pelvic floor physical therapy to strengthen the muscles in the area.
As the vagina heals from childbirth, sexual dysfunction issues can arise.
As you re-enter sexual activity, you can curb discomfort by using a sexual lubricant and clearly communicating with your partner.
“Being patient and knowing what is happening with your body helps both you and your partner understand this is a normal challenge for new parents,” Ross says.
In Your 30s
Regardless of whether or not you’ve given birth, Ross says you should start doing Kegel exercises in your 30s, if you haven’t already. (And really, the earlier the better.)
“Kegel exercises strengthen the pelvic floor muscles, which support the vagina, uterus, bladder and bowel,” she explains. “If Kegels are done correctly and repeatedly, over time, you can avoid symptoms, such as stress and urge incontinence, caused by childbirth, aging and obesity. A bonus is Kegel exercises can also make sexual intercourse more enjoyable for you and your partner.”
Generally, Malekzadeh says in your 30s “the focus is prevention and awareness—using gentle, fragrance-free care, practicing safe sex, keeping up with gynecologic checkups and addressing pelvic floor changes early, especially after childbirth.”
In addition, 30-something women using birth control pills may notice vaginal dryness with sex. “There are many different brands of birth control pills, each varying in the types and doses of two key hormones,” Ross explains. “Some women are more sensitive to one or both of these hormones exacerbating side effects such as vaginal dryness. One size does not fit all when it comes to the pill. Finding the right brand may take some time and patience.”
If you’re experiencing vaginal dryness in your 30s, Dr. Jessica Grossman, an OB-GYN, suggests using FDA-approved lubricants and vaginal moisturizers and, if the issue persists, speaking with your healthcare provider.
In Your 40s
Perimenopause can set in as early as your mid-30s, but more commonly begins some time in your 40s, and typically lasts between four and eight years. Perimenopause refers to those years in the reproductive life cycle where the ovarian production of estrogen becomes irregular and erratic, Ross explains. Symptoms—including dryness and an increased risk of vaginal infections—can begin to crop up in your 40s.
“Some women will go on a low dose birth control pill, or hormone replacement therapy to treat these disruptive symptoms of perimenopause,” Ross says. ”You need to talk to your health care provider about any symptoms that are negatively affecting normal routine, especially in the bedroom.”
Again (and you’re probably sensing a theme here), if vaginal and/or vulvar dryness is an issue, you can always use FDA-approved lubricants or moisturizers (both internal and external) to help deal with it. Minkin recommends using Replens vaginal gel, which comes in both an internal vaginal moisturizer and an external comfort gel.
Generally, Malekzadeh says the most noticeable changes happen when women are in their late 40s and early 50s, when the transition to menopause is getting closer. While every woman’s timeline is slightly different, she says at this time “hormonal shifts accelerate and symptoms often become more noticeable.”
In Your 50s
The average age for menopause to start is 52. Menopause is a time when your ovaries stop producing estrogen and your female hormone reserves are depleted, says Ross. Some choose hormone replacement therapy (HRT) to replace the estrogen and combat some menopausal symptoms. If you don’t take HRT, your vagina may become progressively more dry and dehydrated, she adds.
“With the loss of estrogen nourishing and hydrating the vagina, the tissue can become dry, pale, itchy and dehydrated,” Ross says. “The natural vaginal discharge created by a woman’s sex hormones is gone.”
At this time, you may notice the genitourinary symptoms of menopause (GSM), formerly known as vulva-vaginal atrophy. Possible things to watch for include painful sex and dryness.
Minkin notes that the skin on both your vagina and vulva can end up having dryness issues.
The good news is that non-prescriptive remedies include lubricants—like gels, moisturizers and oils—and can ease and minimize the discomforts related to GSM. “For women with more severe symptoms, localized estrogen treatment can reverse this condition,” Ross notes. “Prescriptive remedies that have the best results include a non-hormonal prescription, Osphena, and oral orvaginal estrogen creams, tablets and the Estring.” Mnkin recommends using Replens gel for this as well.
In Your 60s and Beyond
Postmenopause, meaning in your 60s and beyond, Malekzadeh says your vaginal and vulval care comes down to two things: maintenance and monitoring.
“After menopause, lower estrogen levels can cause the vaginal and vulvar tissues to become thinner, less elastic and more sensitive,” she explains. Your vaginal environment can also change, which could make it easier for infections and irritation to happen. You may also notice the skin on your vulva looking more fragile and pale.
“While these changes are common, they are not something women have to live with, as many symptoms are very treatable with appropriate care,” she adds.
Her advice? Continue to build on the good habits you relied on in decades prior. Don’t forget regular self-checks and doctor’s appointments. Know that it’s important to seek treatment for “pain, itching, burning or bleeding, which are never just a normal part of aging,” she adds.
General Tips for Vaginal and Vulval Care at Any Age
Even though your vagina and vulva can experience some pretty big changes throughout your life, know that there are usually ways to navigate problems and changes that come up—or at least make you more comfortable along the way.
Here are some habits that Malekzadeh says will ensure vaginal and vulval health and comfort at any age: Keep cleansing and washing simple and opt for fragrance-free products that won’t cause reactions or irritation. Avoid douching. Use lubrication when you need to during sex to relieve pain and discomfort.
Keep up with your gynecological appointments and screenings, like pap smears and annual visits.
“Continuing regular gynecologic care, even after menopause, and advocating for comfort are also essential, as vulvar and vaginal symptoms are common and highly treatable when addressed early,” she adds.
Most importantly, do not ignore discomfort and pain when you notice it.
