It's the unsung hero of sex, conception, and childbirth, but I bet you barely know your vagina. If you don’t frequently hold a mirror up to your hoo-ha, I don’t blame you. It’s not my ~favorite~ way to spend a Friday night. But any gynecologist will tell you it's important to know what’s going on down there and to be in tune with any changes taking place. Time and life events (like, say, stretching to accommodate the passage of a baby) all have an effect on your vagina, which can change in size, shape, and lubrication throughout your life. Basically, the only thing that doesn't age in this world is Paul Rudd.
“The effect of aging on our entire body, including our vagina, is inevitable,” Sherry Ross, M.D., OB-GYN in Santa Monica, California, and author of She-ology tells Romper. “Just like any other part of your body with skin, glands and hair follicles, the appearance of the vagina is affected by the aging process and how well you care of it.” There are known offenders, such as childbirth and menopause, which leave battle scars that can be permanent, but this does not mean surgical procedures, such as vaginal rejuvenation, are necessary at any age. “There are doctors who may promote these surgeries, but be aware that they are not supported by the American College of Obstetrics and Gynecology and may present permanent complications such as pain with sex, scarring, and infection,” Dr. Ross adds. “The vagina has the capabilities to expand and stretch appropriately and surgical corrections are not needed to lead a productive sexual life.”
To ease your concerns about your aging and changing vagina, we talked to two OB-GYNs who’ve seen it all and know from experience and firsthand what you can expect in each decade.
In Your 20s: Meet Your Vagina
You may have strolled through your first two decades without really thinking much about how it all works “down there.” Chances are, you’ve had sex, but are not quite past the point of incredibly awkward (and uncomfortable) sexual encounters. One thing you know for certain: Sex doesn’t go down the way it appears on the big screen — and orgasms are way harder to achieve, though easy to fake.
The changes that happen to the vagina in your 20s have to do with a maturing and empowering vagina (💪). “Your ability to enjoy sexual interactions and control promotes more lubrication,” says Dr. Ross. It is unlikely there will be significant physical changes associated with the vagina in this decade — unless you have a baby.
Good news for young moms: experts agree that the best time for your vagina to have a baby is in your 20s, since the healing process after having a baby is faster and easier. "The vagina is more forgiving when you have a baby at 25 versus 35," says Dr. Ross.
Birth control pills, too, might cause minor changes on the inside of your vagina, including dryness and heavier-than-normal discharge. This is not a side effect for all women, but some may notice less natural vaginal lubrication when taking birth control. Changing to another birth control pill is often necessary in order to correct this common side effect with some of the contraceptive pills available on the market today, Dr. Ross adds.
Those jumping on the laser-hair-removal bandwagon, however, may experience changes in pigmentation. “The procedure messes with the hair follicles and can cause discoloration, though this is rare,” says Alyssa Dweck, MD, OB/GYN and author of The Complete A to Z for Your V.
What you should be doing: A healthy vagina needs the same hygienic attention as any other part of your body. “Your 20s are the perfect time to keep your vagina healthy from the inside-out,” Dr. Ross explains. “Between urine, sweat and being so close to the anus, cleaning the vagina regularly is critical to prevent dirty bacterial buildup and to avoid the offensive odors that develop throughout the day.”
While there is some truth to the “self-cleaning” qualities of the vagina, a non-fragrant soap and water is perfectly safe and recommended for use in and outside the vagina. “As a gynecologist, I suggest that you clean your vagina and labia every day as if it was any other part of your body,” she says. “Use two fingers at the entrance of the vagina and one to two knuckles into the vagina using a gentle, non-fragranced soap.”
Adding oral or vaginal probiotics to your daily regimen can also keep the vagina in complete balance and harmony. Dr. Ross recommends looking specifically for ones that support feminine, vaginal health and hygiene, as these types of probiotics maintain a healthy vaginal microflora by increasing the number of beneficial lactobacilli in the vagina. The success of these vaginal probiotics depends on the amount of lactobacilli and the quality of the manufacturer.
Ross also recommends getting into the habit of taking warm baths with a handful of extra virgin coconut oil to keep that area naturally hydrated. “Extra virgin coconut oil, with its antiviral and antibacterial properties, is a great friend to the vagina,” she says. “It lubricates and hydrates the tissue of the vagina in the most natural way and can be used as a daily moisturizer for the vagina and lubricant during sex without any horrible side effects such as a yeast infection.” It is important to note, however, that some women get skin irritation and bumps from using coconut oil, so it may not be the perfect vaginal lubricant for you.
In Your 30s: Meet Your New Vagina
It is true that even your vagina, in all of its elastic and rejuvenating glory, can only stretch so much during childbirth. “With each vaginal delivery, there is a little more stretch, similar to what happens to the elastic band on a pair of pants,” explains Dr. Ross. “The vaginal muscles stretch, distend and tear to allow the baby’s head to come through this tight space — and often, they never completely recover.”
OK. Before you freak out and call your gyno for a new birth-control script, know this: Many, many women don’t notice any changes down there after childbirth. Additionally, Kegel exercises and pelvic-floor-muscle strengthening can help reverse stretching from labor and delivery — even in cases where an episiotomy was not performed. “An episiotomy is a surgical cut in the perineum (space in between the vagina and rectum) to make extra room for or expedite delivery,” says Dr. Dweck. “If an episiotomy is not done, natural tearing is common, but, luckily, the vagina is very forgiving and usually heals quickly.” Some people may have scarring or discomfort with sex afterwards, but this typically resolves with time.
Stretching is not the only side effect of a vaginal delivery. Pigment changes during and after pregnancy can affect the vulval skin, too, and nursing (lactation) can cause significant vaginal dryness similar to that seen in a menopausal vagina. “The physical and hormonal changes seen during the postpartum and breastfeeding period are caused by a dramatically low level of estrogen,” Dr. Ross says. “The low estrogen causes vaginal dryness and burning similar to the changes seen during menopause.” But don’t worry, this is often reversible once your period kicks back in.
What about if you have a c-section? A Caesarean won’t directly affect your vagina, but it does come with its own set of side effects. When it comes to the postpartum vagina, it doesn’t always matter whether you had your baby via c-section or a vaginal delivery. “You are already on a hormonal rollercoaster — and, if you are breastfeeding, your vagina is low in estrogen, so it tends to be extremely dry,” says Dr. Ross. Though, as a new mom, sex is probably one of the last things on your mind. If you do happen to be raring to go (once your doc gives you the green light after the standard 6-8 weeks), a lubricant — by which I mean plenty of lubricant — can help readjust your body to sexual intercourse. Once you stop breastfeeding and your hormones are back in check, your vagina and its natural lubrication will return to normal.
What you should be doing: If you don't have babies in your 30s, you can expect subtle changes as a result of normal aging. "It may not be as noticeable, but there is subtle loosening of the tissue in the vagina," explains Dr. Ross. "I advise women to keep up with their Kegel exercises as regularly as possible to strengthen the pelvic floor muscles and their responsiveness." This, she says, will help lessen the normal aging changes associated with the vagina.
In Your 40s: Hello, Perimenopause
“Perimenopause refers to those years in the reproductive life cycle where the ovarian production of estrogen becomes irregular and erratic,” says Dr. Ross. What does this mean? “Women may experience early signs and symptoms of menopause specific to the vagina, including dryness and an increased risk of vaginal infections.” Also, don’t freak out if you start to notice wiry grey hairs (matching those atop your head) on your vulva.
What you should be doing: “Some women will go on a low-dose birth control pill or hormone replacement therapy to treat these disruptive symptoms of perimenopause,” Dr. Ross says. “If you do notice any symptoms that are negatively affecting normal routine, especially in the bedroom, this is the time to talk to your doc and find a solution that can get you feeling back to normal.”
In Your 50s: Hot Flashes, Night Sweats, Exhaustion, Oh My!
Enter menopause. This is the time in your biological life when your ovaries stop producing estrogen — that is, your reproductive hormones are depleted. “Unless you are taking hormone replacement therapy and replace the estrogen that you are no longer producing, your vagina will become progressively more dry and dehydrated,” warns Dr. Ross. “With the loss of estrogen nourishing and hydrating the vagina, the tissue will become dry, pale, itchy and dehydrated, and the natural vaginal discharge created by a woman’s sex hormones will be gone.”
But, not to fear. Sure, these side effects might make for a slightly painful and uncomfortable sex life, but there are things that can help. For starters, over-the-counter fixes include lubricants, gels, moisturizers and oils. “These can ease and minimize the discomforts related to the menopausal vagina,” says Dr. Ross. For more severe symptoms, localized estrogen treatment can help. “Prescriptive remedies include a recent nonhormonal prescription, Osphena, and oral or vaginal estrogen creams, tablets and the Estring prove to have the best results.”
“With the loss of estrogen to nourish and hydrate the vagina, the tissue becomes dry, pale and dehydrated, the labia can become fused and the vagina and clitoris may shrink,” Dr. Ross explains. “Oftentimes these symptoms are accompanied by urination problems, such as an increase in urgency and frequency.” The medical term for this is vulvovaginal atrophy (VVA). “As a result, intercourse, other forms of vaginal contact and even walking and exercise can become painful if not impossible.”
What you should be doing: Non-prescriptive remedies for VVA may be your first go-to. These include lubricants such as KY, gels, moisturizers, and oils, which can ease and minimize the discomforts of menopausal vagina. A great, natural, alternative lubricant is extra virgin coconut oil, your friend for life. A second-step solution she recommends is the Mona Lisa Laser Touch, a four-minute, painless, non-medical alternative in the treatment of VVA.
“The Mona Lisa Touch Laser Treatment is the newest kid on the block to combat vaginal atrophy,” Dr. Ross says. “An Italian-built laser device, the FDA-approved Mona Lisa Touch Laser holds tremendous promise in treating a vagina that has been transformed in menopause.” Once you’ve had a pelvic exam to assure that you are an appropriate candidate, a physician trained in the use of the Mona Lisa — which is actually, a small vaginal laser — inserts the device into the vagina during three three-minute sessions, six weeks apart. Many women report positive changes after just the first three-minute treatment, which involves removing the dried skin inside the vagina and stimulating collagen production to allow for vaginal revival. The end result is a vagina makeover resulting in greater elasticity and natural lubrication of the tissue inside the vagina. “Although it may sound too good to be true, the results are proving to be a game changer in the way vagina atrophy is being treated (without hormones!) which is a relief to many women and their partners,” Dr. Ross assures.
In Your 60s And Beyond: Your (Gracefully) Aging Vagina
Unless you’re pulling a Samantha from Sex and the City and clinging onto your hormone replacement therapy for dear life, you can expect your vagina to age along with the rest of you. “The vagina will continue to become drier and the tissue thinner and more pale,” explains Dr. Ross. “Burning and pain with sex will be more noticeable and, unfortunately, disruptive in the bedroom.”
What you should be doing: Thankfully, vaginal lubricants can still come in handy — even natural options like extra virgin coconut oil can help a dry vagina. However, Dr. Ross points out to avoid any over-the-counter treatments that contain alcohol or anything that causes drying of the skin.
Tightening treatments like the Mona Lisa Laser are also available, but be sure to talk to your doctor about any side effects that may come along with them. “Some women gain the extra benefit of feeling tighter in the vagina after the Mona Lisa Touch Laser treatment,” she says. “For those women who have had a few vaginal births and notice looseness in this area, vaginal surgery may be necessary.” An OB-GYN would be the best person to access if this is a surgery you could benefit from or not.
Bottom line: Your vagina is as young as you think it is. With that said, Dr. Ross agrees that a young vagina is healthy and confident. "Keeping the vagina clean, hydrated and enjoying sexual pleasures keeps the vagina young regardless of age." In other words, be nice to her and she will do her best to be nice to you back.
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