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While this is commonly known as Atrophy of the vagina, the truth is there are many parts of our reproductive organs that are impacted by Menopause, so in a good medical practice that understand this, you will hear it being referred to as GUSM, because it captures the full spectrum of structures in our bodies that can be impacted at this time.

In her book the Menopause Manifesto, Dr. Jen Gunter also points out that the term ‘Atrophy’ is no longer acceptable in society, because it is quicky associated with diminishing stereotypes of women, being ‘decrepit shrinking violets’ or ‘shriveled up’. I agree with her, but I am using the term here, because it is still the most commonly used when you go in and describe experiencing dryness and I have a positive spin that you can consider…..calling your bits ‘A’ ‘Trophy’, something that you can be proud of and want to talk about, and display from time to time, not just keeping it on a shelf getting dusty! Anyway, that is how I am thinking of it.

Whatever you wish to call this, 15% of us will experience the effects during the Peri Meno transition, most commonly at about 45 years old, and then up to 80% of us will have some type of experience of it in our lifetime. So, we need to talk about what it is and why it happens.

First and foremost, it is a condition characterized by dryness and thinning of the vaginal lining as a result of estrogen levels diminishing or simply being non-existent. It also occurs because our blood flow starts to reduce as we age and we are equally losing collagen, which gives our tissues the ability to stretch and provide strength. When this occurs, it can be a sign that your vagina is changing shape and, sometimes size, and that it is becoming less elastic and therefore more fragile.

Another consideration is that your vagina microbiome is going away from a lactobacillus dominant environment, making it more alkaline, with a much higher pH and resulting in a potential burning sensation and less lubrication. This change brings with it a change in how you smell and the type of mucus you produce down there, meaning you tend to have a more watery discharge than you are used to. Then there is with declining hormonal levels, they can also affect the pelvic floor muscles and ligaments, which could lead to incontinence & leakages.

While all this is going on, many of us will experience difficulty in reaching a climax when having sex (let’s talk about sex baby….). It could be that it takes much longer to achieve an orgasm or that the strength is greatly reduced. It goes without saying that if any of this is happening to you, you will likely be experiencing low libido and interruptions to, or simply stopping your sex life altogether.

Before we go any further it is important to get back to basics. It is not like our bits are the easiest to see and inspect, so here are a couple of diagrams to help understand what we are talking about. The vulva is outside reproductive bits and is made up by the mons pubis, clitoris, labia, and perineum. The inside bits are the vaginal tract, cervix, uterus, urethra, and bladder. You can see then, why the change in description is so important, to GUSM, because simply having a dry vagina or labia, does not capture the scale of what we are talking about.

The positive news is that there are lots of things you can do to get relief and manage your symptoms of GUSM.

First and foremost, keep soap away from that area! It seems obvious, but it’s not always apparent what you are using on yourself, so have a look and make the change if you need to. You want things that are not perfumed, and this includes cleansers, moisturizers, and deodorants. You have a natural pH down there, so adding things that are artificial will disrupt the balance.  Rather than go out and by expensive things that claim to do, this and that, simply get yourself an unscented gentle facial cleanser, that is from your local pharmacy, this is the best option. Keep in mind that the fewer the ingredients, the better a product is likely to be for your bits.

Try to avoid wipes, as these also disrupt the pH balance. Interestingly Dr Jen Gunter has a passionate hatred for wipes and their marketing to women, reinforcing the ‘infantilizing’ of women. She states, ‘we are not babies, and we are capable of cleaning ourselves with toilet paper’. An the reason she is so passionate is because the patriarchy are reinforcing that we are dirty and must be clean and prepped at all times for them (by using wipes). So please try to avoid buying into the oppression. With that said, I have used wipes myself when I am bleeding heavily and needed to tidy up at the office. They have their place, just avoid using them all the time.

Moisturise, moisturise, and lubricate! This is not only about sex, but rather to improve any dryness and irritation, if this is what you are experiencing.  There are more and more products coming on the market, but you don’t have to go expensive to get relief, simply using coconut or olive oil regularly is a good starting point and both are 100% natural. If this is too out there for you, then you can try using a paraben-free and hormone-free vaginal moisturiser, for example YES® Vaginal Moisturiser. The aim is to rehydrate your vaginal tissues and a good one will last several days. You will more than likely need to experiment with a few different things to see what works and feels good for you. Remember that you do not need to try and control ‘feminine odour’ when you are looking at products, you do not smell down there, the changes are normal and this is an unhelpful message, again from the patriarchy! With lubricant this is a specific product that you may use during sex. Personally, I have always loved using lubricant, and I know many others who do as well, so this is not an exclusively Meno related phenomenon and for mild symptoms of GUSM, this could be all you need. There are even more lubes than there are moisturisers! As a starting point try a silicone based, pH balanced version, like ‘Uber Lube’, or a water based one like ‘Yes Baby’ vaginal-Friendly Lubricant. Again, simply using Coconut oil or Olive oil is just as effective. But try different things and see what works for you from a slip and slide perspective!

Hormonal treatments are especially helpful when localised. You can ask for vaginal estrogen, which comes in the form of creams applied to the labia, or a 3-month vaginal ring, or pessary inserted directly into the vagina. I am using the Vaginal estrogen, and I have found that it helps with dryness, urinary symptoms, and urinary tract infections. It is by far the most superior treatment for GUSM and is the most widely studied. This type of treatment can and should only be accessed under the guidance of your medical professional.

I personally have struggled with hypoactive sexual desire dysfunction (HSDD) and that is where you have very low sexual desire or very low interest in having sex at all. It has been very distressing, so after some research I knew I could ask for testosterone treatment. I am using Androfeme® which is a body-identical 1% testosterone cream that’s now available by prescription in Australia. It can help with sexual desire, pleasure, orgasm, responsiveness and as a result your own self-image. For me It has also really helped my cognitive function, and my brain fog has really improved. Be aware however that this is not currently covered under the Pharmaceutical Benefits Scheme (PBS), so it was almost $200 for a 3-month supply.

On the point the natural balance of “good” and “bad” bacteria in the vagina, perimenopause is a time when the balance changes, many women report increases of infections such as bacterial vaginosis (BV) and urinary tract infections (UTIs). BV is excess bacteria growth in the vagina. UTIs are an infection of the urinary tract, which includes the bladder, kidneys, ureters, and urethra. It is especially important to see your health professional if you have itching or smelly discharge, as this could be a vaginal infection that requires treatment. If you have an uncomplicated UTI you can get advice and treatment at a chemist in Australia with out a script.

Hair, yes, your Mons Pubis! You should have a bit of hair down there! Thanks 2000’s era porno, for making all of us think we need a Brazilian to be appealing to the opposite sex!!! Hair is there for a reason, and it not only protects your vulva, but it also keeps it humid, trapping moisture against the skin. Removing it in any way, damages the top layer skin and makes you prone to damage, which can quickly escalate to other things, such as infections, including UTI’s.   

Make sure you do your pelvic floor exercises or Kegels, as these are the muscles that contract during an orgasm, but equally will assist with urinary symptoms, like leakage and frequently needing to go to the toilet. Practice them regularly, and if you don’t get any relief then book into a physiotherapist who specialises in women’s health, such as Juliana from Centered Ground.

Finally, if you haven’t already, then do your best to give up smoking! Smoking reduces blood flow to your whole body and especially your skin, but more importantly it has an anti-estrogenic and anti-collagen effect. Being smoke free has several benefits, so please give it a go.

If you are in a sexual relationship with someone and due to GUSM you no longer wish to have sex or just need to have a break, you have to communicate what is going on. Even though I have been with my husband for almost 30 years and we share everything, I found this incredibly difficult to articulate. Because at first, I just started avoiding having sex. I thought something was wrong with me, and so I didn’t want to talk about it. I had pelvic pain and pain during sex, and I was also getting UTI’s as regularly as I was bleeding, so to say that it was uncomfortable is an understatement.

Here is the thing though, not wanting to have sex during this time is way more common and normal than you think, and it is not just the Menopause that contributes to the dryness and lack of libido, it is family responsibilities, work stress and general life stress. Rather than making your sexual partner feel rejected, which could make them feel quite distressed and emotional, leading to arguments, or affairs with another sexual partner, have a chat. Open up about what is going on and help them understand what you are going through. If they love you, they’ll want to work through solutions with you.

Remember intimacy is not just about sex. Intimacy is about connecting at a deep level with another human being. As a result of my upbringing, I did not realise what intimacy was! I know this must sound ridiculous! It wasn’t until I saw my wonderful sexologist after really struggling and thinking that I was going to leave my husband, that I realised simply holding hands on the lounge is intimacy. Just lying together in bed in a hug is a way to be close and communicating calmly, explaining what is going on in my head and vagina is intimacy. It was transformative for my husband and me. We didn’t want to leave each other. So as Gwen McCrae says, “We spend a lot of time searching for love. And never know where it’s coming from. And as soon as we get it somehow. We seem to think that our work is done! But the same thing it took to get that love. Are the things that you’ll have to do to keep it. You gotta stay on your J.O.B. You gotta give a little, take a lot. Give it all you got, oh!”. Yes, you can listen to this on the Mimi Moon Playlist! Basically, what I am saying is, if you can’t have sex, you can still go to the movies and dinner and stay in love with each other like you did at the start of your relationship, if that is what you want. If you have not seen it yet, have a look at the Meno journal about Menopause & Sexuality: Embracing Change and Rediscovering Passion

Remember that It is super important to be self-aware of your vulva and vagina at all stages of life, but especially during Menopause. You may develop spots for example or lumps, as well as experience dryness and other things, so while it is not easy to see, there are ways. Get yourself a long-handled mirror and check your bits out. Feeling yourself in the shower is also recommended. Get familiar with what you feel, smell, and look like and if there are any changes make sure you put your hand up. There are plenty of women health specialists to guide you, including me!