Many of us spend a lot of time thinking about our appearance as we get older, often looking for ways to make ourselves appear younger and age gracefully. However, less attention is paid to the most intimate area of our bodies, our vaginas, despite the impact that vaginal health have on the way we feel about ourselves, our comfort and our sex lives.

Ensuring you have an awareness of your body and how it changes, will keep you healthy and feeling good about yourself. Here are the answers to some of the common questions that Tania Adib, consultant gynaecologist from The Medical Chambers Kensington, has been asked by women about their vaginal health and how their vagina changes over the years…

IN YOUR TWENTIES…

Q: Why does my vagina feel dry?

A: Your 20s should be a time your vagina and inside the vulva (the surrounding area) look pink and well-lubricated – ideally, everything should be in full working order. However, young women do sometimes experience vaginal dryness due to oral contraceptives, which put the natural hormonal balance out of sync – you should speak to your GP or gynaecologist if this happens as changing to an alternative form of contraceptive may be helpful.

Q: Why does it hurt to insert tampons?

A: A common reason women find it painful to insert tampons is due to a condition called vulvodynia, which affects one in ten women. Vulvodynia can cause much distress and is often not talked about. This chronic condition gives women the sensation of burning, stinging and stabbing. We can’t say for sure what triggers it, but nerve damage or a genetic susceptibility may be to blame. It can cause issues with sex and putting tampons in. It is really important to see a gynaecologist who specialises in vulval problems as they can discuss treatments which can help with the discomfort.

Q: I have a lot of white discharge. Is this normal?

A: When it comes to discharge, many women wonder what is normal. As the vagina is self-cleaning and the mucus produced varies over the course of the month, you shouldn’t worry too much about changes and should avoid over-washing. When you do wash, I advise to use plain water and unscented soap around the outside of the vulva area – never put soap inside the vagina or on the moist inner tissue.

Another reason for discharge is thrush – also known as candida albicans – which is an imbalance of yeast, which can cause a thick, curd-like discharge and itchy symptoms. Thrush requires treatment as it can also trigger bouts of cystitis, so seeking appropriate help and treatment is vital.

IN YOUR THIRTIES…

Q: Why does sex feel different since having my baby? And why am I leaking urine when I sneeze and cough?

A: The average age of women becoming mothers in the UK is 30, it’s perhaps not surprising that this is the decade when vaginal health starts to change. Many women find it surprising that after childbirth the outside of the vagina may look different – it can have a more ‘open’ appearance and may feel a bit wider, which is perfectly normal. Intercourse may feel different and tampons may slip. For many couples this doesn’t cause any issues and intimacy can be just as satisfying.

You may experience leaks due to a weakened pelvic floor, which is something that will need to be addressed. Characterised by having ‘accidents’ when laughing, coughing, sneezing, jumping, or passing wind can erode women’s confidence. Physiotherapy and pelvic floor exercises can be hugely helpful, and there are some devices that can even train the pelvic floor for you, like INNOVO shorts, which deliver 180 perfect muscle contractions in 30 minutes. Find out more at www.myinnovo.com.

Q: I have a smelly discharge. Is this normal?

A: Thrush is still very much an issue for women in their 30s, but many have learned to recognise the symptoms and understand their triggers – such as sugar and alcohol. If discharge has an unpleasant fishy odour, women should go to their doctor and have it checked. It’s likely to be bacterial vaginosis (BV), a condition which can occur in women of all ages. However, as many women use contraceptive coils after childbirth which coincides with a slightly higher incidence of BV, I see an increase of cases when women are in their 30s.

IN YOUR FORTIES…

Q: Why are my periods more irregular?

A: As women enter their 40s, it’s typically the period of their life which doctors refer to as the perimenopause. It’s the time when the ovaries start to produce less oestrogen, and symptoms of the menopause become more pronounced. The age at which this happens will vary, but as the average age of the change in life is 51, by the late 40s, most women will have noticed some changes. The well-known hot flushes may not be a surprise, but the altering condition of the vagina is something that is often less spoken about, including vaginal dryness. As oestrogen levels go down, many women experience very heavy periods. This heavy bleeding, along with wearing tampons for longer, can cause the vagina to be even dryer and cause infections, such as BV and thrush.

Q: I look different down there. Is that because I’m getting older?

A: Outwardly, women may notice their pubic hair becomes sparser – some of us won’t mind about that. However, the labia may look looser, as the natural fat content decreases due to lowering oestrogen. Like everywhere else on the body, the skin becomes slacker, less plump. Some people fare better than others, but it is part of the natural ageing process. It is nothing to worry or be ashamed about.

IN YOUR FIFTIES AND BEYOND…

Q: I am experiencing vaginal itching, burning and discomfort. What can I do about this?

A: When women are in their 50s, they are well on the way to the menopause. If you hadn’t experienced vaginal changes in your 40s, you will certainly see them now, especially if you’re not taking hormone replacement therapy (HRT). The skin around the vagina will become paler, and internally, the skin may be more fragile. Vaginal dryness, also known as Genitourinary Syndrome of Menopause (GSM), is a recognised condition that affects many women in their 50s. GSM can cause some distressing symptoms, such as pain during sex, itchy, dry sensations and an urgent need to urinate.

It’s important for all women to maintain the quality of life that they had before the menopause and understand that these symptoms can be treated. There are various safe, effective treatments available for vaginal dryness, burning and discomfort such as vaginal moisturisers and topical oestrogen creams that can provide relief. Longer lasting solutions are also now available, including laser treatments which are a proven, effective solution for vaginal dryness symptoms, eliminating troublesome itching, irritation, and in some cases, pain.

For more information on vaginal dryness or leading laser treatment, MonaLisa Touch®, visit www.TakeOutThePause.co.uk or to book an appointment with Miss Tania Adib, call The Medical Chambers Kensington on 0207 881 418.