Vaginal and Vulva Changes With Age: Care Tips

Vaginal Care Over a Lifetime

Let’s start off by clarifying the anatomy of the female genitalia. The vagina itself is an internal organ that is a muscular tube which leads to the uterus. This is the area where a penis may enter, or a child may exit during vaginal birth. The outer part of the female anatomy is called the vulva. People often confuse the vulva as the vagina, but really it is its own separate entity. The vulva, also referred to as the “lips,” is composed of the labia minora and labia majora. The clitoris, as well as the urethra, are also located in the vulvar area.

The vagina is a unique and dynamic part of the female anatomy with its own special environment. It has a finely tuned ecosystem, one that is self-cleaning and maintained like a well-oiled machine. The vagina maintains its own pH, creates moisture and lubrication, and performs a balancing act of keeping the good bacteria and ridding itself of the bad bacteria on a daily basis. It truly is a one-of-a-kind structure of the female body.

Knowing how to care for such a delicate and complex organ is a very important aspect of maintaining feminine health. Knowing the ins and outs of the vagina, and what occurs to it during your lifetime, will help you to keep healthy and become better in tune with your body. From your reproductive years to menopause, it is of the utmost importance to know your vagina well, and to take care of your vaginal health throughout your lifetime.

Vaginal and Vulva Changes With Age

Childhood

In a newborn girl, the exterior portion of the vagina, the vulva, may appear to be swollen or enlarged. This is due to the exposure of the mother’s hormones in utero. As the female child begins to grow, their hormones will wear off, and the vulva will return to a normal size and appearance. During childhood, there are generally no changes in the appearance of the vulva until the onset of puberty.

Puberty

Puberty is a natural process that involves the physical, emotional, and sexual transition from childhood into adulthood.^[1] Puberty usually starts between the ages of 8-13 and ends by age 14.^[2] During this time, the breasts begin to enlarge, the vulva becomes larger and more pronounced, pubic hair appears, and the vaginal skin becomes more pigmented. Approximately two years after the onset of breast development, girls may experience their first period (menarche), at an average age of 12-13 years old.^[2] These changes occur due to estrogen, the hormone responsible for the development of a female’s sex characteristics. Puberty is the time where the vagina prepares for womanhood and reproduction.

Reproductive years

The reproductive years are when a woman’s body prepares to have a child.^[3] Monthly menstrual cycles occur, and the female body is fully developed and ready to house a child in its womb.^[3] At this point, the breasts are fully matured to allow for breastfeeding, and the hips begin to widen to prepare for vaginal delivery if a woman were to become pregnant. During this time, it is important for women to maintain their health by refraining from tobacco use, maintaining a healthy body weight, and limiting alcohol consumption, as they directly correlate with female reproductive health.^[4] If a woman chooses to have a child, it is important that she participates in healthy behaviors that promote reproductive wellness. This is done in order to optimize the overall health of both mother and baby.^[4]

Menopause

There are three stages in menopause: perimenopause, menopause, and post menopause. Unlike puberty, where estrogen begins to peak and cause female development, in menopause, estrogen begins to decline and causes a different set of female bodily changes.

Perimenopause occurs 3-5 years before menopause, around the age of 50. During this time, estrogen begins to decline and women may experience symptoms of hot flashes, insomnia, night sweats, mood changes, and vaginal dryness.^[5]  The transition from perimenopause to menopause varies among women, but can take anywhere from 1-3 years. Technically, a woman enters menopause after she has missed her period for 12 straight months.

During this time, all women experience different and unique symptoms as they transition. Menopause and post menopause are very similar, however in post menopause, after hormone levels has stabilized, women are at a higher risk of osteopenia, osteoporosis, and heart disease due to the decline in estrogen.^[6]

Knowing Your Vagina

Discharge is normal

Discharge is part of the natural self-cleaning mechanism of the vagina. Many women experience vaginal discharge that may vary with their menstrual cycle. The amount of discharge can vary, as well as odor and color. It can also change during sexual arousal and during and after pregnancy. Normal discharge generally has a non-offensive odor, ranging in color, from clear to milky white.^[7] Abnormal discharge can be malodorous with a thickened white, frothy green or yellow color.^[7] If this is accompanied by itching or burning, it may be a sign of an infection.

Vaginal odor

The vagina is not designed to smell like a flower. It is natural and normal to have an odor. However, if the odor becomes more pungent and smells “fishy,” that is abnormal and may be a sign that there is an active infection.^[7] While it might be tempting to douche or use soaps to clean away the odor, it actually may cause more harm by disrupting the natural pH, which can increase your risk for infection, or may even exacerbate a preexisting infection causing the odor in the first place.

Menstruation

Having your monthly visitor, otherwise known as your menstrual “period,” is an event that happens to every woman. It is a monthly cycle of hormonal changes, that sheds the lining of your uterus resulting in bleeding from the vagina if an egg has not been fertilized.^[8] Depending on the woman, a normal period can last anywhere from 4-8 days, which cycles on average every 28 days.^[9] The length of a woman’s menstrual cycle can change throughout her life. Irregular periods are common during adolescence and women approaching menopause.

What is Wrong with My Vagina?

Since the vagina is such a sensitive female organ, there are often times in a woman’s life when issues can arise. It is important to know that these issues are common and easily treatable. Bacterial vaginosis, yeast infections, and urinary tract infections can happen to anyone, and it is important to recognize the signs and symptoms in order to maintain the health of your vagina.

Bacterial vaginosis (BV)

Bacterial vaginosis is an infection that occurs commonly in women. In fact, it is the most common vaginal condition in women aged 15-44 in the United States.^[10] Although not fully understood how women get this infection, what is known is that it results from an imbalance of the bad bacteria in the vagina.^[10]

Signs and symptoms of BV include a strong fish-like odor, thin grey to white colored vaginal discharge, vaginal itching, and burning sensations.^[10] The strong malodor can also be more apparent after sex. Bacterial overgrowth isn’t as detrimental to our health as it is inconvenient. However, it does create a problem if someone is pregnant. Studies have shown that there is an increased risk of preterm labor in women who have bacterial vaginosis.^[11]

Treatment options for bacterial vaginosis include antibiotics and boric acid which can be prescribed, but if you are pregnant and suspect you have BV it is important to talk to your provider.^[10]

Yeast infections

Yeast infections are another common occurrence among women. They can occur in response to many factors, such as pregnancy, antibiotic use, immunocompromised states, washing the vagina with harsh soaps or douching, as well as having diabetes.^[12] These infections are caused by an overgrowth of a fungus called Candida that naturally live inside the vagina.^[12] When this overgrowth occurs, it can lead to an infection and cause uncomfortable symptoms, including a white cottage cheese-like discharge, itching, burning, painful urination, and painful sexual intercourse.^[12]

Treatment for yeast infections include topical and oral antifungal medications that can be found over the counter, or prescribed by a medical provider.^[12]

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are a bacterial infection of the bladder, urethra, ureters, or kidney. In the beginning stages of infection, typically only the bladder and urethra are affected. Many different kinds of bacteria can lead to a UTI, but the most common is E. coli.^[13] Women are prone to UTIs since their urethra is much shorter than men’s and it is closer to the anus.^[13] Sexual intercourse can also induce a urinary tract infection, especially if you do not urinate before and after sex.^[13] Intercourse can introduce bacteria into the urethra, causing an infection. Women who are menopausal can also experience UTIs.^[13]

Signs and symptoms of a UTI include painful urination, having the urge to urinate with little to no outflow of urine, lower abdominal pain, and a fever.^[14] If symptoms such as fever and pain in the abdomen occur, it is very important to be seen by a medical professional right away, as these could be signs that a more serious infection is present.^[14]

Caring for Your Vagina

Step away from the soap!

While washing your hands, feet, and your body with soap is hygienic, it is not a good idea to do the same with your vagina. Recall that the vagina is the internal female organ, which has naturally self-cleaning properties. This doesn’t mean you shouldn’t maintain your vaginal hygiene, but it means you don’t need harsh soaps or douching to clean the internal area. However, it is important to clean the vulva, the outer portion of the vagina. Gently cleansing the vulva maintains hygiene, and should not negatively affect the vagina.

In fact, cleansing with soap can actually increase the risk of having bacterial and yeast overgrowth.^[15] The vagina has a naturally acidic pH. When soaps are introduced into the acidic environment it can kill off all the natural vaginal bacterial flora that normally function to maintain the pH and natural defenses against bad bacteria and bacterial overgrowth.^[15] Additionally, many soaps may contain fragrances which could irritate the vagina and cause an adverse skin reaction.

A good alternative to soap is to use warm water to clean the exterior of the vagina and the crevices and folds around the area, instead of the inner portion where all the healthy bacteria live.

Don’t forget to get your Pap Smear

According to The American College of Obstetricians and Gynecologists, women ages 21-29 should have a Pap test every three years, and every five years with the addition of Human Papilloma Virus (HPV) testing for women ages 30-65.^[16] This test screens for cervical cancer, which is the second most common cancer among women worldwide caused by the Human Papilloma Virus.^[17] If found early, cervical cancer is one of the most successfully treatable cancers.^[16] In addition to screening, vaccines against HPV can also help prevent the risk of developing cervical cancer.

Safe sex practices

As mentioned previously, the vagina is a sensitive organ, and is more susceptible to acquiring sexually transmitted infections (STIs) even more so than the penis due to its naturally thinner skin and moist environment, which helps viruses and bacteria to thrive more easily.^[18] Protect yourself and your vagina by using condoms with every sexual partner and encounter, and being regularly tested for STIs.

Key Points

• Throughout the female lifetime, vulvar changes occur via hormonal surges and fluctuations. From childhood to menopause, the vagina is ever changing and adjusting to each milestone in life.
• The menstrual cycle is a normal event that happens among females from adolescence to perimenopause.
• Take care of yourself during your reproductive years. These years cover a long portion of a female’s life, and healthy behaviors promote wellness to the reproductive organs.
• Vaginal odor and discharge are normal, but a yellow or thickened discharge with a “fishy” odor is abnormal.
• Take special care when cleaning your vagina. Harsh soaps are not needed, as the vagina is a naturally self-cleaning organism. But don’t forget to clean the vulva!
• Infections such as UTIs, yeast infections, and bacterial vaginosis are common. Visit a health care provider for treatment to clear these infections properly.
• Keep your vagina healthy! This means regular visits to a medical provider to be seen for a Pap smear and STI screening.

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