FEMALE PHYSICAL CHANGES AFTER 50
Thinning and Tightening of the Vaginal Wall
As levels of the sex steroids, estrogen and testosterone, begin to fluctuate, changes may first be noticed in the genitals. Dropping estrogen levels will cause the vaginal walls to thin, and they will not have the same elasticity and soft padding. The vagina may shrink, with its mouth becoming narrower.
Because the vagina has lost some of its cushioned effect, some women will experience arthritis (sometimes called the honeymoon disease, it is an irritation of the urethra and bladder from the penis hitting them during intercourse). The labia minora and labia majora (inner and outer vaginal lips) can also atrophy, thus leaving the clitoris more exposed. This means that direct stimulation of the clitoris can become painful.
Vaginal atrophy is a consequence of diminished estrogen production and/or lack of use. Many women have thus benefited from estrogen replacement therapy (ERT) and/or estrogen creams, which aid in restoring the vaginal wall and improving lubrication. It is possible to increase vaginal muscle tone by regular Kegel exercises, which involve pubococcygeus (PC) muscle contractions. These exercises are also very effective in maintaining vaginal blood circulation. Two hundred Kegels a day will go a long way in preserving the vaginal tissue by increasing blood flow to the area.3 Adding more soy products to your diet is a natural way to boost estrogen, as soybeans contain phytoestrogens, which can rebuild and moisturize thinning vaginal walls.
Here are two different types of exercises that you can practice to strengthen your PC muscle. They are easy to practice while in the car, on the telephone, or watching television.
1. Become familiar with your PC muscle (which goes from your pubic bone to your coccyx/tail-bone and is the muscle you would contract to stop urinating) as you contract and immediately relax it. Do these rapidly five times as you inhale and then exhale. Repeat five times.
2. Pretend your husband's penis is at the mouth of your vagina and you are trying to suck it into your vagina by pulling with your PC muscle. Pull for three seconds and relax. Repeat ten times and then rest.
Decrease in Vaginal Lubrication
The loss of estrogen can affect lubrication too. It may take longer to lubricate, and the amount may be less. While in the past it may have taken seconds to create arousal and sufficient lubrication, it may now require several minutes of love play (for some women, dryness will require artificial lubrication). Vaginal dryness can be helped by regular Kegel muscle exercises in that as you increase blood circulation, natural lubrication will be enhanced. There are a variety of lubricants that can be used during intercourse to reduce irritation and friction. Begin by trying water-based lubricants like Astroglide, Gyne-Moistrin, Moist Again, Probe, and Aqualub, to name just a few on the market. Some brands like Wet or Eros market both a water-based or oil-based formula. Replens is a moisturizer and lubricant that helps restore a proper pH in the vagina as well as actually plumping up the tissue. Don't use oil-based petroleum jelly (Vaseline), as it doesn't clear easily from tissue and can result in infection. Women who are sensitive to yeast infections should also avoid the oil-based preparations.
Daily intake of zinc (15 mg), vitamin E (400 IUs), essential fatty acids (salmon, tuna, evening primrose oil, black currant seed oil), and other herbal extracts can often help improve lubrication.4 When possible, avoid the substances that dry up membranes, such as antihistamines, diuretics, alcohol, and caffeine, as they also will dry the lining of the vagina. And don't forget to drink eight glasses of water a day.
Dyspareunia (Painful Intercourse)
This is the most common sexual complaint in older women. It's not hard to understand why this may be the case, with the loss of a cushioned vagina that is also less lubricated. Changes in the vaginal mucous membrane can increase one's vulnerability to infections that can provoke pain during intercourse. In addition, pain may be the result of a change in uterine contractions. The uterus experiences atrophy as a result of lower estrogen levels, so during orgasm, the uterine muscle contractions that used to be smooth and pleasurable become more spastic and painful.5 Again, estrogen replacement will often restore full sexual functioning without pain for many of these problems. Estrogen replacement and other options when ERT is not possible or recommended will be discussed at more length in the next chapter.
Decrease in Frequency of Sexual Desire
As we mentioned earlier, there can be significant individual variation in how aging impacts desire and sexual frequency in women. What seems to account for the difference? Testosterone, in women as well as in men, seems to be "the libido hormone." It is likely that some of the desire changes in women are linked to a fall in testosterone, since the level of this hormone also drops along with estrogen. If a woman experiences low levels of sexual desire in the absence of relational problems or conflict, she should be encouraged to ask her physician to have her free testosterone level checked. If it is in the low range of normal, she may benefit from testosterone replacement. It can be formulated as a cream to be applied in the vulval area (but not before intercourse), or applied as a gel to the shoulders.
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