(V Is For Vagina)
How Your Vagina Changes Throughout Your Life — And How To Care For It At Every Stage
Here’s something you may have never really thought about: Your vagina is constantly changing. Just like your skin, hair, and other parts of the body, your vagina and its needs will often change with age and as you move through different life stages — and so should the way you care for it.
Many don’t learn a whole lot about what to expect down there beyond what they (maybe) got taught about puberty, periods, and sexual education in a middle school health classroom. So, as adults with vaginas, many are just figuring things out as they go. In fact, some don’t actually think too much about their vagina at all until something’s wrong — an itch, a bump, an uncomfortable experience during sex, or the like. But by understanding in advance how age, hormonal changes, and major moments like a pregnancy might affect your body, you can be prepared and take proactive steps to keep your vagina (plus your vulva and pelvic floor) happy and healthy as the years go by.
So with that in mind, here’s a quick primer on what you can expect and how to care for your vagina in each life stage, according to doctors.
In Your 20s
The vagina tends to be at its most elastic and well-lubricated in your 20s because the body’s levels of sex hormones estrogen, progesterone, and testosterone generally tend to peak around this time. Estrogen in particular helps keep the walls of the vagina thick, elastic, and lubricated.
That’s one of the reasons these years tend to be referred to as your “reproductive prime” (physically speaking) and why, for example, the vagina tends to heal from childbirth more quickly for those who give birth in their 20s in comparison to those who give birth in their 30s or older. “During the reproductive years, the vagina responds to [these] ovarian steroid hormones, and the tissues adapt to the needs of pregnancy and delivery,” explains Jessica Shepherd, MD, MBA, FACOG, gynecologist and chief medical officer at VeryWell Health. Those heightened sex hormones are also why your libido may be higher around this age and why your vagina might more easily get wet when you’re aroused.
Typically, your vagina needs fairly minimal extra care in your 20s. The vagina itself (the actual internal canal) is self-cleaning, and you should always avoid putting any extraneous cleaning products up there, says Dr. Sherry Ross, OB-GYN, author of she-ology, and co-founder URJA Intimates Skincare. For the vulva (all the external bits), she recommends a daily rinse with water and a gentle, fragrance-free soap. You may want something specifically designed for your intimate bits, particularly something that supports the pH balance of your vaginal microbiome.
“The vagina is normally acidic, which protects it from infections, inflammation, and premature aging. An acidic pH between 3.8 and 4.5 is the ideal environment for the vulva and vagina. This sounds pretty scary, but it’s the preferred pH balance and perfect for the many protective organisms which all live happily together in the vagina,” Dr. .Ross explains. “Anything that disrupts this delicate balance could lead to vulva and vaginal misery such as an infection, dryness, itching, or burning.”
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When You’re Sexually Active
According to Mary Jane Minkin, MD, gynecologist and clinical professor at the Yale University School of Medicine, individuals who are sexually active might experience two things that can definitely affect the vagina: hormonal birth control and pesky vaginal infections.
Hormonal contraceptives can sometimes cause vaginal changes, according to Minkin. “If the woman goes on a very low dose birth control pill, she will occasionally experience dryness,” she says, but notes that sometimes just going up to a pill with a slightly higher dosage of estrogen will help improve moisture. Having a go-to lubricant on hand can also help make sexual experiences more pleasurable, and Dr. Ross stresses the importance of drinking a lot of water and eating a plant-rich diet — when your body is hydrated and nourished, your vagina is more likely to be, too.
Having sex in general also means you’re coming into contact with other people’s fluids — and their bacteria, whether from fingers, genitalia, or toys. In addition to the risk of sexually transmitted infections (STIs) inherent to sex, the introduction of foreign bacteria can also throw off your vagina’s microbiome, which can potentially trigger yeast infections or other irritation. And because that foreign bacteria (or even bacteria from your own vagina) can make its way into the urethra, being sexually active can also up your risk of urinary tract infections (UTIs).
The good news: There are plenty of ways to maintain your vaginal flora and reduce your risk of infections, including taking probiotics, using barrier protection methods like condoms and dental dams during sex to prevent the spread of bacteria, peeing regularly to flush out your system, and practicing good sexual hygiene. (Wash those fingers before they go anywhere near your vag!) If you find yourself getting recurring infections, you can ask a healthcare professional about options like antibiotics, estrogen creams, and other prescription treatments.
If You’re Taking Testosterone
Given that the vagina is so governed by hormone levels, using testosterone can of course produce some significant changes.
“If a TGD [transgender or gender diverse] person is using testosterone, it is common to see vaginal irritation since testosterone counteracts the estrogen in the genital tissues, making those tissues thinner and weaker,” says Juno Obedin-Maliver, MD, MPH, MAS, OB-GYN, assistant professor at Stanford University School of Medicine, and co-director of The PRIDE Study. “This can cause dryness, irritation, micro-tears, loss of the folds of the vagina, pain with and without sexual activity. We call this vaginal atrophy.”
Topical lubricants, moisturizers, and estrogen creams (which only work locally and won’t affect the testosterone therapy being used for gender affirmation) can all help make the area more comfortable, Obedin-Maliver says.
There may also be an increased risk for UTIs and bacterial vaginosis (BV) because of the change in the vaginal bacteria and pH levels caused by the hormones, she adds. All of the aforementioned treatment and prevention strategies for infections apply!
In Your 30s
Unless you’ve given birth, there aren’t too many significant vaginal changes from your 20s until you reach perimenopause, which is the time usually in your 40s — though sometimes starts in your 30s — when your body begins getting ready to transition into menopause, says Minkin. In general, as your hormone levels shift from your peak in your 20s, you might notice your labia continue getting darker and thinner throughout your 30s.
One notable change is that your pelvic floor strength may start to decrease in your 30s, which can affect a person’s bladder control and may be associated with more discomfort during sex. One 2016 study found one in 10 women between ages 25 through 35 deal with urinary incontinence, with the prevalence increasing with age. There are many ways to care for your pelvic floor, including the classic Kegel exercises and generally maintaining an active lifestyle. Strengthening your pelvic floor may also lessen the odds of injury during childbirth, if that’s something on your horizon.
If you do decide to have kids, you probably know to expect some significant changes: “Childbirth probably has the most dramatic effect on the vagina, especially if you have a vaginal delivery. A recent statistic showed that 30% of women who have a vaginal birth will have some form of trauma to the tissue and muscles in the vagina and pelvic floor,” Dr. Ross says. “The more vaginal deliveries you have, the more the vagina stretches, especially in the vaginal opening.”
The vagina can often return to its pre-pregnancy state after delivery, according to Dr. Shepherd, though Dr.Ross notes that more deliveries and particularly those that stretch and tear the pelvic floor muscles may cause long-lasting changes. About half of women deal with incontinence after giving birth, for example, and one study found 42% of women still dealt with incontinence 12 years following delivery.
Many people also experience vaginal dryness while breastfeeding or chestfeeding, Minkin says, because the hormones being produced at that time suppress ovulation and estrogen levels that would usually keep the vagina moist. “The vagina behaves similarly to what happens to it during menopause—dryness, decreased vaginal secretions, thin and dehydrated vaginal tissue, and pain with vaginal penetration,” Dr. Ross explains, but adds that these changes are only temporary: “Once you stop breastfeeding, the vagina will return to its normal healthy and hydrated state.”
In Your 40s
Perimenopause will usually begin by the time you’re in your 40s up until around age 55, Dr. Ross says. “Perimenopause refers to those years in the reproductive life cycle during which ovarian function becomes irregular,” she explains. “The ovaries start to produce hormones irregularly.”
Dr. Ross says vaginal dryness (and a low sex drive, as it happens) are common for those on in their 40s, but vaginal lubricants can help a lot. Minkin also recommends a vaginal moisturizer like Replens, which can be used two to three times a week internally via an applicator or topically whenever the vulva itself is feeling too try. Vaginal dryness is very easy to treat, she stresses—if none of these over-the-counter methods work, an OB-GYN can help you with prescriptive treatments as well.
Another great thing for your vagina around this time? Sex!
“Using a vibrator can be very helpful—it stimulates pelvic blood flow, and anything that stimulates blood flow will help with vaginal moisture,” Minkin says. “And along those lines, regular sexual activity is also helpful.”
Minkin adds that the vagina’s pH levels also generally reflect your estrogen levels, meaning that decreasing estrogen might also come with a less acidic vagina—meaning potentially more susceptibility to infections and other irritation. Using a product like RepHresh can help re-acidify the vagina and support a balanced pH and vaginal microbiome, she says.
In Your 50s & Beyond
Menopause — the point in time when your menstrual cycles end — usually happens in your 40s or 50s, and it comes with a slew of changes to your body and of course your vagina.
“Following menopause, the vulva and vagina have a severe depletion of estrogen, and the tissue gets thin and fragile due to atrophy,” Shepherd says. “The skin of the vagina becomes less elastic, and the underlying fat and connective tissues can break down, which can lead to more irritation and more prone to infections due to changes in the pH.”
Luckily, there are plenty of ways to prevent irritation and infection: In addition to all the strategies mentioned above, Shepherd says vagina owners can consider options like hormone replacement therapy, vaginal estrogen, vaginal rejuvenation therapies, and PRP injections.
Dr. Ross adds that vaginal dryness can cause significant discomfort and pain during intercourse. As mentioned above, vaginal moisturizers, lubricants, sexual stimulation, and prescription treatments can all treat dryness with ease.
Yes, your vagina and vulva will change and age just like the rest of your body, and you should expect to experience shifts in appearance, lubrication, stretch, and strength over the years. By knowing the natural changes to expect over your lifetime—as well as how potential big things like childbirth and the introduction of hormones can factor in—you can adjust your care routine to ensure maximum vaginal comfort, pleasure, and well-being.
And remember: Most of the tricky bits of vagina ownership can be managed with the right habits and treatments. Shepherd recommends seeing a doctor if you’re dealing with any recurring irritations with the vaginal tissue, changes in discharge color or amount, or any other significant shifts to make sure there’s no underlying health issues that need to be addressed.