A lot of the patients in my menopause practice are single women. My patients who have no sexual partners can be quick to dismiss my questions about sexual symptoms, figuring that without a partner in their lives, they have no sexual concerns. I have two worries about that.
First, you don’t need a partner to have orgasms. Self-satisfaction is good for us physically and mentally. As a doctor, I often encourage women to consider this, particularly older single women, because of the health benefits.
Second, self-stimulation helps us maintain patent vaginal tissues.
My friends would like me to point out that “patent” is a term doctors use when talking about tube-like structures. Patent means “open.”
Maintaining patent vaginal tissues means making sure your vagina remains open, usable, in case one day you do find someone worthy of a sexual relationship.
If you have lived with your vagina for 40 years without giving it much of a thought, you should know that its patency has been maintained largely through hormonal influence. Now, as estrogen declines, particularly if it declines abruptly (as it does in surgical menopause), the tissues of your vagina will become thinner and more fragile, and circulation to those tissues will decrease.
If your vagina isn’t receiving any stimulation, those changes will happen more quickly. The more you use your vagina, the slower the changes go. When we say “Use it or lose it,” this is what we mean.
I have met plenty of patients who did not know that vaginas need to be maintained. When you can't see the vagina and have little use for it, it's easy to completely forget about it. Tissues became thin and dry, in more extreme cases the walls of the vagina adhere to one another, losing patency. In lay terms, vaginas begin to close up.
This can be very upsetting when love comes along later and we are faced with months of therapy to reopen and restore the vagina. It can be done, but it’s so much easier to maintain patency than to lose it and then work to get it back. Often you can't completely restore what is lost.
What does it take to maintain patency? There are plenty of options ranging from localized estrogen therapy you can discuss with your doctor, or use of vaginal moisturizers, lubricants, and dilators. We also recommend regular clitoral stimulation, to maintain blood flow and keep your clitoris strong and responsive. And of course, Kegel exercises, which will not only help us maintain strong orgasms, but helps us retain urinary continence too.
We work hard after 40 to maintain our skin, our hair, our bodies, brains, and hearts. Why not our vulvovaginal tissues too? Strong vaginas are not just for couples!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.
Thank you for asking this question! We find lots of women have similar issues. However, before considering vaginal laser treatments, check with a doctor who specializes in women’s sexual health issues to rule out any physical issues or problems you may have.
There are several references to vaginal laser treatments on the MiddlesexMD.com website. One is a question-and-answer type post and another is an article where the Mona Lisa vaginal laser treatment is discussed — benefits, expectations, costs associated with the treatments, and successful outcomes. To find these articles, go to the middlesexmd.com website and click on the magnifying glass in the upper right corner of your screen. When you click on the magnifier, enter “vaginal laser treatments” and/or “Mona Lisa” in the search field.
My friends are discussing and getting vaginal laser treatments to increase blood flow and thicken vaginal walls. What is your experience/comments regarding this treatment? I have been naturally post-menopausal since my early 40s, and have been on systemic hormone replacement as well as local topical estrogen since then. Nonetheless, lately sex has been painful and orgasm increasingly difficult to achieve. Might I be a candidate for this treatment?
Rachel, you may begin to see some changes during perimenopause, the years leading up to menopause. Like all of us, you’re subject to the “use it or lose it” reality of our bodies. It’s terrific that you’re in good overall physical health; being close to your ideal weight before you reach menopause makes it easier for you to avoid some of the gain that’s typical. I hear from a number of patients who find a partner late in life, so that possibility as well as your comfort suggests that you may want to use a vibrator or dilators to keep circulation in those tissues. Both orgasm and Kegel exercises will help with pelvic tone (search for that for more on that topic), which not only keeps organs in place but helps prevent incontinence. Regular Kegel exercises are a very good idea; whether you choose to use a tool will depend on how successful you feel you are targeting the right muscles. There’s lots of information for you here on our website! And use the “Let’s Talk” link, if you like, to send additional questions.
I’m a 48 yr old single woman who has never had a sexual experience. I always thought someday but I’ve never met that person. What concerned me was getting my Pap test today and finding it was rather painful, I bled a little and cramping resulted after. I realize that’s normal but it’s never been that uncomfortable before. I am also premenopausal but I’m very active and in great shape. I am concerned with vaginal atrophy as I age and problems that can arise from that. Is a dilator something I should consider? After reading the articles I’m even more concerned. I sometimes do Kegels but not consistently should I be using a Kegel mechanism? I’m concerned it will be more painful as my doctor told me I’m rather small. I’d appreciate your advise.
> We work hard after 40 to maintain our skin, our hair, our bodies, brains, and hearts.
So wise! Yes, of course!
I’m a sexuality writer, and I didn’t know the term “patency” either. When I first read the title, I thought it was a misprint. Thanks for educating me.
Author of Better Than I Ever Expected: Straight Talk about Sex After Sixty
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