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.