You may not be able to leap up from a lotus position in a single bound. (Heck, you may not even be able to get into a lotus position.) You may find your back a little cranky when your two-year-old demands to be carried. Most disappointing of all (to your love life, anyway), you may find yourself falling into an exhausted stupor every night at the same time as your kindergartner.
For all the delights of motherhood, it’s a different ballgame at midlife.
And more moms are having their first babies later in life, after they’ve established their careers and their relationships. According to government statistics, first births to women over 35 increased eight-fold between 1970 and 2006. In 1970 one in 100 first babies was born to a woman over 35. In 2006, that number was one in twelve!
And that means that many women are entering menopause while still in the throes of active parenting. So, in the midst of diapers and runny noses, perimenopausal women with young children are likely to ignore the effects of menopause, and specifically the effects of menopause on their vulvo-vaginal area.
Most women who come into my office know about mood swings and hot flashes, but they don’t know that menopause compromises their sexual apparatus as well. But keeping these parts operating smoothly is important to your sex life and, thus, to your quality of life. (And yes, you will have a sex life again.) So, in addition to everything else you have to do, establish a healthcare regimen for your vagina as well, because you’ll continue to use it long after the kids have grown and gone.
Here’s what happens to your vagina during menopause:
When your estrogen supply begins to diminish your skin and other tissues lose collagen—the substance that keeps skin supple and youthful-looking. Loss of collagen causes vaginal and genital tissue to become thin and dry. You may also notice that your vagina no longer lubricates well when you become aroused. This is called vaginal atrophy, and it can make sex very uncomfortable. Vulvo-vaginal atrophy can also exacerbate urinary tract infections and cause burning, itchy genitals.
Fortunately, this condition is easily remedied, but your vagina and pelvic floor will need ongoing attention to stay in shape. If you’re noticing any of these menopausal symptoms, talk to your doctor—yes, about sex. Trust me, doctors have heard it all.
Generally, a maintenance plan for a healthy vagina and pelvic floor involves
- Moisturizers. Use vaginal moisturizers, such as Yes or Replens, regularly—two or three times a week. Vaginal moisturizers help hydrate vaginal walls and maintain a normal pH balance. Your doctor might also prescribe a topical estrogen, which restores vaginal tissue to pre-menopausal condition without being absorbed into your system.
- Lubricants. Apply lavishly before and during sex to ease discomfort and can add an element of fun.
- Kegels. These muscle-tightening exercises will tone your pelvic floor, which keeps your internal organs in place, makes orgasm more powerful, and reduces stress incontinence, that lingering embarrassment that often accompanies vaginal birth.
Finally, have sex. I know you’re not in the mood. I know you’re tired, not to mention being pulled in a thousand directions, but regular sex is the best prescription for maintaining vaginal health and capacity. As we say at MiddlesexMD, “use it or lose it.”
It may not be the most romantic solution, but here’s how one late-in-life mom schedules sex with her hubby: “I'd just suggest, ‘Hey, tomorrow night, after we put [the kids] in to bed and get them asleep, let's go right into the bedroom.’ Sometimes I'd do this more than a night or two in advance. Not romantic in the least... but in practice, the planning didn't diminish the enjoyment.”
The same vaginal maintenance advice applies to single moms at midlife, too. You may feel like you’re in a sexual desert with zero chance of scoring in the love lottery. You may have forged an uneasy peace with being alone for a long time. But consider this: it’s a lot easier to maintain your sexual apparatus than to repair it after the fact. And you don’t want to find your Prince Charming only to discover that your vagina isn’t willing or able.
In addition to the three-part vaginal health program I outline above, I advise single women to to self-stimulate regularly (you can use a vibrator with lubricant). This is important in maintaining vascular and nerve pathways to the vulvo-vaginal area.
Whether you’re single or partnered, being a mom at midlife is complicated. In the long run, educating yourself about the physical changes you may already be experiencing will help you to stay healthy and responsive. You owe it to yourself.
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.