Last week we went through the signs and symptoms of genitourinary syndrome of menopause (GSM). One of the things that people are often unaware of is how much the vulva changes during peri and post menopause. Up until about 2014, this diagnosis used to be called “Vulvovaginal atrophy”. The problem with this is, it doesn’t encompass all of the genital, urinary, and sexual changes that occur during menopause, which is why they changed it. 

Even if you never develop these symptoms, it’s important that you become familiar with your vulva. I don’t just mean feeling the tissue as you clean yourself in the shower.

I mean pick a time at least once a month, go somewhere where you feel safe and you know you will be undisturbed. Lock the door to that room if you need to. Get comfortable in a reclined position. Support yourself with pillows if you need to. Grab your hand mirror, or your phone if you’re in a pinch. 

Begin by inspecting the tissue along the outside of your labia majora (the big lips). Look for any bumps that are new, if you have moles, check in on them. Does the tissue look plump? 

Then separate your tissues. Start by taking note of the color of your tissues. Does the area around your vaginal opening look like it has a pink hue? Or does it look white and glassy?

Now apply some gentle pressure and try to move the tissue. How does the tissue move? Does glide easily? Or does it feel rigid and difficult to move? 

Is there bruising anywhere along the tissue?

Can you see that your labia minora are separate from your labia majora? Above the clitoris, are you able to move the tissue so that you can see the clitoris itself? Or is the tissue rigid and adhered?

Now look along your vaginal opening. How does the tissue at the bottom of your vaginal opening move? Does it move well? Or does it feel stuck? Is there anything that looks red and angry?

I recommend to patients that they start doing self exams as early as they can, so that they’re familiar with their vulva before things begin to change with age. 

It’s important to note, changes in these areas (increased rigidity, loss/adherence of your labia minora, etc) are not always a problem. Often they’re expected, age related changes. But, if you have any of the symptoms from the previous blog post, they may be an indication that you need a combination of pelvic floor PT and vaginal estrogen.

What does vaginal estrogen do for you? Check back next week to learn more!

-Naomi