Embracing My Aging Vagina & Tackling Perimenopause With Grace

I was itchy — down there, really itchy. It felt so good to scratch, but I knew that simply scratching the itch wasn’t the answer. There was no baking bread scent or discharge, so I ruled out a yeast infection. And there was nothing to see or feel, no red bumps or rash. I was pretty sure I was STI-free (I test regularly).

I decided to try some Vagisil cream. It was a bad idea. It burned — a lot. Luckily, the burning sensation went away quickly, but I was still itchy.

I decided it was time to stop diagnosing myself and speak with an actual doctor. I emailed my OB-GYN and explained the situation and how I went from itching to burning. I’m 52, and I figured whatever it was could be related to perimenopause. 

“Is it time for my estrogen cream?” I asked eagerly. “You better come in for an exam,” she suggested. 

Vaginal atrophy? It's not as scary as it sounds.

As a sexuality educator in a medical setting, I’ve spent years educating women in perimenopause and menopause on how their sexuality and their vulva will likely change over time. I often get patients complaining of pain with vaginal intercourse. I coach them on not pushing through the pain and taking penis-in-vagina intercourse off the menu for now while they address what's happening. And we go over all the ways to address it, estrogen cream being one of them. 

Read More: Painful Sex: Beyond the Usual Suspects

But I wasn’t having pain with sex. This itching was not something I had anticipated. 

When I arrived at my appointment, the medical assistant told me to undress only from the waist down. I got comfy on the exam table with a blue paper draped over my bottom half and waited for the doctor. I relayed my story to her about the itching and the burning. 

Before even looking inside, just seeing my mons pubis, she said, “You are dry!” A quick internal exam revealed more dryness, leading her to the same conclusion. I was aging, and my poor vulva was calling out for attention. 

This natural part of aging for people with vaginas used to be called “vaginal atrophy,” but many doctors and sex educators are shifting away from that terminology. Not only does “vaginal atrophy” sound a lot scarier than it actually is, it’s also inadequate as it didn’t explain everything that might be happening. Genitourinary syndrome of menopause, or GSM for short, is the new preferred term. GSM refers to a collection of symptoms, including vaginal atrophy, that result from a decrease in estrogen and can affect the entire vulva and the urethra and bladder.  

As my gynecologist prescribed me estrogen cream, one of the most common first-line treatments for GSM, I reveled in the realization that I’d hit a milestone. I was joining the women I had counseled for years. I felt a new sense of maturity in belonging to this special community. 

Now when the young checker at the local market gives me the 10% senior discount without question, I can say to myself, I may be only 52, but my vagina has crossed over to the other side. I will proudly take that senior discount on behalf of my genitals.

Embracing the estrogen... cream

When some people hit this special milestone, they’re concerned about putting hormones directly in their vagina. This is often because they’ve heard that hormone replacement therapy can have uncomfortable or annoying side effects. Though putting topical estrogen in the vagina to treat GSM is technically a form of hormone replacement therapy, there's a big difference between putting a low dose of estrogen in one’s vagina and taking estrogen systemically.

Systemic estrogen comes in the form of a pill, skin patch, ring, gel, cream, or spray foam. The hormones are spread throughout the entire body, hence the word “systemic.” For some people, having additional estrogen circulating throughout their entire body does cause some unpleasant side effects. 

But as a wise nurse practitioner once said to me, “What goes in the vagina, stays in the vagina.” 

When using estrogen to treat GSM, a very low dose of estrogen is administered directly in the vagina in the form of either a cream, a flexible plastic ring, or a dissolvable capsule. The estrogen in these topical treatments gets absorbed into the vagina and doesn’t circulate through the rest of the body. 

According to Dr. Lisa Sundberg, an OB-GYN and sexual health expert, topical estrogen treatments are not only superbly effective, but they can also drastically improve quality of life. 

“Vaginal estrogen has a long track record of safety and efficacy in treating GSM and other causes of vaginal atrophy,” she explained. “With consistent use, it can significantly alleviate vaginal dryness, dyspareunia (vaginal pain), and urinary frequency. It can also help to decrease risk of vaginal and bladder infections. Vaginal estrogen works well alone or in conjunction with genital moisturizers. Because of its excellent safety profile and significant improvement in quality of life, both in and out of the bedroom, I recommend vaginal estrogen to all of my postmenopausal patients without hesitation.”

As soon as the appointment was over, I rushed to the pharmacy and proudly told the pharmacy tech my doctor had just sent over a new prescription. I was a little worried about the number that would appear when they rang up the prescription because I’ve heard scary stories over the years about how much estrogen cream can cost, thanks to America’s less-than-ideal healthcare system. So, I was relieved it was nothing more than my usual copay. 

Though I was excited to bring my new cream home and get started, the itching and irritation had to be addressed first. If you’re having symptoms other than dryness, it’s essential to treat those as your doctor suggests before you start any topical estrogen treatments. So, I used the gentle ointment my doctor prescribed for a few days to nourish my poor desert of a vulva.

She also suggested a daily moisturizing regimen using olive oil or coconut oil. I know, it sounds weird, but it totally works. Just think of it like any other skincare routine. 

Read More: Vaginal Dryness: What to Do When Natural Lubrication Isn’t Enough

Vaginal rejuvenation, the natural way

Finally, the momentous day arrived, and I was ready to insert the cream. At first, I tried using the applicator that came with the cream, which kind of looks like a plastic syringe without a needle attached, obviously. But it was hard to know how much was actually getting in there because some of it stayed stuck to the applicator. Cleaning it nightly was an additional chore. Plus, I hated to see that wasted cream, even a tiny amount, go down the drain as I washed the little piece of plastic. 

Driven partially by laziness and partially by a stroke of inspiration, I put the applicator aside and began using my finger to apply the cream manually. The finger method worked very well for getting a little bit of cream on the outside of the vaginal opening and just inside the vagina, where I also wanted it to go.

It seemed like the perfect solution, but I wanted to check in with my doctor to make sure using my finger was okay. She assured me that using a finger is just fine since the cream doesn’t need to go all the way up inside the vagina. So, I was in the clear. 

It’s been a few months, and my “down there” skincare routine seems to work! The itchiness is gone, which is totally worth the olive oil-stained undies. Things are a bit juicier in there, too. 

And I’m proud to be a woman with a tube of estrogen cream on my nightstand, aging gracefully.