How does the vulva change with age ?
With age, vulval anatomy and tissues change. The labia majora may lose their contours, while genital skin and mucous membranes may become thinner and more fragile, particularly after menopause.
Reduced labia majora volume is associated particularly with a reduction in the fatty tissue they contain. They may then appear thinner and less full and cover the internal vulval structures less completely.
Menopause causes other changes associated with declining oestrogen levels. Genital tissues sometimes become thinner, drier and more sensitive. This development may cause dryness, burning, irritation or pain during sexual intercourse. When these symptoms are associated with menopausal hormonal changes, they may form part of the genitourinary syndrome of menopause.
These changes do not occur at the same age or with the same intensity in every woman. There is considerable natural anatomical diversity.
What hygiene measures help preserve vulval skin ?
Gentle hygiene is sufficient to preserve vulval skin. Excessively frequent washing or using irritating products may, on the contrary, weaken this sensitive area.
Cleaning should concern only the external vulva. Vaginal douching, perfumed soaps, intimate deodorants and other perfumed products applied directly to the vulva should be avoided because of the risk of irritation.
The vagina requires no internal cleaning.
The aim of intimate hygiene is therefore to keep the vulva clean without harming the skin or mucous membranes. Seeking a feeling of cleanliness should not lead to repeated washing or excessive intimate hygiene products.
Should the vulva be moisturised daily ?
No. A vulva with neither dryness nor irritation does not need daily moisturising.
For vulval or vaginal dryness, appropriate moisturising products may be used regularly. Lubricants have a different function : they mainly reduce friction and discomfort during sexual intercourse. These non-hormonal solutions may, in particular, be offered for genitourinary symptoms of menopause.
Essential oils, perfumed products and cosmetics not designed for the intimate area should be avoided because of the risk of irritation.
If dryness persists despite using an appropriate product, it is important to investigate its cause rather than multiply moisturising products.
What can be done at menopause to preserve vulval and vaginal tissues ?
At menopause, it is particularly important to manage dryness, fragility or pain that may appear with declining oestrogen levels.
When symptoms are mild, vaginal moisturisers may be used regularly to improve comfort. Lubricants have a different action : they mainly reduce friction and discomfort during sexual intercourse.
When symptoms of the genitourinary syndrome of menopause are more significant, other treatments may be considered. Low-dose vaginal oestrogens are, in particular, among the recommended options when the patient's medical situation allows.
The aim is therefore not to routinely perform “vaginal rejuvenation” at menopause, but to identify the changes responsible for discomfort and offer treatment appropriate to each symptom.
Can loss of labia majora volume be prevented ?
No. There is no cosmetic care that can prevent the loss of labia majora volume that may occur with age.
The contours of the labia majora depend particularly on their anatomy and the amount of subcutaneous fatty tissue. When this volume decreases, the labia majora become less full and the labia minora may appear more visible without having increased in size themselves.
Moisturising creams may improve skin dryness, but do not act on fatty tissue and therefore cannot restore lost volume.
When loss of labia majora volume becomes bothersome, the aim is no longer to prevent it, but to assess whether correction is indicated.
Which aesthetic medicine treatments can improve age-related intimate changes ?
Intimate aesthetic medicine treatments must be chosen according to the change to be corrected : hyaluronic acid acts on loss of labia majora volume, whereas laser treatment acts on vaginal tissues.
• Hyaluronic acid can be injected into the labia majora when they have lost volume with age. The aim is to restore their contours and volume. It does not reduce the size of the labia minora. It is also used to treat vaginal dryness.
• Vaginal laser treatment acts on the vaginal mucosa. It may be considered for certain symptoms of the genitourinary syndrome of menopause, including dryness, irritation or vaginal discomfort. It does not restore labia majora volume.
Which vulval changes should not simply be attributed to age ?
A new lesion, persistent itching, pain, bleeding or an unusual change in vulval skin should not be regarded as a normal consequence of ageing and requires medical examination.
After 40 or 50, not every vulval change is associated with age or menopause. Certain vulval dermatoses, infections and other conditions may cause symptoms resembling dryness or simple irritation.
Persistent discomfort should therefore prompt investigation of its cause. Repeated cream application or aesthetic treatment must not delay diagnosis of a possible vulval condition.
What should actually be done to preserve the vulva with age ?
It is not necessary to multiply care products or treatments to preserve vulval health with age. Useful measures mainly involve protecting tissues, preventing irritation and treating symptoms when they appear.
• Maintain gentle hygiene and avoid irritating products.
• Use a lubricant when intercourse causes friction associated with insufficient lubrication.
• Manage persistent dryness rather than allowing it to worsen.
• Seek advice for pain, itching, bleeding or an unusual vulval change.
• Specifically treat symptoms of the genitourinary syndrome of menopause when present.
• Distinguish loss of labia majora volume from a vaginal mucosal problem or vulval condition.
In Geneva, a consultation determines whether this is a normal anatomical change, loss of labia majora volume or a medical problem requiring specific treatment.
Preserving the vulva with age therefore means, above all, maintaining tissue comfort, avoiding irritation and managing changes responsible for discomfort.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
Learn more about