Last week, Dr Maina Muriithi, an obstetrician-gynaecologist at Aga Khan University Hospital, discussed the changes that come with menopause, particularly the greying of pubic hair. The topic seemed to strike a chord, as one reader posed an interesting question: Why do the labia disappear during menopause?
"The decline in the hormone oestrogen during the menopausal transition is responsible for many of these changes," says Dr Muriithi. "The vulva undergoes noticeable structural changes during menopause. Reduced oestrogen leads to a gradual loss of collagen and fatty tissue, making the vulval tissues thinner, smaller and less elastic. The labia may appear shrunken, wrinkled and dry, while pubic hair often becomes thinner and less dense," he says, adding that natural secretions also decline, contributing to persistent dryness.
"Inside the vagina, the lining becomes thinner and more fragile. Blood supply decreases, resulting in a paler appearance and reduced elasticity. Natural lubrication diminishes, making sexual intercourse uncomfortable or even painful."
Additionally, thinning of the vulvovaginal lining is the leading cause of bleeding in postmenopause. However, he advises that all cases of postmenopausal bleeding must be investigated to rule out other sinister causes.
Some common misconceptions Dr Muriithi encounters are that after menopause the labia disappear. "This is untrue, although shrinkage usually occurs during this period, as mentioned," he says. He also adds that the myth that dryness and complete loss of libido are normal and have no treatment is untrue, as there are treatment options tailored to the level of symptoms.
Still, there are lifestyle habits that one could undertake in preparation for the genitourinary changes of menopause. These include making sure you are well hydrated, wearing loose-fitting clothing, adopting a healthy diet by eating well and exercising, practising safe sex, and using safe lubricants in the event of vaginal dryness.
While there might not be natural ways to prevent the process of ageing and vulval thinning, Dr Muriithi notes there are treatment options for these changes, and these are mostly directed at comfort and managing dryness. These include the use of water-based or oil-based lubricants, local hormone therapy such as oestrogen creams, and systemic oral hormone replacement therapy, especially in patients with concomitant systemic symptoms of menopause who qualify for it.
For women whose main concern is reduced sexual desire, testosterone therapy may be considered in carefully selected cases under specialist supervision.
"Other emerging treatment options include regenerative therapies like Platelet-rich plasma injections and energy-based options like laser and photodynamic therapies that are yet to gain traction in this sensitive area."
Similarly, natural products like isoflavones and plant-based soy extracts have been incorporated into some supplements with mixed results. "The use of collagen and hyaluronic acid supplements has also shown mixed results and lacks strong scientific backing for the reversal of skin effects of ageing," he says.
Additionally, Dr Muriithi notes that genitourinary symptoms are among the most common yet least discussed consequences of menopause. "If left untreated, they can affect comfort, confidence, intimacy and overall wellbeing. Women should know that effective treatments exist, and no woman should feel compelled to endure persistent symptoms in silence. Spouse support is also very essential during this period of transition." of transition."
