Common conditions 'downstairs' you should be aware of

Most women feel comfortable talking about the changes to their hair, skin and face as they get older, but when it comes to those areas on the body that are less visible — such as the vagina — it can be a bit embarrassing.

As women get older, and especially after menopause, it is common to experience urogenital problems such as vaginal discomfort and urinary incontinence. Roughly 40 per cent of post-menopausal women experience vaginal dryness but only half of these women seek treatment from their medical professional. The following are common conditions and should help you identify when to seek help.

A dry or sore vagina, or painful sex

Once you’ve been through menopause, the skin and support tissues of the vulva and the vagina become thin and less elastic. This is due to your body no longer producing oestrogen. Vaginal dryness is a common condition because the glands in the vagina don’t produce mucus. When the vaginal and vulval skin become thinner, it can make sex painful. You might find that these parts of your body are more easily damaged and even gentle friction can lead to discomfort. You might have also noticed a change in the appearance of your vulva. They might not be as plump as they once were. This too can make sex tricky and you might find yourself not wanting it at all.

Any burning, itching, or discomfort in the vaginal area warrants a call to your doctor or gynaecologist. Your health history will be established, including how long you’ve been experiencing symptoms and whether anything — such as douching or taking medication — seems to worsen them. Your doctor might then do a pelvic exam, checking your vagina for any thinning or redness, and will help rule out other possible causes for your discomfort such as a vaginal or urinary tract infection. The doctor may also do a pap smear test to remove and test cells from your vaginal wall or cervix.

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Options for managing this condition include:

  • avoiding perfumed soaps
  • treating any underlying skin conditions
  • a course of antibiotics
  • oestrogen therapy.


Oestrogen therapy

As mentioned above, dryness, soreness, burning and irritation can happen to women as they age, but these conditions respond well to oestrogen treatment. The can alleviate the discomfort you experience during sex and assist in rebalancing the pH levels of your vaginal bacteria.

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Topical oestrogen replaces some of the hormone your body is no longer making. That helps relieve vaginal symptoms, but it won’t put as much oestrogen in your bloodstream as oral oestrogen hormone therapy. After speaking with your doctor or gynaecologist, you might be prescribed vaginal tablets and/or creams or have a vaginal silica ring inserted to increase the oestrogen delivery.

To aid in the lubrication of your vagina, a vaginal moisturiser can help.

Changes to your pelvic floor and prolapse

Pelvic prolapse is the loss of pelvic support occurring when soft connective tissue that supports the pelvic organs is stretched, weakened or torn. This is a very common condition in women, caused by age as well as a loss of muscle tone, menopause and low oestrogen; pregnancy and child birth, especially if you delivered naturally; being overweight or obese; family history; pelvic trauma or surgery; and certain medical conditions, like diabetes.

You should seek medical advice if you feel a lump or swelling in the vagina that might be uncomfortable, you experience a dragging or dropping sensation, or if you have back ache.

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Not everyone with a prolapse needs treatment, but your health care professional might advise against any heavy lifting or straining. However, those that do need treatment might undertake physiotherapy or require surgery.


It is also common for women to have problems with their waterworks as they get older. You might suffer from stress incontinence, which is the leaking of urine when you cough, sneeze of jump. However, it is also common for some women to experience ‘urge continence’, when you cannot delay the bladder’s message to empty. Urge Incontinence is the most common type of incontinence and is usually readily treated with medication. If you suffer this type of incontinence you could experience:

  • difficulty maintaining your urine on the way to the toilet
  • frequent visits to the toilet during the night to urinate
  • a need to go to the toilet at least every two hours
  • a feeling of a weak or small bladder.

If you are suffering stress incontinence your doctor might recommend pelvic muscle training or surgery. If you have an overactive bladder (urge incontinence) the treatment could include monitoring and adjusting your fluid and caffeine intake, retraining your bladder and/or medication.

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Other strategies for managing the condition involve pelvic floor exercises. A physiotherapist that specialises in the pelvic floor will best assess your pelvic floor function and teach you the appropriate techniques to strengthen it and train your bladder.

In some circumstances surgery will be required, which is why it is important to see your health care professional if you feel there is something ‘not quite right’ down below.

What health issues concern you as you get older? Has there been a time where you have been too embarrassed to see professional help? Share your stories with us.