The vulva and vagina through your ages and changes

Vagina as you age

Your vagina and vulva will change huge amounts from when you are born to when you are nearing the end of your life.

     Your vagina and vulva in the womb and as a newborn

To develop as a female, a few things have to happen. First, you are conceived female – you get an X chromosome from either parent, and a sperm is either a girl or a boy. The ovaries start to develop, which make hormones that stimulate the growth of your uterus, fallopian tubes and vagina, while the external genitalia also develop – the vulva and vestibule.

At birth, your vulva looks swollen, with more well developed labia minora (inner labia) than you might imagine. This is due to the effect of your mother’s oestrogens, which can take weeks or months to disappear from your body. Bacterial colonies also exist in your vagina, because oestrogen stimulates your vaginal cells to produce glycogen, which is a food source for lactobacilli. Without food, these colonies do not exist – a baby girl has bacterial colonies like a fertile-age woman (her mother, specifically).

A baby girl may even bleed a little when this oestrogen disappears. This is called breakthrough bleeding, and occurs when oestrogen is suddenly withdrawn. Anyone on hormonal birth control actually experiences breakthrough bleeding, which is not a real period, due to the sudden withdrawal of the hormones during the seven-day sugar pill phase.

A baby girl will not develop pubic hair, since this is the activity of the adrenal glands, not the ovaries. When the baby’s legs are opened, the vaginal opening can be seen between the labia, with thick mucous covering the vaginal opening, plus the hymen, which is a thin membrane that covers the vaginal opening. They hymen has some openings to allow fluid to be dispersed.

     Childhood

During childhood, the vagina may be protected by the hymen, and has very little going on in any way. There are very few bacteria present, since increases in bacterial numbers (good bacteria) are determined by the presence of oestrogen, as this provides the food for bacteria. The mons pubis and outer labia fat pads diminish, leaving the clitoris and labia minora (inner labia) standing out more.

Because there is very little oestrogen, the vulva tissue looks thin and pale red or pinkish, as blood vessels show through. Labia may stick together, known as labial adhesion. This occurs due to a lack of oestrogen that would normally produce fluids that would keep the labia separate.

The pH of a child’s vagina is alkaline or neutral, which is more like a menopausal woman. Irritation is therefore more common in children from bubble bath and dyes from toilet paper.

     Puberty

The adrenal glands start to produce androgens, which causes girls to start to have body odour and pubic hair, and acne can start to appear. This is also when kids tend to start being interested in each other a bit more with crushes and kisses, and due to the impact of testosterone on the clitoris, nipples and vagina, masturbating may become interesting.

Then, a year or two later, the ovaries kick into gear, and you’ll start to grow breasts, and eventually your period will come as the final wave of puberty’s magic wand. Your vulva will change in appearance, with your inner labia growing longer and maybe wrinkly, and darker in colour. Hips widen, and the fat pads on the mons pubis and labia majora return.

With the return of oestrogen also comes the return of vaginal microflora, who are fed on glycogen produced by vaginal cells.

    Reproductive years

The whole puberty shebang takes about four years to complete, from the ages of 8-9 and 16. Hair grows around the pubic area and armpits, breasts develop, hips widen, and menstruation kicks off and keeps going.

     During pregnancy

The vulva and vagina change during pregnancy. After about six or eight weeks, the blood volume has increased across the body, and as a result, mucous membranes start to look bluish or violet in colour. Pressure can also cause veins to enlarge, forming harmless but maybe uncomfortable varicose veins around the vagina and vulva.

Connective tissue softens in the vulva and perineum, so as to allow for the birth, while the vaginal walls produce thicker mucous, loosen off connective tissue, and increase muscle fibre size. This results in an increase in the length of the vaginal walls which may cause some bulging of the front vaginal wall.

Lactobacilli are at their height, and anaerobic bacterial colonies decrease, keeping the vagina acidic and pathogens to a minimum. You may experience a thick, white discharge, which may have a yellowish hue due to the effects of progesterone. Any discharge during pregnancy that is watery needs to be checked, as it may indicate fluid loss.

During birth, the vaginal walls expand dramatically to allow the baby to travel to the outside of the body. This is due to the rugae – folds – that open up, like pleats. After birth, the fourchette (bottom join of vagina nearest the anus) is flattened. Any cuts (episiotomy) or tears during delivery may have stitches, and can leave a small scar on the perineum. Each of you will have unique changes to your vulva and vagina immediately after birth, and you will heal and return to a new version of normal. The rugae get back to normal after about three weeks, with the vagina gradually shrinking back to more or less prepregnancy dimensions.

Bacterial colonies also change, most likely due to the abrupt change in hormones – to breastfeed, you need prolactin levels to be high, which is the opposite hormone to oestrogen. This may allow pathogens to sneak in, so being hygenic and diligent after birth is important.

It’s advised to avoid sex for six to eight weeks at least, but most women will find it takes much longer for full healing to occur, and the desire to have sex to return.

     Perimenopause

Perimenopause is the period of time as you transition into menopause. There is no defined time frame for this, but your forties is usually about the time it begins, with perimenopause lasting for usually no more than four years. Some women will go through early menopause, which is genetic or induced by surgeries or treatments for health conditions. Your ovaries slow down their production of oestrogen, which also reduces your good bacterial colonies over time. You may experience a change in the look and function of your vulva and vagina, as they feel the impacts of less oestrogen.

First, progesterone drops, leaving just oestrogen, which may make you feel like you are in a state of PMS all the time – cramping, bloating, tender breasts. Then, oestrogen slows, which causes hot flashes, memory interruptions, heart palpitations, headaches, and vaginal dryness. Then, you hit menopause, and it all grinds to a halt.

     Menopause

Most women will hit menopause before they turn 55. Your vulva and vagina will change as the fat deposits again disappear, just like in childhood, and the skin becomes thin and dry. Labia minora may shrink away, with the vaginal opening – the introitus – becoming smaller. Pubic hair may turn grey and thin out. The cells of your vagina become less active, and less robust, resulting in greater opportunity for damage to occur.

Your pH will become more alkaline and neutral. The urethra and bladder start to lose robustness, and infection or other symptoms may appear. These symptoms are named the genitourinary symptoms of menopause – GSM. The previous name was atrophic vaginitis. Sex may become painful, however one of the best ways to keep your vaginal cells active is to use them! Women who have active sex lives have much healthier vaginas into older age.