The menopause vulva | understanding GSM and how to care for your intimate health

When we discuss menopause, we usually focus on hot flushes, night sweats, and mood changes, these are the symptoms everyone recognises and talks about. But what about our intimate health?
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Many women in perimenopause and postmenopause experience changes in their vulva, vagina, urinary tract and sexual function, yet feel too embarrassed to talk about them or ask for help. Symptoms like vaginal dryness, labia shrinkage, odour changes, recurrent UTIs or pain during sex are often considered taboo, even though they’re common and very treatable.

It's time to open up the conversation, and get the help we deserve and that is readily available for everyone.

This is a sponsored blog post.

Understanding your menopause vulva and Genitourinary Syndrome of Menopause

What is GSM?

The medical term for these changes is Genitourinary Syndrome of Menopause (GSM). It describes a range of symptoms caused by falling oestrogen hormone levels, affecting both the vagina and the lower urinary tract.

GSM can include:

• Vaginal dryness and irritation.
• Painful sex.
• Labia shrinkage or vulval atrophy.
• Odour changes and changes to the vaginal discharge.
• Urinary urgency, stress or urge incontinence, and recurrent urinary tract infections.

The good news? These symptoms can be managed and often dramatically improved for the majority of women with the right care.

Vulval and vaginal changes in midlife

Falling oestrogen levels affects both the external vulva and the internal vaginal tissue. The skin around the labia can become thinner, less elastic and more fragile, while the vaginal wall may lose lubrication. This can lead to itching, burning and pain during sexual intercourse.

The vulva is the external part of the female genitalia, including the labia majora and labia minora (outer and inner lips), while the vagina is the internal muscular canal that connects the vulva to the cervix.
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What helps:

• Use gentle, pH-balanced cleansers or just warm water. Avoid harsh washes, wipes, or deodorisers, remember the vagina is self-cleaning.
• Choose breathable, natural fibre lingerie like organic cotton underwear to reduce friction and irritation.
• Apply vaginal moisturisers regularly (try products like Replens or YES) and use oil-based lubricants during sex (coconut oil can also be soothing).
• Speak to your GP about vaginal oestrogen creams or pessaries (see more details below), which restore moisture and elasticity.

Vaginismus and pelvic floor tightness

Some women experience vaginismus in midlife, where vaginal muscles spasm involuntarily, making penetration painful or impossible. This can be linked to hormonal changes, anxiety or past trauma.

How to manage:

• Book an appointment with a pelvic floor physiotherapist, they specialise in supporting women with these concerns.
• Use vaginal dilators under professional guidance to help relax the muscles gradually.
• Have open conversations with your partner and remember, not all intimacy has to involve penetration. Exploring other forms of connection and using clitoral stimulators can also help and trying different vaginal lubricants could make a massive difference.
• Above all be kind to yourself, patience and time, are often the biggest healers.

​It’s important not to miss your cervical smear appointment because of GSM symptoms. If you’re worried about discomfort, speak to your GP or Practice Nurse beforehand. They are experienced in supporting women with GSM and can offer reassurance, adjustments (like a smaller speculum or a water-based lubricant) or advice to make the procedure as comfortable as possible. 

Odour changes and discharge

Hormonal changes may alter your natural vaginal odour and discharge. Mild variations are normal, but a strong or unpleasant smell, particularly when combined with changes in discharge, may signal infection.

Tips:

• Avoid douching or using scented products, which can disrupt the vaginal microbiome and cause vaginal infections.
• Wear underwear made from natural, breathable fabrics to keep the area balanced.
• Consider using panty liners to improve your confidence.
• If odour is persistent or unusual, consult your doctor.
• For increased underarm body odour in midlife, switch to a natural deodorant, like Fussy Refillable Natural Deodorant.

Urinary symptoms and repeated UTIs

GSM doesn’t just affect the vagina it also impacts the urinary tract. Thinning tissues and lower oestrogen can make you more prone to urgency, frequency, overflow incontinence and repeated UTIs, which can be frustrating and affect quality of life.

What helps:

• Stay hydrated and empty your bladder regularly.
• Avoid perfumed soaps or wipes around the genital area.
• Vaginal oestrogen can also greatly improve urinary health and reduce infections.

There are many supplements on the market claiming to help prevent recurrent UTIs, and I’ve previously written about some of them on my blog. And while vaginal probiotics - particularly those containing Lactobacillus rhamnosus and Lactobacillus reuteri - may support a healthy vaginal microbiome and offer some benefits, they are not always enough on their own. If you suffer from repeated infections, it’s worth discussing vaginal oestrogen with your GP, as it is often a highly effective treatment that can be used alongside the right supplements.

The Debbie bra and brief set from JulieMay Lingerie

The huge benefits of vaginal oestrogen

One of the most effective treatments for GSM is vaginal oestrogen. This low-dose hormone treatment is applied locally and absorbed directly into the tissues where it’s needed, restoring moisture, elasticity and comfort. Because it works locally rather than systemically, most women, even those who have had cancer treatments including breast cancer, can use it safely.

Vaginal oestrogen is life-changing for many women. It helps with dryness, discomfort during sex and recurrent UTIs. If you’re struggling with these symptoms, speak to your GP about whether it’s right for you.  Localised vaginal treatments come in various forms so you can find one that is right for you, pessaries, the vaginal ring and vaginal cream for example are all easy to use.  You can visit Menopause Matters for an excellent infographic about vaginal treatments.

HRT (hormone replacement therapy) can also play an important role in managing GSM, as it helps restore oestrogen levels throughout the body. It can be safely combined with localised vaginal treatments, such as vaginal oestrogen, to target symptoms more effectively. In some cases, the addition of testosterone may be recommended, not only to improve libido, but also to support energy levels, mood, and cognitive function, helping to reduce brain fog. Together, these therapies can significantly enhance overall wellbeing during and after menopause.

The beauty of every vulva

It’s important to remember every vulva is unique. Just like the male penis, vulvas come in all shapes and sizes, there’s no “normal”. Natural childbirth, ageing and hormonal shifts can all change their appearance. These differences are nothing to be embarrassed about. Celebrating this diversity helps remove stigma and allows women to feel more comfortable in their own skin.

Did you know there is a Vagina Museum in London? Or that you can view The Labia Library online, a female health initiative by Women's Health Victoria.

Breaking the taboo

It’s time to start talking openly about these changes. They are not shameful, they are part of life. Sharing experiences and seeking help is empowering. Midlife is not the end of intimacy or comfort; it’s the beginning of understanding your body on a deeper level.

Kate Muir says in her book 'How to have a magnificent midlife crisis' "We’re not just talking about UTIs here; we’re talking about a whole generation of women who have felt shame around this, kept their miserable urinary symptoms secret, and just carried on necking Nurofen and antibiotics. What matters now is education, education, education - telling women that prevention is key, and that local estrogen and probiotics will help."  I can't recommend this book enough by the way, full of common sense advice and insights into midlife health.

How to care for your midlife vagina

• Keep the vaginal area clean and dry using gentle methods and a mild soap.
• Choose breathable, sensitive-skin-friendly lingerie.
• Stay hydrated and support skin health through your diet.
• Speak to your doctor about vaginal moisturisers, lubricants, or hormone therapy if needed.
• Don’t suffer in silence - support is available.

Cotton and silk underwear from JulieMay

Choose the right underwear

As skin becomes thinner and more sensitive during midlife, synthetic fabrics, tight underwear, or harsh detergents can easily trigger irritation. Choosing lingerie made from soft, organic fibres can make a big difference. JulieMay Lingerie, endorsed by menopause experts, uses natural fabrics such as organic Pima cotton combined with silk, which allow your skin to breathe, reduce friction, and minimise irritation, essential for midlife skin comfort. Their knickers also feature a silk gusset, specially designed to reduce friction and limit bacteria growth, providing additional support for intimate health.

The vulva and vagina goes through many changes in menopause, but with the right care, they don’t have to affect your quality of life. Understanding GSM and knowing the treatments available is the first step to feeling good again.

Get 15% off your order from JulieMay Lingerie using my code FAB50 at checkout!

Love from
Michelle xx

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Disclaimer: this article is sponsored by JulieMay Lingerie - specialists in organic, skin-friendly lingerie designed to support women’s intimate comfort at every life stage.

Other blog posts you might find useful and relevant:

The best deodorant for menopause odour | why do we sweat more as we hit midlife?
Understanding menopause skin itching | how to soothe your allergies with JulieMay Lingerie
​Low libido in menopause | how to have a better sex life after 50
​Life lately ... and how I am getting on with the HRT implant