Vaginal Health and Menopause

What Really Happens and What Women Can Do About It

Menopause is a major transition, but it should not mean the end of comfort, confidence, or pleasure. On the Shameless Care Podcast, we talk often about how misunderstood this phase is. Women are told that dryness, pain, changes in desire, and discomfort are “normal.” What they are not told is that these issues are treatable, and often completely reversible.

Vaginal health during menopause is not about aging badly. It is about predictable hormonal changes and simple, evidence based tools that restore comfort and intimacy.

Here is what every woman deserves to know.

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Why Things Change During Menopause

Estrogen keeps the tissues of the vulva and vagina lubricated, elastic, and well supplied with blood. When estrogen declines during perimenopause and menopause, several predictable changes occur:

• Vaginal walls become thinner
• Natural lubrication decreases
• Blood flow to the vulva and clitoris drops
• Tissue becomes more fragile and more prone to tearing
• Vaginal pH shifts
• The microbiome changes
• Infections become more common

These changes can make sex uncomfortable or even painful. None of this means a woman has “lost her sexuality.” It simply means her hormones have changed and her tissues are responding exactly as expected.

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Vaginal Dryness Is Physiological, Not Emotional

One of the most damaging myths is that dryness happens because women are “less attracted” to their partner. That is simply not true. Vaginal lubrication is primarily a hormonal and vascular function.

Many women still want sex, still enjoy their partner, and still feel mentally aroused. Their body just is not responding the same way.

Understanding that difference removes so much unnecessary shame.

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Pain With Sex Is Treatable

Pain during sex is not something women should push through. Thinner, drier tissue can cause burning, microtears, and lingering soreness. Over time, many women avoid intimacy, which lowers blood flow, increases dryness, and repeats the cycle.

The good news is that this is absolutely treatable with hormonal and nonhormonal options.

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Lower Estrogen Increases the Risk of STIs

Estrogen does more than support lubrication. It maintains healthy vaginal ecology. Estrogen keeps the vaginal walls rich in glycogen. Glycogen feeds lactobacillus, the beneficial bacteria that maintain an acidic pH. When estrogen declines, glycogen drops, lactobacillus decreases, and vaginal pH rises. A higher pH is more welcoming to harmful bacteria, including chlamydia and other STIs. This is one reason postmenopausal women can be more vulnerable to infections even if their sexual habits have not changed.

Supporting vaginal tissue health protects pleasure and reduces infection risk.

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Vaginal Estrogen: The Gold Standard Treatment

Vaginal estrogen is one of the most effective, safest treatments in all of women’s health. It restores the vaginal tissue that thins due to hormonal decline and dramatically improves:

• Lubrication
• Elasticity
• Comfort during sex
• Vaginal pH
• Recurrent UTIs
• Overall pelvic health

Shameless Care does not offer vaginal estrogen yet, but expects to soon. It is the gold standard therapy for postmenopausal vaginal changes.

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Full Body Hormone Replacement Therapy

Some women choose full body hormone replacement therapy to treat whole body symptoms of menopause. Hormone therapy can improve hot flashes, sleep quality, energy, mood, cognition, sexual function, and bone density. Recently the FDA removed its black box warning on estrogen therapy after reviewing decades of data. This reflects the modern understanding that hormone therapy is safe and beneficial for many women. Not everyone is a candidate, but for many women HRT is life improving. We talk through the science on the Shameless Care Podcast in a way that actually makes sense.

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What Shameless Care Offers Right Now

Until vaginal estrogen is available, several medications can meaningfully support pleasure and sexual responsiveness.

Shamelessly Aroused

A topical medication that increases blood flow and sensitivity, often improving lubrication and arousal within minutes.

Shameless Chemistry

A blend of oxytocin and tadalafil designed to increase bonding, relaxation, and pelvic blood flow for deeper sexual responsiveness.

Oxytocin Nasal Spray

Used by many women to enhance intimacy, reduce anxiety, and help transition into a sexual mindset more easily.

These treatments do not replace estrogen, but they can improve comfort, arousal, lubrication, and pleasure while supporting emotional connection.

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Additional Tools That Help

Lubricants and moisturizers

Lubricants reduce friction during sex. Moisturizers help tissues retain hydration between encounters.

Regular sexual activity or stimulation

Anything that increases pelvic blood flow helps maintain tissue health, including masturbation. Physiology, not morality.

Pelvic floor physical therapy

Some women develop pelvic floor tension or pain during menopause. Therapy can dramatically improve comfort and function.

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Other Menopause Changes Worth Knowing

A world class menopause article must address the broader changes women experience. Here are key areas women are rarely told about:

Mood and cognition

Many women experience irritability, anxiety, brain fog, and difficulty concentrating due to hormonal shifts. These changes are reversible.

Sleep disturbances

Hot flashes and night sweats disrupt sleep. Poor sleep then worsens mood, weight gain, libido, and overall health.

Metabolic changes and weight

Declining estrogen changes how the body stores fat. Weight tends to shift to the abdomen. This is hormonal, not a failure of effort.

Bone health

Estrogen protects bones. After menopause, bone density declines rapidly. Hormone therapy and resistance training both help protect long term health.

Heart health

Modern data show that healthy women who start hormone therapy near the onset of menopause have lower cardiovascular risk, not higher.

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Menopause is not a disease

It is a physiological transition. The suffering around it comes from untreated symptoms and lack of education, not from the transition itself.

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Women Deserve Better Care

Too many women are told to “just deal with it” or “wait it out.” That is outdated thinking. With the right treatment, women can experience:

• Comfortable sex
• Stronger arousal
• Better lubrication
• Reliable orgasms
• Enhanced intimacy
• Restored confidence

Menopause changes the body. It does not diminish a woman’s sexuality or her right to pleasure.

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How Shameless Care Helps

Shameless Care is committed to offering science based solutions for women’s sexual health. Today we offer medications that support arousal, connection, and comfort. Soon we will offer vaginal estrogen, the gold standard therapy for vaginal changes caused by menopause.

Women deserve answers, treatment options, and providers who take their symptoms seriously. That is what we deliver.

If you are experiencing dryness, discomfort, changes in arousal, or shifts in sexual response, you are not alone and you are not stuck. Shamelessly Aroused, Shameless Chemistry, and Oxytocin may help you feel more responsive, more connected, and more comfortable in your own body.

Connect with a Shameless Care clinician today.

Your pleasure matters.