Estrogen depletion and vaginal atrophy: In menopause, painful intercourse is associated with dramatic decreases in circulating estrogen concentrations cause physiologic changes.
The vaginal tissues become dry, less elastic, more fragile and more susceptible to tearing, bleeding or pain during sex or during a pelvic exam.
For many women, vaginal atrophy also causes tightening of the vaginal opening making intercourse painful.
Vaginal pH imbalance and Infections: The loss of estrogen causes the vagina to become less acidic, which makes the body more susceptible to urinary tract infections (UTI's) and overgrowth of pathogenic bacteria (BV) and yeast infections. Vaginal infections cause irritation, dryness and burning.
After menopause, falling estrogen levels also cause the vaginal microbiome to shift away from a lactobacillus-dominant ecosystem. The loss of protective lactobacilli is the main cause of the increased rate of UTI's.
Vaginal and pelvic muscle tonus: Low estrogen levels impact the strength and tonus of vaginal and pelvic muscles that support and keep the uterus, bowel, bladder or top of the vagina in place. Up to 40% of women will experience pelvic organ prolapse (POP), due to loss of support from the connective tissue, in menopause.