Hormonal Changes Affecting Vulva - An Overview

Introduction

The vulva plays a crucial role in the female reproductive system, and its function can be affected by hormonal fluctuations across a woman's lifespan. These hormonal shifts can happen at significant times, such as during puberty, pregnancy, menstrual cycles, and menopause. Hormonal fluctuations can influence both how the body functions and its physical characteristics. In the female body, estrogen and progesterone are the dominant hormones, with the ovaries largely generating estrogen. In addition to regulating the female reproductive system, estrogen is essential for the development of secondary sex traits. Progesterone is important for the female reproductive system and is vital to sustaining the early phases of pregnancy. This article explores how hormonal changes impact the vulva.

What Is a Vulva?

The vulva forms the external aspect of the female genitalia and incorporates structures related to both reproduction and the urinary tract. In addition to safeguarding the reproductive system, the vulva is essential for childbirth and contributes to sexual arousal. It consists of:

• Labia: The structure includes both the inner and outer labia, skin folds that protect the female genitalia. The labia majora (outer labia) and the labia minora (inner labia) are rich in blood vessels and swell during sexual arousal.

• Clitoris: It is a sexual organ in women, separated into the glans and the body, where the glans are particularly nerve-dense.

• Vaginal Opening: It serves as a muscular channel involved in sexual intercourse and the delivery process.

• Urethral Opening: It serves as the outlet for the bladder, leading to the outside.

• Mons Pubis: This presents as a fatty prominence over the pubic bone, especially evident in females, with a covering of pubic hair. It provides a soft barrier during sexual activity and emits pheromones.

• Vestibular Bulbs: These are tissues with erectile properties situated on either side of the vaginal orifice.

• Vulva Vestibule: This space is situated between the labia minora and features both the urethral and vaginal openings.

• Bartholin’s Glands: These small, pea-sized glands, located near and behind the vaginal opening, secrete mucus to function as a natural lubricant.

• Skene’s Glands: These small glands are positioned adjacent to the urethra.

How Do Hormonal Changes Affect the Vulva?

These two critical hormones, estrogen and progesterone, are fundamental to properly functioning and regulating the female reproductive system. During different stages of life, estrogen levels rise during puberty, ovulation, and menstruation but fall during menopause and perimenopause. Consistently elevated or diminished hormone levels may result in health issues. Various conditions can also contribute to hormonal changes, including breastfeeding, smoking, increased stress, immune disorders, side effects from medications, and certain cancer treatments. The impacts of estrogen include:

• One of estrogen's effects on the vulva is increased blood circulation.

• The rise in elastin and collagen driven by estrogen results in a more resilient and well-toned vulvar region.

• Estrogen also enhances vaginal acidity, helping to prevent bacterial infections.

• Estrogen enhances the vaginal wall's thickness.

• Estrogen contributes to the natural lubrication of the vaginal wall.

Whereas progesterone aids in preparing the body for pregnancy by halting ovulation, preparing the breasts for breastfeeding, and suppressing uterine contractions to prevent preterm labor.

Hormonal fluctuations impact the vulva at different stages of life, such as:

1. Puberty: The onset of puberty signifies the transition from childhood to adulthood, with notable physical and emotional changes. For girls, this phase generally starts between the ages of 8 and 13. Hormonal changes during puberty in females puberty can lead to several changes in the vulva, including:

• As puberty progresses, the labia minora grows larger and wider.

• The vulvar area may exhibit greater pigmentation, which might also extend to the mons pubis.

• As puberty progresses, pubic hair grows in a thicker, curlier pattern.

• Before the onset of menarche, white vaginal discharge may be observed.

2. Menstruation: Menstruation can impact the body in several different ways:

• During the follicular phase, hormones boost blood circulation to the vulva, resulting in heightened sensitivity and improved lubrication.

• As estrogen peaks during ovulation and then decreases before menstruation, vaginal dryness may occur, leading to possible discomfort and pain during intercourse.

• Menstrual-related drops in estrogen can change vaginal pH, which can elevate the risk of yeast infections.

• The lack of lubrication combined with wearing pads can sometimes cause bumps in the genital region.

3. Pregnancy: During pregnancy, the following changes typically occur:

• Increased blood circulation to the vulva, noticeable about a month post-conception, can lead to swelling and puffiness of the labia.

• The labial skin might change color, occasionally appearing purplish or bluish for a short period.

• The labia minora may look larger due to a minor retraction of the labia majora.

• The increased pressure exerted by the uterus may contribute to a higher risk of varicose veins in the vulva.

• There may be a rise in vaginal discharge, with the mucus becoming thicker and stickier.

• Further, postpartum hormonal changes can influence various aspects. As hormone levels fall after childbirth, the vulvar pigmentation may revert to its pre-pregnancy state, the labia minora might become smaller, and lower estrogen can contribute to vaginal dryness.

• An episiotomy performed during childbirth can lead to itchiness. Postpartum, the vaginal opening may look more expanded, softer, and less tight.

4. Menopause: As estrogen levels drop during menopause, it leads to the following effects:

• As estrogen declines, the vagina may experience dryness, thinning of its walls, and reduced elasticity, called vaginal atrophy. This dryness can lead to irritation, making the vagina more prone to damage and infections.

• The vaginal opening may become more constricted.

• The vaginal walls may become smoother and lighter in color.

• Dryness and reduced lubrication in the vaginal area can contribute to painful sensations during sex. When vaginal discharge diminishes, it can contribute to a burning sensation while urinating.

• The drop in hormone levels during menopause can make women more susceptible to yeast infections.

• The labia may reduce in size or, in some instances, fuse together.

• The menopausal period can increase the chances of experiencing lichen sclerosus (a condition that causes the skin to become noticeably thin and discolored, with a patchy appearance) and vulval dermatitis (painful, red, and itchy vulva) and may also lead to more frequent urinary tract infections.

To address these changes, options include using lubricants, applying vaginal moisturizers, or employing topical hormonal treatments. For females on birth control pills, hormonal changes can elevate cervical fluid levels, potentially causing a whitish discharge. This may occasionally also lead to vaginal dryness. A study involving postmenopausal women indicated that those who smoke have more severe atrophic changes in the vagina than their non-smoking counterparts.

Conclusion

Throughout a woman's lifetime, the vulva undergoes substantial changes. As women move from puberty to menopause, hormonal fluctuations may result in vaginal swelling, modifications in vulvar tissues, shifts in elasticity, and fluctuations in sensitivity. Personalized hormonal therapies and lifestyle adjustments suited to these transitional periods can optimize vulvar health and contribute to overall well-being.