When we talk about vaginal health, we are not just talking about the vagina alone. The term is often used as an umbrella to describe the wider vulvovaginal and urogenital area, including the vagina, vulva, bladder, urethra and pelvic floor. These tissues work closely together and are deeply influenced by hormones, particularly oestrogen.
Vaginal health plays a vital role in everyday comfort, bladder control, sexual wellbeing, confidence and overall quality of life. When this area is healthy, the tissues are well supplied with blood, naturally lubricated, elastic and supported by a balanced vaginal microbiome that helps protect against irritation and infection.
Changes in vaginal health can affect far more than intimacy. They can influence how we sit, walk, exercise, sleep and feel in our own bodies. Symptoms such as dryness, burning, recurrent urinary infections, bladder urgency or discomfort during sex are common, but they are often normalised, dismissed or simply not talked about.
Vaginal health is not something that stays the same throughout life. It shifts and adapts as hormones change, life stages unfold and the body responds to events such as pregnancy, menopause or medical treatment. These changes often happen quietly and gradually, which is why symptoms can feel confusing or unexpected when they appear. Understanding this natural progression helps us make sense of what the body is experiencing, rather than seeing symptoms as something sudden or unexplained.
Oestrogen is the key hormone supporting vaginal and vulval tissue. It helps keep the vaginal walls thick, elastic and well lubricated, supports healthy blood flow and maintains an acidic vaginal environment where beneficial bacteria can thrive.
As oestrogen levels fluctuate and decline during perimenopause, menopause and postmenopause, the vaginal tissue can gradually become thinner, drier and more fragile. Blood supply reduces, natural lubrication decreases and the vaginal pH becomes less acidic. This creates a tissue environment that is more vulnerable to irritation, inflammation, bladder symptoms and recurrent infections.
These changes are biological and hormone-driven. They are not hygiene-related, not psychological and not something that should simply be accepted as part of ageing.
Vaginal oestrogen is a low-dose, body-identical, local treatment that supports the health of vaginal and vulval tissue. Unlike systemic HRT, it works directly where oestrogen is needed, with clinically insignificant absorption into the bloodstream.
By restoring moisture, elasticity and tissue strength, vaginal oestrogen can significantly reduce dryness, bladder symptoms, recurrent UTIs and pain during sex. It is one of the simplest and most effective treatments available for maintaining comfort, bladder health and quality of life as hormone levels decline.
Updated 2025 guidelines for Genitourinary Syndrome of Menopause (GSM) confirm that vaginal oestrogen is safe and effective for women of all adult ages and can be used long term. It is considered appropriate for the majority of women, including many with a history of cancer, following individual assessment. Evidence also shows it remains highly effective even when started later in life.
Age should never prevent access to effective treatment, yet vaginal oestrogen is still frequently withheld from older women. Symptoms such as recurrent UTIs, bladder leakage, vaginal discomfort and confusion are often dismissed as “just ageing”, rather than recognised as signs of untreated oestrogen deficiency.
Recurrent UTIs are one of the most common causes of hospital admission for older women and a major contributor to serious infection and urosepsis, which can be life-threatening. UTIs in older adults may also present as sudden confusion or delirium, increasing the risk of falls, rapid decline and loss of independence.
Current evidence confirms that vaginal oestrogen is safe and effective at any adult age, including in women in their 80s and 90s. Ensuring elderly mothers and grandmothers receive appropriate vaginal care, particularly in care and nursing home settings, is not just about comfort or dignity. It can be a critical part of protecting health, independence and quality of life.
Our bodies are home to billions of bacteria, and not all of them are bad. While gut health has become a popular topic, the same care is just as important for the vaginal microbiome. This community of beneficial bacteria helps protect against infections, supports tissue health, and maintains natural pH and moisture levels.
When the balance of these bacteria is disrupted, we may notice dryness, irritation, recurrent urinary infections or discomfort during intimacy. Factors like hormonal changes, antibiotics, hygiene products, and even diet can all affect this delicate ecosystem.
Supporting the vaginal microbiome is simple. Natural, breathable underwear, gentle cleansing, non-toxic sanitary products, and vaginal oestrogen when needed all help maintain the balance. Thinking of vaginal bacteria as your allies, just like probiotics for your gut, can transform how we care for this sensitive area and protect overall health, comfort and wellbeing.
Vaginal oestrogen is available in several forms. All work locally in the vaginal tissues and use very low doses of oestrogen. It is recommended by UK menopause and urogynaecology guidelines and can be used long term, including in older age. Symptoms do not need to be severe to justify treatment.
Applied inside the vagina using an applicator, they can also be used externally around the vaginal opening if needed.
Access: NHS prescription only
Common example: Ovestin (estriol)
Small, low dose oestrogen treatments inserted into the vagina using an applicator. They are usually used daily for a short loading phase, then reduced to twice weekly for ongoing maintenance.
Access: Available over the counter from UK pharmacies or via NHS prescription, depending on the product.
Common examples: Vagifem (estradiol tablet), Gina (estradiol soft gel capsule)
A soft, flexible ring placed inside the vagina that releases a steady low dose of oestrogen over several months.
Access: NHS prescription only, usually fitted by a clinician
Common example: Estring (estradiol)
Genitourinary Syndrome of Menopause, commonly called GSM, is the medical term used to describe the changes that occur in the vaginal, vulval and urinary tissues when oestrogen levels decline. Vaginal atrophy is one part of GSM and refers specifically to the thinning, drying and loss of elasticity of vaginal tissue. GSM reflects the wider picture, including effects on the bladder, urethra and pelvic floor.
Oestrogen plays a vital role in keeping these tissues thick, flexible, well lubricated and resilient. As levels fall, the tissue becomes more fragile, less elastic and more vulnerable to irritation, micro tears and infection. This can lead to symptoms such as vaginal dryness, burning, itching, pain during sex, recurrent urinary tract infections, urgency, frequency, leakage and discomfort when sitting or walking. Symptoms often develop gradually and may worsen over time without treatment.
GSM is frequently missed or under treated in primary care. Symptoms are often treated in isolation, such as repeated UTIs or bladder issues, rather than recognised as part of an underlying hormone driven condition. Many women are also reluctant to raise intimate symptoms, and some clinicians still wrongly believe these changes are an unavoidable part of ageing.
GSM is common, progressive and highly treatable. Recognising it early allows effective, simple treatment that can significantly improve comfort, dignity and quality of life.
The bladder, urethra and vagina sit closely together and share the same hormone support, particularly oestrogen. When oestrogen levels are healthy, these tissues stay strong, elastic and well lubricated. As hormone levels decline, the tissues can thin, dry and become more sensitive. This affects how well the bladder seals, empties and responds to pressure. Bladder symptoms are often treated as a separate issue, but in many cases they are part of wider hormone-related changes in the vaginal and urinary tissues.
Bladder symptoms often improve most when we look at the whole picture, not just the bladder alone. Vaginal oestrogen helps strengthen and nourish the tissues around the urethra and bladder opening, which can improve comfort and control over time. Pelvic floor health is also important, as these muscles support the bladder and help prevent leaks. For some women, especially after childbirth, surgery or menopause, pelvic health physiotherapy can be very helpful. Supporting the tissues and muscles together often leads to better, longer-lasting improvement than treating symptoms in isolation.
Hormone changes can make bladder and vaginal tissues more vulnerable, increasing the risk of urinary tract infections. Understanding the causes and prevention strategies helps maintain comfort, confidence, and long-term bladder health.
Hormone changes can make vaginal tissues thinner and drier, which can make infections like UTIs more likely.
Shifts in natural vaginal bacteria and pH can make it harder for the body to fight off infections.
Recurrent UTIs become more common when the tissues around the bladder and vagina lose strength and elasticity.
Antibiotics can clear infections but don’t fix the tissues, and using them too often can make infections return.
Pelvic floor muscles support the bladder and help prevent leaks and bladder infections.
Noticing early warning signs like burning, urgency, or frequent toilet trips helps prevent more serious problems.
Regular medical check-ups make sure you get the right support and treatment for your bladder health.
Vaginal oestrogen helps keep tissues strong, soft and healthy, reducing the chances of infections coming back.
Drinking plenty of water, urinating regularly, and gentle hygiene can keep the bladder and vagina healthier.
The pelvic floor is a group of muscles at the base of the pelvis that support the bladder, bowel and vagina. These muscles help control bladder and bowel function and play an important role in comfort, movement and sexual wellbeing.
Pelvic floor changes are common after pregnancy and childbirth, during perimenopause and menopause, and following gynaecological or abdominal surgery. Symptoms can include bladder leakage, urgency, pelvic heaviness, pain during sex or ongoing discomfort. These symptoms are often dismissed as normal, but they are signs the muscles may need support. Hormonal changes, particularly falling oestrogen, can also affect tissue strength and muscle coordination, linking pelvic floor health closely to vaginal and bladder wellbeing.
Pelvic floor exercises, often called Kegels, can be helpful for some women, but they are not always the right solution. If muscles are tight, overactive or poorly coordinated, strengthening alone may worsen symptoms. This is why assessment matters.
Pelvic health physiotherapists are specially trained to assess pelvic floor function and provide personalised treatment. In the UK, they can be accessed through NHS referral or privately. Treatment may include relaxation techniques, coordination work, breath awareness and gentle strengthening when appropriate.
Simple at-home awareness exercises can also help. These include noticing how the pelvic floor responds to breathing, learning to fully relax the muscles, and avoiding constant clenching throughout the day. Pelvic floor health is not about doing more, but about doing what is right for the body. With the right support, symptoms can improve significantly.
Pain during sex (Dyspareunia) is common, but it is never something we should expect or simply put up with. Hormonal changes, particularly falling oestrogen, can cause vaginal tissue to become drier, thinner and less elastic, making penetration uncomfortable or painful. GSM, pelvic floor tension, previous trauma, surgery or medical treatments can also contribute to pain.
For many women, pain develops gradually and may feel like burning, tightness, tearing or deep discomfort. This can lead to anxiety around intimacy, avoidance of sex and a loss of confidence in the body. These emotional effects are just as important as the physical symptoms.
Pain during sex is often very treatable once the underlying causes are understood. Vaginal oestrogen can help restore moisture, elasticity and tissue health, making intimacy more comfortable over time. Pelvic floor physiotherapy can be very helpful where muscles have become tight or overprotective after pain, helping them relearn how to relax and function comfortably again.
Lubricants used during sex and vaginal moisturisers used regularly can provide additional support and comfort. Painful sex is not a normal part of ageing, menopause or long-term relationships, and it should never be ignored.
Wash the outside area only using warm water or a gentle, fragrance-free cleanser
Wear breathable underwear made from cotton or bamboo and check fabric labels
Change out of damp clothes and swimwear as soon as you can
Choose unbleached, natural sanitary products made from cotton or organic fibres
Use a vaginal moisturiser regularly if dryness or irritation is present
Use lubricant during sex to reduce friction and discomfort
Drink enough fluids and empty the bladder regularly throughout the day
Pay attention to changes like dryness, itching, burning or discomfort
Do not use heavily fragranced soaps, shower gels or scented products
Do not spray water or wash inside the vagina, it cleans itself naturally
Avoid bath bombs, bubble baths or soaking products with colour, shimmer or glitter
Do not use food items like coconut oil or olive oil on or in the area
Avoid bleached sanitary products that are not organic or made from natural fibres
Check period underwear does not contain BPA or other harmful materials
Do not use wet wipes, douches or intimate deodorants with added chemicals
Avoid tight, synthetic underwear for long periods and choose breathable sleepwear
Why ditching toxic high-street period products for natural, eco-friendly options is the ultimate move for your body and your wellbeing.
For decades, most high-street pads, tampons and liners have been made with bleach, synthetic fibres, fragrances and chemical additives. Research shows that some of these substances may disrupt hormones and have been linked to reproductive issues, fertility problems, chronic conditions, and irritation or infection of sensitive tissues. Long-term exposure to these chemicals can also contribute to hormonal imbalance and may increase the risk of certain chronic conditions later in life.
Today there are safer, modern alternatives. Menstrual cups, period pants, and unbleached, natural pads or tampons allow your body to breathe, reduce chemical exposure, and support overall hormone and vaginal health. Choosing eco-friendly, non-toxic products is a simple monthly swap that adds up over time, protecting your health, comfort, and the environment. Small changes now can make a lifetime of difference.
