Do Your Labia Change After Menopause?What's Normal and What to Get Checked

Many women notice the vulva looks different after menopause: the inner lips seem smaller or flatter, and the skin looks paler or feels drier. Some of that has been measured.

• The inner lips (labia minora) tended to be shorter in older women.¹
• The area between the vagina and the anus (the perineum) was a little shorter with age too.¹
• The outer lips were longer in women with a higher body mass index.¹

The study measured different women at different ages, all of them white, at one hospital.¹ It shows a pattern across ages, not how any one woman changes over time.

Why it happens

Doctors call the effects of lower estrogen on this area the genitourinary syndrome of menopause (GSM). Its definition names changes to the outer and inner lips, the clitoris, the vaginal opening, the vagina, the urethra and the bladder.² Symptoms can include dryness, burning and irritation; dryness or pain during sex; and urgency, painful urination or repeat UTIs.² These only count as GSM when they bother you and nothing else explains them better.²

See what GSM is, moisturizer vs lubricant and vaginal estrogen forms compared.

Expected change, or worth a check?

Usually lower estrogen	Get it checked
Dryness, burning or irritation2	Itchy white patches that are smooth or crinkled and bleed or hurt when rubbed3
Less natural lubrication, discomfort with sex2	The vulva shrinking or tightening so sex becomes painful3
Urgency or repeat UTIs2	A lump, a sore, a growth or an ulcer4
	Red, white or dark patches, or thickened, raised skin4
	Itching that doesn’t get better, a mole that changes, or burning when you pee4

Lichen sclerosus deserves its own mention. It causes itchy white patches, most often around the vulva and anus, and it’s much more common in women over 50.³ It can’t be cured, but a strong prescription steroid ointment usually relieves it.³ See lichen sclerosus follow-up checks.

Vulvar cancer is rare, 0.3% of new cancers in the US, with a median age at diagnosis of 70.⁵ Finding it early matters: 58% of cases are caught while still local, and five-year survival for those is 85.5%.⁵ The NHS⁴ stresses that these symptoms are very common and usually have other causes.⁴ See vulvar itch, lump or sore: when to get checked and why your vulva is itchy.

Try: “Since menopause my vulva looks different, and the skin is itchy at night. Could you examine it and check for lichen sclerosus or another skin condition?”

Down There, Decoded covers how wide normal runs in Chapter 10, “What It’s Supposed to Look Like.” The one kind of looking it says is worth keeping is looking for change over time, with a dated note in your Down-There Log whenever something seems new. See the book.