Many women never received clear, practical education on vaginal health. What filled that gap over the years has been a mix of well-meaning advice, outdated habits, and social media posts of varying reliability. A recent article from Mayo Clinic Press by Sara Youngblood Gregory, featuring guidance from Jean Marie McGowan, M.D., a women's health internist and sexual health specialist at Mayo Clinic, offers a practical reset on what actually matters.
Here is what stood out, and why it is relevant if you are navigating perimenopause, menopause, or hormonal changes.
The Vagina and the Vulva Are Not the Same Thing
This is a distinction that matters more than it might seem. The vagina is the internal muscular canal that extends to the cervix. The vulva refers to the external structures: the labia, clitoris, and urethral opening. Products, symptoms, and care differ depending on which area is involved, and using the wrong terms can lead to confusion in conversations with a provider.
Simpler Hygiene Is Better Hygiene
One of the strongest points in the Mayo Clinic article is how little the vagina actually needs in terms of cleaning. It is self-cleaning. Warm water is sufficient, and products marketed as vaginal cleansers, detoxes, or pH-balancing washes can do more harm than good by disrupting the natural bacterial balance.
That applies to douching as well. Despite decades of marketing, there is no medical reason to douche, and doing so can increase the risk of infections. The vulva can be washed gently with mild, unscented soap, but the vaginal canal itself does not need intervention.
Vaginal Dryness Deserves Attention, Not Dismissal
This is where the article connects most directly to hormone health. Vaginal dryness is common during perimenopause, menopause, and breastfeeding, all periods when estrogen levels drop. The vaginal lining thins, moisture decreases, and sex can become uncomfortable or painful.
Dr. McGowan recommends pH-balanced lubricants with minimal additives for use during sex, and vaginal moisturizers, creams, or suppositories for persistent dryness. These are available over the counter, and many women find relief without a prescription.
For persistent dryness, especially during perimenopause or menopause, a provider may recommend options such as a vaginal cream, suppository, moisturizer, or another therapy tailored to the situation.
Discharge, Discomfort, and When to See a Provider
Normal vaginal discharge varies in color, consistency, and amount throughout the menstrual cycle. That variation is expected. What is not normal is a sudden change accompanied by itching, swelling, unusual odor, or pain. Those symptoms warrant a visit to a healthcare provider rather than a trip to the drugstore for an over-the-counter remedy.
The same applies to urinary symptoms. Burning during urination or increased frequency should be evaluated rather than managed at home with nonprescription products. Urinary tract infections left untreated can become more serious, and recurrent UTIs in menopausal women sometimes point back to hormonal changes affecting the urinary tract.
The Pelvic Floor Is Part of the Picture
Pelvic floor health is often left out of conversations about vaginal wellness, but the two are closely connected. Weak or tight pelvic floor muscles can contribute to urinary incontinence, pain during sex, and a general sense that things feel different. Pelvic floor therapy, which involves working with a specialized physical therapist, can help with all of these.
Pelvic floor issues are common in midlife and beyond. Urinary leakage, overactive bladder, and pelvic organ prolapse are all conditions that can develop or worsen with age, childbirth, and hormonal changes. As Dr. McGowan notes, the hips, low back, bowels, bladder, and sex organs share much of the same nerve and blood supply, and pelvic floor therapy can help retrain coordination when something is off.
Bring Changes to a Provider, Not the Drugstore
The thread running through much of Dr. McGowan's guidance is straightforward: pay attention to what changes, and bring those changes to a healthcare professional rather than trying to manage them on your own. Vaginal dryness, discomfort during sex, thinning tissue, bladder symptoms, and pelvic floor concerns are all worth discussing.
When hormonal changes are part of the cause, treatment may include therapies aimed at improving dryness, comfort, and related symptoms. But even when the path forward is unclear, the first step is the same: find a provider who is comfortable talking about these topics and who takes your concerns seriously.
As Dr. McGowan puts it, your questions deserve to be addressed. If it helps, write them down before your visit.
Source:
The Dos and Don'ts of Vaginal Health, Mayo Clinic Press, February 23, 2026. By Sara Youngblood Gregory, featuring Jean Marie McGowan, M.D.
