Understanding normal changes in female intimate tissues

Function, Sensation, and Aesthetic changes during perimenopause and menopause 

Both external and internal female sexual organs change over time—just like facial skin, hair, and body composition. These changes are normal, hormone-related, and part of aging, especially during perimenopause and menopause. Although these changes are considered normal, they can have a considerable impact on a women’s overall feeling of wellness .  Hormones and the aging process can affect the Function, Sensation and Aesthetic appearance of a women’s sexual organs and overall change how intimacy and relationships are experienced. 

The Hormones Behind the Changes

Estrogen: supports thickness, hydration, blood flow, and elasticity

Androgens (testosterone and DHEA): support tissue volume, blood flow, and nerve sensitivity

Progesterone: helps regulate inflammation, circulation, and tissue balance

Changes in these hormones affect intimate tissues just as they affect skin elsewhere on the body. As these hormones fluctuate and decline—especially in perimenopause and menopause—tissues lose the support they need to function, feel, and look the same.

This is why hormones alone or topical creams alone often aren’t enough. At Sin Worthy/Worthy wellness we believe in combination therapies and guidance in care is what will achieve optimal outcomes. Combining Hormone replacement therapy, topicals and clinical treatments will.

The external and internal changes to female intimate tissues

Labia Majora (Outer Folds)

Function: The labia majora provides protection and cushioning for the vulva.

Fat and skin quality in the labia majora are androgen- and estrogen-dependent. With flections/loss: Fat volume decreases, Skin becomes thinner and less elastic, Oil production declines.

This can reduce natural padding and protection

Sensation: As a result of volume loss -Increased sensitivity to friction, more awareness of dryness or irritation can be experienced.

Aesthetic Changes: In appearance a women may notice a loss of fullness, wrinkling or deflation and overall weaker external structure. Although these changes are common and normal, they can have a big impact on confidence in intimacy. 

Suggested Treatments for best results: Sin Worthy treatments that support collagen, circulation, and structure such as Morpheus8 , the Oh-Shot, and especially the Plump Shot to restore lost volume.

Hormone replacement therapy to restore tissue responsiveness, Without hormonal support, treatments aimed at restoring volume or skin quality struggle to hold results.

Labia Minora (Inner Folds)

Function: The labia minora protect the vaginal opening and help maintain moisture, comfort, and play a role in sensation during intimacy. The labia minora are highly estrogen-dependent. Without adequate estrogen, the tissue simply cannot maintain thickness, elasticity, or comfort—no matter how good the topical care.

Tissue becomes thinner and more fragile, blood flow decreases, hydration is reduced.

Sensation: With more fragile tissue, sexual sensations move from positive and arousing to dryness or burning, Irritation during movement or intimacy and

heightened discomfort.

Aesthetic Changes: As a result women may notice  shrinkage or flattening, colour changes, and less plump appearance. These changes often happen gradually and vary from person to person.

Suggested Treatments for best results :

Targeted Sin Worthy treatments that improve collagen/elastin, blood flow, and barrier function such as the L-tight/Morpheus 8 and Oh- Shot.

Local or systemic hormone therapy to restore tissue health.

The Clitoris

Function: The clitoris plays a key role in sexual response and arousal and depends on healthy blood flow, nerves, and tissue elasticity. Clitoral tissue relies on both estrogen and androgens to maintain erectile tissue, nerve signalling, and vascular response. With hormonal changes: blood flow may decrease, erectile tissue becomes less responsive and nerve signalling can shift

Sensation: Changes in sensitivity, slower arousal response , altered/lessened orgasm intensity. These are tissue-based changes, however can lead to a loss of desire 

Aesthetic Changes: With the hormonal shift a women may notice a smaller or less prominent appearance and less swelling with arousal

Suggested Treatments for best results: Without hormonal support, aesthetic or regenerative treatments alone cannot fully restore function.

-Hormone replacement therapy to support blood flow and nerve health

-Sin Worthy treatments that enhance circulation, tissue quality, and responsiveness such as the Oh-Shot 

While the external vulva often shows the first visible signs of hormonal change, the most impactful shifts for comfort, intimacy, and confidence often happen internally. The vaginal canal, internal clitoral complex, and pelvic floor are all deeply hormone-responsive tissues that rely on healthy blood flow, collagen, hydration, and nerve signalling to function normally. As estrogen and androgens decline through perimenopause and menopause, these internal structures can change in ways that affect lubrication, arousal response, orgasm intensity, and even bladder control—often before a woman realizes what’s happening. Understanding these internal changes helps normalize the experience and opens the door to treatment options that support function, sensation, and long-term intimate wellness.

Internal Vaginal Canal

Function: The internal vaginal canal supports comfort, lubrication, elasticity, and the ability for penetration to feel smooth and pain-free. It also plays an important role in maintaining a healthy vaginal microbiome and natural protection against irritation and infection. The vaginal canal is strongly estrogen-dependent. As estrogen declines during perimenopause and menopause:

• Vaginal walls become thinner and less elastic

• Natural lubrication decreases

• Blood flow reduces

• Tissue becomes more fragile and prone to micro-tearing

• pH changes can disrupt healthy bacteria and increase irritation or recurrent infections

This can lead to a condition often called vaginal atrophy or genitourinary syndrome of menopause (GSM), which affects far more women than most realize.

Sensation: With reduced lubrication and thinner tissue, sensations that once felt pleasurable can become uncomfortable or painful. Many women experience:

• Dryness, burning, or stinging

• Pain with penetration (dyspareunia)

• A “tight” or “raw” feeling during intimacy

• Decreased arousal response due to reduced blood flow

• Increased sensitivity to friction even outside of sex

These changes are real, tissue-based, and often misunderstood as “just aging” or “in your head”—but they are treatable.

Aesthetic Changes: Although internal changes aren’t always visible externally, many women notice:

• A feeling of narrowing or shortening of the canal

• Less natural stretch and softness

• Increased discomfort with tampons, pelvic exams, or intercourse

These internal shifts can strongly affect confidence, intimacy, and overall wellbeing.

Suggested Treatments for best results: Because these changes are driven by hormones and tissue quality, the best results come from a combined approach:

• Local estrogen therapy (when appropriate) to restore thickness, lubrication, and tissue resilience

• Hormone replacement therapy to support tissue responsiveness and long-term comfort

• V-Tight/Plus 90 targets lubrication, sensation, pain, and some types of incontinence by improving tissue health and blood flow; it is Health Canada–approved for stress urinary incontinence and can help reduce recurrent UTIs and yeast infections by restoring a healthier vaginal environment.

Internal Clitoris (Clitoral Complex)

Function: The clitoris is not just the external structure you can see. Internally, the clitoral complex includes deeper erectile tissue (crura and bulbs) that surrounds the vaginal opening and contributes significantly to arousal, orgasm, and overall sexual response.

This internal erectile tissue relies on estrogen and androgens to maintain:

• Blood flow and swelling response

• Nerve signalling and sensitivity

• Tissue elasticity and responsiveness

With hormonal changes during menopause:

• Internal erectile tissue may become less responsive

• Blood flow decreases, reducing engorgement during arousal

• Nerve response may shift, changing how stimulation feels

This can affect orgasm strength and how quickly arousal builds.

Sensation: Women may notice:

• Less intensity during stimulation

• Longer time to reach arousal or orgasm

• Orgasms that feel “muted” or less full-bodied

• More need for direct, consistent stimulation

• Reduced overall genital “awareness” or responsiveness

Even when desire is present mentally, the body may respond differently due to these internal tissue changes.

Aesthetic Changes: Because the internal clitoral complex influences external swelling and fullness during arousal, women may notice:

• Less swelling or “puffiness” with arousal

• Less visible response externally even when turned on

• A subtle decrease in fullness around the vaginal opening

These are normal, hormone-driven changes—but they can feel alarming when no one has explained them.

Suggested Treatments for best results: For clitoral changes, treatments must support both hormones and tissue responsiveness:

• Hormone replacement therapy (especially androgen support when appropriate) to maintain blood flow and nerve health

• Sin Worthy treatments that enhance circulation and regenerative response such as the Oh-Shot uses platelet-rich plasma to enhance local tissue health and nerve function, which can increase natural lubrication, improve clitoral and G-spot sensation, and enhance orgasmic response.

  
  

Pelvic Floor

Function:The pelvic floor is a group of muscles and connective tissue that supports the bladder, uterus, and rectum. It plays a major role in:

• Core stability and posture

• Bladder control and continence

• Sexual function (tightness, grip, orgasm strength)

• Comfort during penetration and daily movement

Pelvic floor tissue is influenced by hormones, circulation, collagen, and overall muscle tone. During perimenopause and menopause:

• Collagen and elasticity decline

• Muscles may weaken or lose coordination

• Connective tissue support becomes less resilient

• Recovery after childbirth or aging becomes harder

This can result in weakness or tension—many women experience both at different times.

Sensation: Changes in pelvic floor function can create very noticeable symptoms, including:

• Reduced sensation during intercourse

• Less intense orgasms

• Feeling of heaviness, pressure, or “dropping”

• Urinary leakage with coughing, sneezing, jumping, or exercise

• Pelvic tension, tightness, or pain during penetration

• Lower back or hip discomfort connected to pelvic instability

Many women assume these issues are “just part of being a mom” or “normal aging,” but pelvic floor changes can be improved with the right support.

Aesthetic Changes: While pelvic floor changes are mostly functional, women may notice:

• A change in the openness of the vaginal opening

• A sense of laxity or reduced “support”

• In some cases, visible bulging or prolapse symptoms

Even subtle changes can affect confidence, comfort, and intimacy.

Suggested Treatments for best results: Pelvic floor support is one of the most overlooked parts of intimate wellness, and it requires a layered approach:

• Hormone replacement therapy to support tissue integrity and collagen maintenance

• Pelvic floor physiotherapy to strengthen weak muscles or release overly tight muscles (both matter)

• The Vagilangelo focuses on pelvic floor and perineal support and vaginal angle restoration; it is especially beneficial postpartum and can help re-establish vaginal positioning for improved sensation, lubrication, and sexual satisfaction.nce circulation and tissue response when paired with strengthening and hormone support

• V-Tight/Plus 90 is designed to strengthen pelvic floor muscles, often marketed for feminine wellness to address issues like stress, urge, and mixed urinary incontinence. It is sometimes used for postpartum recovery and as a treatment for conditions requiring neuromuscular re-education of the pelvic floor muscles. 

When pelvic floor changes are addressed alongside vaginal and vulvar tissue health, women often experience the biggest improvement in function, comfort, and confidence.

The Sin Worthy/ Worthy Wellness Approach

At Sin Worthy/Worthy Wellness, we believe changes to female intimate tissues deserve the same respect and understanding as facial skin. When we normalize these changes, we create space for education, comfort, and confidence at every stage of life. We believe the best outcomes come from understanding that Function, Sensation and Aesthetics may have a profound impact on women and often these concerns cannot be treated in isolation. During your consultation we will explore these areas, educate and create a plan that is unique to your needs, concerns and goals.