As a woman goes through perimenopause and into menopause, estrogen levels decline, leading to thinning of the vaginal tissues as well as the bladder lining and the vulvar skin. The opening to the vagina involutes, which makes it become smaller and tighter. There is a decrease in vaginal secretions and therefore, dryness. Painful intercourse occurs, as well as loss of pleasure when a woman is touched in the clitoral, vulvar and vaginal area. Many women then will avoid sex due to discomfort. The prevalence of vulvovaginal atrophy is about 75% to 90% among postmenopausal women
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