The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.

Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.

Here’s what happens to your vagina as you age, whether you notice or not.

Let’s clear up the terminology

We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.

What happens to the vagina as you age?

Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.

Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:

• less vaginal secretions, potentially leading to dryness
• less growth of vagina surface cells resulting in a thinned lining
• alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
• fewer blood vessels around the vagina, which may explain less blood flow after menopause
• a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.

What symptoms can I expect?

Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.

Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.

Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.

Not everyone has the same experience

Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.

In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.

If symptoms bother you

Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.

While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.

In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.

Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.

Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.

Are there other treatments?

New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.

For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.

Where to from here?

The normal ageing process, as well as menopause, both affect the vagina as we age.

Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.

While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.

Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.

Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This time of year, most fridges are stocked up with food and drinks to share with family and friends. Let’s not make ourselves and our guests sick by getting things wrong when preparing and serving food.

As the weather warms up, so does the environment for micro-organisms in foods, potentially allowing them to multiply faster to hazardous levels. So put the drinks on ice and keep the fridge for the food.

But what are some of those food safety myths we’ve long come to believe that aren’t actually true?

Myth 1: if you’ve defrosted frozen meat or chicken you can’t refreeze it

From a safety point of view, it is fine to refreeze defrosted meat or chicken or any frozen food as long as it was defrosted in a fridge running at 5°C or below. Some quality may be lost by defrosting then refreezing foods as the cells break down a little and the food can become slightly watery.

Another option is to cook the defrosted food and then divide into small portions and refreeze once it has stopped steaming. Steam in a closed container leads to condensation, which can result in pools of water forming. This, combined with the nutrients in the food, creates the perfect environment for microbial growth. So it’s always best to wait about 30 minutes before refrigerating or freezing hot food.

Plan ahead so food can be defrosted in the fridge, especially with large items such as a frozen turkey or roll of meat. If left on the bench, the external surface could be at room temperature and micro-organisms could be growing rapidly while the centre of the piece is still frozen!

Myth 2: Wash meat before you prepare and/or cook it

It is not a good idea to wash meats and poultry when preparing for cooking. Splashing water that might contain potentially hazardous bacteria around the kitchen can create more of a hazard if those bacteria are splashed onto ready-to-eat foods or food preparation surfaces.

It is, however, a good idea to wash fruits and vegetables before preparing and serving, especially if they’re grown near or in the ground as they may carry some dirt and therefore micro-organisms.

This applies particularly to foods that will be prepared and eaten without further cooking. Consuming foods raw that traditionally have been eaten cooked or otherwise processed to kill pathogenic micro-organisms (potentially deadly to humans) might increase the risk of food poisoning.

Fruit, salad, vegetables and other ready-to-eat foods should be prepared separately, away from raw meat, chicken, seafood and other foods that need cooking.

Myth 3: Hot food should be left out to cool completely before putting it in the fridge

It’s not OK to leave perishable food out for an extended time or overnight before putting it in the fridge.

Micro-organisms can grow rapidly in food at temperatures between 5° and 60°C. Temperature control is the simplest and most effective way of controlling the growth of bacteria. Perishable food should spend as little time as possible in the 5-60°C danger zone. If food is left in the danger zone, be aware it is potentially unsafe to eat.

Hot leftovers, and any other leftovers for that matter, should go into the fridge once they have stopped steaming to reduce condensation, within about 30 minutes.

Large portions of hot food will cool faster if broken down into smaller amounts in shallow containers. It is possible that hot food such as stews or soup left in a bulky container, say a two-litre mixing bowl (versus a shallow tray), in the fridge can take nearly 24 hours to cool to the safe zone of less than 5°C.

Myth 4: If it smells OK, then it’s OK to eat

This is definitely not always true. Spoilage bacteria, yeasts and moulds are the usual culprits for making food smell off or go slimy and these may not make you sick, although it is always advisable not to consume spoiled food.

Pathogenic bacteria can grow in food and not cause any obvious changes to the food, so the best option is to inhibit pathogen growth by refrigerating foods.

Myth 5: Oil preserves food so it can be left at room temperature

Adding oil to foods will not necessarily kill bugs lurking in your food. The opposite is true for many products in oil if anaerobic micro-organisms, such as Clostridium botulinum (botulism), are present in the food. A lack of oxygen provides perfect conditions for their growth.

Outbreaks of botulism arising from consumption of vegetables in oil – including garlic, olives, mushrooms, beans and hot peppers – have mostly been attributed to the products not being properly prepared.

Vegetables in oil can be made safely. In 1991, Australian regulations stipulated that this class of product (vegetables in oil) can be safely made if the pH (a measure of acid) is less than 4.6. Foods with a pH below 4.6 do not in general support the growth of food-poisoning bacteria including botulism.

So keep food out of the danger zone to reduce your guests’ risk of getting food poisoning this summer. Check out other food safety tips and resources from CSIRO and the Food Safety Information Council, including testing your food safety knowledge.

Cathy Moir, Team leader, Microbial and chemical sciences, Food microbiologist and food safety specialist, CSIRO

This article is republished from The Conversation under a Creative Commons license. Read the original article.