The menopause is associated with a gradual change in the vagina which can take up to 5 to 8 years to stabilise. The length and the diameter decrease with age and the pH can rise to between 6 and 8 increasing the risk of infection. Elasticity and blood supply decrease with age and the upper vagina may atrophy. The epithelium becomes thinner which is an important consideration in intravaginal drug delivery since this would lead to an increased permeability. Vaginal secretions and hence lubrication decrease and become more watery. The levels of several enzymes increase, such as E-glucuronidase, acid phosphatase and nonspecific esterases, in postmenopausal women.
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