Part 1: Moisturizing the Skin of your Vulva and Vagina
Part 2: Massaging Your Vulva
Part 3: Internal Massage Using Vibration

The Process of Menopause
Comfortable Vaginal Penetration
What to do if You Have Pain and/or Bleeding
Part 2: Massaging Your Vulva

HOW TO MASSAGE This is a different kind of massage than you might be thinking of. Rather than applying friction to the skin (rubbing, stroking), the aim here is to press and release. You will be pressing the old fluids out of your skin tissues which allows fresh blood and lymph to flow into the area; this is how your body rebuilds from the inside out. The press-and-release massage encourages your skin layers to become more flexible, with better blood flow and thicker, more resilient tissue underneath. The entire massage should take about 5 minutes.

You might want to practice the press-and-release motion on the back of your hand. Just press your fingertips onto the back of your hand; it should feel comfortable but firm. Now lift your fingers off, and watch the paler skin on the back of your hand turn back to its normal color. You have just watched the fluid exchange that leads to healing. Remember, do not rub. You should feel pressure, not friction.

VULVA MASSAGE Now, try this on your vulva. The goal is to press and release every bit of skin and tissue on your vulva, beginning with your outer lips. First, apply a quarter-sized dab of lubricant and smooth it lightly around so everything is slick. Then, begin to press and release, using two or three fingertips, working your way around the outer lips of your vulva. It might help to think of a clock face, and work your way from 12:00 around and back to 12:00 again.

When you are finished massaging your outer lips, massage your inner lips. If you need more lubricant, apply some. Press the inner lips between your thumb and fingertips, with a gentle, squeezing motion. This should not hurt; your goal is just to move the blood out, and allow it to return. Work your way all around the inner lips on both sides, and up to the clitoris. Press and release on the clitoris and clitoral hood, too.

Next, massage the area around your vaginal opening. Press and release all around the opening, from 12:00 to 12:00 again.

PERINEAL MASSAGE The last area you should focus on is your perineum--the skin between your vaginal opening and anus. The flexibility of the perineum is crucial for comfortable vaginal penetration, so if you're having pain with penetration, be sure to include this part.

Apply ample lubricant to your thumb and index finger, and gently insert your thumb into your vaginal opening. Press down into the skin of your lower vaginal wall (toward your anus) with your thumb while gently squeezing the tissue of the perineum with your index finger. Concentrate on relaxing the muscles underneath the skin by gently sweeping your lubricated thumb from side to side. You are not trying to stretch the skin, but rather help it become more flexible.

WHO IS VULVA MASSAGE FOR? If you are not experiencing thinning of the skin, or "vaginal atrophy" as your physician might call it, vulva massage can be used as an effective preventive measure. Prevention is generally preferable to developing a problem and then treating it, so if you can work this into your schedule, we recommend it. If you don't feel you have time for it now, remember it for the future when you might need it. In the meantime, you might choose to increase blood flow to your vulva by having at least one orgasm a week, doing Kegel exercises for your pelvic floor (pick up the Pelvic Floor Health brochure or look it up online at www.awomanstouchonline.com) and increasing how much area of your vulva you touch when you self-pleasure. Any increase in blood flow to the area is helpful for maintaining skin integrity and lubrication.

If you are already experiencing vaginal atrophy, the external massage is likely to be very effective and will help prevent your symptoms from worsening. If you occasionally have some discomfort (but not pain or bleeding) with penetration, be certain to include the perineal portion of the massage, and use lubricant, including silicone lubricant (see Lube purchase tip #4, page 4) when you attempt penetration.

If you have pain with sexual touching on your vulva , the entire external massage with lots of moisturizing lubricant may be very helpful to you. However, if it turns out that it is painful to massage, begin with just the moisturizing portion of the Vaginal Renewal program and try the massage again after a week or two of frequent moisturizing. If you are still too uncomfortable to massage, consult your health care provider to determine the cause of the problem.

If you have pain or bleeding with penetration, massaging the areas around your vaginal opening, perineum, and inner and outer lips is crucial. Pain or bleeding with penetration can lead to the development of non-stretchy scar tissue on your perineum. By moisturizing and massaging the area, you will be restoring flexibility to the perineum as well as increasing the flexibility of the surrounding tissue. The more flexible and stretchy all the tissues in the area are, the more likely that you will be able to have comfortable penetration. Just be sure to go slowly, take your time, and breathe. Remember, you're in control of this, and it should not hurt! Your goals are to increase flexibility and blood flow, and to be able to relax while experiencing touch in that area. (See page 13, Pelvic Floor Strength and Flexibility if you are having problems relaxing your muscles during penetration).