"What you're experiencing is called vaginal atrophy. And it happens to most women after menopause."
She pulled out her chair—that familiar squeak of medical office furniture—and leaned in close.
"Let me show you what's happening."
She drew three simple circles.
"First, when estrogen drops after menopause, your collagen production plummets. Think of your vaginal tissue like a rubber band that's lost its stretch."
"Second, you produce less hyaluronic acid—your body's natural moisturizer. Without it, tissues become dry and prone to tearing."
"And third—this is crucial—your vaginal microbiome gets completely disrupted."
"Wait," I interrupted. "You're saying this isn't just about hormones? That there's actually something breaking down in the tissue itself?"
"Exactly!" She smiled.