As a doctor, I occupy two distinct worlds. My background is in obstetrics and gynaecology and I work part-time in the NHS. But I also specialise in advanced aesthetics, specifically cosmetic gynaecology. This means I look after the functional and aesthetic health of the intimate area, covering everything from skin texture and volume to pelvic floor strengthening and rejuvenation.
But recently I've been seeing a new type of patient. While everyone seems to be talking about 'Ozempic face' - the gaunt, aged look that can accompany rapid weight loss from GLP-1 drugs - fewer are aware of a phenomena I'm seeing. It's a condition you could call 'Ozempic vagina'.
It's unlikely to be something people even consider but the truth is that any medication that makes you lose weight quickly can also have an impact down there, and not in the way you might hope.
That sagging and laxity that you see on the face when a patient starts taking these types of drugs is often reflected in the intimate area. But, unlike the face, it's not so easily visible. I am seeing a rising number of women - particularly those who are perimenopausal or menopausal - who are delighted with their weight loss but are suddenly dealing with an intimate area that looks older, feels uncomfortable and functions differently (yes, really).
Here are the primary issues my patients are facing, and how we can treat them...
Lax labia
Just as you lose volume in your cheeks, rapid weight loss strips volume from the intimate area. Patients often tell me that their labia look saggy, particularly when they stand up.
From an aesthetic perspective, the area no longer looks youthful and this can have a knock-on effect on their self-esteem and, subsequently, their relationships.
Crucial cushioning
Beyond aesthetics, the loss of fat has serious physical implications. We naturally have a layer of fat across the pubic bone (the mons pubis) and the outer lips (labia majora) and that cushion has a functional role to play.
When patients lose that padding they can find that wearing underwear or tight clothes becomes painful because there is no support for the inner lips. The increased friction can also lead to pigmentation issues but, more worryingly, this anatomical change affects your health. Increased friction can result in higher susceptibility to thrush and bacterial vaginosis, and as the labia lose volume, the urethra becomes less protected, increasing the risk of urinary tract infections (UTIs).
If the women are already menopausal or perimenopausal, a time at which the tissues in this area already have a tendency towards atrophy, then weight loss just compounds the problem.
Hormonal horrors
Even if GLP-1 users aren't menopausal or perimenopausal they may still find that taking these types of drugs has an impact on their hormone levels. Adipose tissue (body fat) actually plays a role in producing oestrogen, meaning higher body fat usually correlates with higher oestrogen levels.
When a patient takes a drug like Ozempic (Wegovy in the UK) or Mounjaro, they experience a rapid decline in body fat, which can lead to a rapid decline in oestrogen levels. This effectively mimics - or exacerbates - perimenopausal symptoms which can include vaginal dryness, decreased lubrication and a lower libido.
Dehydrated down there
Weight-loss drugs don't only reduce appetite, they can also reduce thirst, often leading to general dehydration. If you are dehydrated systemically, you will experience intimate dryness. This combination of low oestrogen and dehydration can make intercourse painful and diminish sensation.
THE SOLUTION
Before I treat any patient it's imperative that I understand what is causing the problem - you can't just treat the symptom without understanding the root cause.
Although the use of GLP-1s has become more commonplace, it's still not something that a patient will automatically reveal, so we'll do a very in-depth consultation before discussing what their major concerns are.
Sometimes, I'll use a treatment that will improve the quality of the skin and give a lifting effect. You may have heard of the Morpheus 8, which is a radio frequency micro-needling treatment that is used on the face. The Morpheus 8 V is similar but designed for the intimate area. For more significant changes, we might use non-surgical labiaplasty which uses radiofrequency at higher temperatures to tighten the area and improve aesthetic appearance.
Once we have improved the skin quality with treatments like micro-needling, we can look at replacing that lost volume. We can use fillers to restore the 'cushion' in the outer lips, which provides the necessary support and protection for the inner structures. We might also focus on pelvic floor strengthening to improve overall support.
And to combat dryness and laxity, I often combine treatments. So maybe using hyaluronic acid injections to deeply hydrate the tissues alongside internal radiofrequency treatments to rejuvenate the area, improve blood flow, and help with dryness and sensation.
There is no quick fix. My approach is holistic and customised to each patient's specific complaints. It usually takes three to six months to achieve the desired results and most of my patients will come back in for annual maintenance treatment. Just like losing weight, it's not a one-and-done thing.