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Atrophy: Use It Or Lose It?

A trans masc Redditor asked: “If you’re more sexually active, can you slow atrophy? Kind of like a ‘use it or lose it’ situation?”

Table of Contents

Content Warning!

Reproductive organs and genitals will be mentioned by name, for the sake of accuracy. I will always correct exclusionary and cisnormative language where possible, and I’ll do my best to avoid potentially dysphoria-inducing imagery without a warning. Primary sources tend to be cisnormative – please keep that in mind when clicking any links!


If you’re more sexually active, can you slow atrophy? Kind of like a ‘use it or lose it’ situation?

Sexual activity may be potentially helpful in the management of atrophy. Several articles published in medical journals cite sexual activity as a “lifestyle modification” that may aid in reduction of symptoms. Other modifications include factors such as stress, smoking, and even the type of underwear you choose.

Increased sexual activity is advised for

maintaining robust vaginal muscle con-

dition. There is a positive link between

sexual activity and maintenance of

vaginal elasticity and pliability as well as

lubricative response to sexual stimulation.


Sexual intercourse improves blood

circulation to the vagina and seminal

fluid also contains sexual steroids, pros-

taglandins, and essential fatty acids,

which serve to maintain vaginal tissue.

Vulvovaginal tissue stretching also helps

to promote vaginal elasticity. Masturba-

tion or sex devices are options for

patients without a partner.


Stress reduction therapy and psychological

counseling may benefit people with

nonorganic causes of vaginal dryness.

Cessation of smoking can help relieve

symptoms. Lastly, wearing looser un-

dergarments and legwear may improve

air circulation, discouraging growth of



Is It Enough?

The usefulness of sexual activity is limited in the trans masculine population, as many trans men have bottom dysphoria making them unable to participate in penetrative activity. Plus, if you are already experiencing symptoms of atrophy, penetration may be difficult or uncomfortable. It’s also worth noting that I was unable to find evidence that sexual activity increases the presence of lactobacilius to the vaginal microbiome or decreases vaginal pH.

Additionally, these cis-hetero-normative sources did not clarify whether external stimulation alone is effective at promoting vaginal health. I would guess that the pelvic contractions which take place as a result of orgasm may help maintain vaginal muscle condition, even if that orgasm was achieved externally. However, external stimulation obviously can’t provide the conditioning action of stretching the internal tissues, like a dilator or other penetrative processes can.

Speaking from personal experience, regular PIV sex was not sufficient in preventing or treating my atrophy symptoms.

Gentle stretching of the vagina

with the use of lubricated vaginal dilators of graduated sizes

can play an important role in restoring and then maintaining

vaginal function. Re-initiating regular sexual activity once

vaginal penetration is again comfortable will help to maintain

vaginal health. Many patients with this condition benefit

from referral to pelvic floor physical therapy. Starting

vaginal estrogen before initiating vaginal dilatation and/or

pelvic floor therapy may facilitate progress. (Source)

Bottom Line

The bottom line is that sexual activity may be helpful and it’s worth a try if it is accessible to you. If not, that’s okay – the first-line therapy for atrophy is not sexual activity, but topical estrogen. Penetration and sexual activity are not necessary for treating atrophy.