The vaginal mucosa is the lining of the vagina which is in direct contact with the vaginal secretions. It composes part of the vaginal wall. Beneath the mucosa lies muscle, nerves, blood vessels and adipose tissue. Together they make up the vaginal wall. It extends form the inner labia minora of the vulva to the cervix. The average length of the front wall of the vagina is a 7.5cm and the back wall is 9cm. The difference in length occurs due to the projection of the cervix into the vagina at approximately a 45 degree angle. The vaginal caliber at the opening is approximately 3.5cm. When lack of estrogen occurs, the vagina shrinks in length and in caliber. The mucosa gets thinner, less elastic, pale and dry. Problems that arise from these changes include central pelvic pain during intercourse from the penis hitting the cervix and  pain and tearing with intercourse to symptoms of atrophic vaginitis. These symptoms can include vulvar burning, rawness and stinging, chronic bacterial and/or yeast infections and urinary frequency and urgency.  In most women virtually any type of estrogen applied to the vagina fixes these problems. However, there is a group of women who have high estrogen demand vagina (HEDV). This means their vaginal mucosa will only respond to higher levels of estrogen and in the correct proportion of bio-identical estrogens. These women are often frustrated because they travel from provider to provider looking for answers but receive the same old therapy. This group of women are uncommon but their symptoms are usually most extreme. If you are one of these women, your vaginal mucosa is likely not healthy, meaning the squamous cells are likely mostly Intermediate cells or parabasal and basal cells. This can be corrected but must be done by a provider who is aware how to treat HEDV’s. This is a particular expertise at FGI. So take it to heart that there is a provider out there who can get your condition fixed.