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Posts Tagged ‘vaginal comfort’

It sounds like you’ve done a great job with regular, sustained use of dilators to restore the vaginal opening. Be aware that the top of the vagina tapers a bit, so it’s possible that the largest-diameter dilator, because of its width, just won’t go in as far as the others. The only way to assess for certain what’s happening is to have a pelvic exam with your health care provider; I’d explain to her or him that you’ve been using dilators and see whether s/he finds anything other than normal.

During intimacy with a partner, many women find that they can control the depth and angle of penetration more easily when they are on top. That seems to be a safer starting point for women who have reason to better understand what’s most comfortable–and pleasurable.

Congratulations on taking care of yourself!

To ask your own question, use the pink “Ask Dr. Barb” button top and center on our website. You’ll receive a confidential reply via email, and your question may be used as the basis for a Q&A post here on our blog. 

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Whether you’re using a cream, tablet, or ring to add localized hormones to your vagina, your partner is not absorbing any—no more than he did when you were producing your own hormones before menopause. You (and he!) can feel perfectly confident about your use of these products, and your intimacy will benefit from the increased comfort you’re likely to experience.

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If you can comfortably insert any size tampon, you don’t need much more space to allow for intercourse. I use two fingertips as a rule of thumb; that is, if I can insert index and middle fingers during an exam, I can assume intercourse is likely to be comfortable. The only time I’ve done surgery to enlarge the vaginal opening was when only a Q-Tip could be inserted–a definitive intact hymen.

What you might find helpful is vaginal dilators to help to extend the elasticity that you already have. The graduated sizes of dilators, regularly used, can gently stretch the tissue to assure comfortable penetration. I’d certainly try that before opting for surgery!

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Dilators are not intended to fit all the way inside your vagina. The extra length gives you some space to hold on to and to apply gentle upward pressure. The pressure gently stretches the tissues to achieve additional length or depth in your vagina.

The graduated diameters of the dilators in the set are intended to address narrowing of the vagina. Use the smallest one until it’s comfortable, and then move to the next-larger size. We offer a more complete description of how to use dilators on our website.

I also encourage the consideration of vaginal moisturizers and localized estrogen to help keep the tissues healthier and more supple. That in combination with the dilators can give you more comfortable, faster, more lasting results.

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The odor and discharge that you describe sounds most consistent with bacterial vaginosis; it’s not a result of your partner’s medications. This infection is not serious or particularly worrisome, but the symptoms are certainly a major annoyance!

You could first try RepHresh, a product that may alleviate the symptoms by correcting the vaginal pH (you can read more about pH in this recent blog post). Vaginosis can also be treated with an antibiotic, administered orally or vaginally.

Douching is not helpful and can be harmful: It disrupts normal bacteria in the vagina and makes you more susceptible to infection.

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Estrace, or estradiol, is an estrogen that was circulating in your bloodstream, produced by your ovaries, for 40 years or so! Any allergy is likely to be to the “vehicle,” the substance that contains the estradiol as an active ingredient. I assume your reaction was local–in the area where you applied the cream.

An option that may work for you is Vagifem, a bioidentical estradiol in tablet form that you place in the vagina twice a week (usually after starting with daily use for 14 days). Vagifem comes with a very slim applicator to place it in the vagina.

Another choice might be Estring, another bioidentical estradiol in the form of a ring. The ring is placed in the vagina for 90 days and is then replaced.

Take the time to find an option that will work for you!

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Yes, vaginal dilators will help gently and gradually to assure that your vaginal tissues are stretched. I recommend using them one or two times a day for 20- or 30-minute sessions. The more you use them, the more quickly you’ll get the results you’re looking for.

Dilators come in graduated sizes, starting as small as a half-inch diameter and stepping up to 1 3/8-inch diameter. Take your time, and I’m sure your first experience will be a comfortable one! Congratulations.

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Remember that play that premiered a few years back called, “The Vagina Monologues”? Well, I wish someone would write one called, “The Vagina Dialogues” so that women would start to realize that it’s okay to talk with their doctors about their vaginas!

As you know, menopause brings with it all kinds of changes to various body parts, including your vagina.  There’s a very common condition called vulvovaginal atrophy (referred to as VA in the medical world), in which the walls of the vagina become thin, dry, and possibly even inflamed due to a decline in estrogen. (The vulva refers to your external genital organs, including the labia and clitoris.)

Symptoms of vulvovaginal atrophy include:

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

About half of all postmenopausal women will experience some symptoms of atrophy. But often they’ll look at these signs in isolation, not realizing that a urinary tract infection may be directly related to the discomfort they feel during intercourse—and that both might be indicative of vulvovaginal atrophy.

Although treatment is readily available, it has to be diagnosed first. But because women are often too embarrassed to talk with their doctors about vaginal problems, they don’t mention it during annual physicals, let alone pick up the phone when symptoms first concern them.

Instead, they try to treat it themselves, guessing at what might work, not knowing there’s a name for what they’re experiencing. And while over the counter lubricants may offer some short-term relief for dryness, vulvovaginal atrophy is chronic and requires ongoing treatment to address the underlying cause.

Typically, treatment for vulvovaginal atrophy involves some sort of estrogen therapy, in the form of a vaginal tablet or ring or topical cream. But the first step is getting a diagnosis. That’s why it’s so important to talk with your doctor about any changes you experience in your vaginal area.

So please: Don’t be shy and don’t wait. Be proactive and bold when it comes to taking charge of your own body. As with many other parts of life, it’s much easier to maintain healthy tissues and organs than to treat problems long after they’ve begun.

As soon as you feel anything unusual, lubricants don’t seem to work as well, or you begin experiencing any of the symptoms listed above, make the call to your physician. And begin your own vagina dialogues, the sooner, the better.

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What you describe–feeling like your partner is “hitting a wall” when you attempt intercourse, sounds most consistent with vaginismus. A physical exam can look normal; with careful palpation of the pelvic floor muscles, you can feel them tightening, which is what makes the “wall.”

You might go back to your physician with the specific question, “Do my pelvic floor muscles seem too tight?” If that is the case, dilators and/or physical therapy are good solutions. A dilator set will include much smaller sizes–as small as a half-inch–so you can increase your comfort gradually.

Good luck! This is an issue you and your partner can work through.

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Dilators don’t treat vaginal atrophy, but they do help counter a consequence of vaginal atrophy: narrowing or shortening of the vaginal. Used over time in graduated sizes, dilators help to restore vaginal length and width, which we also call vaginal capacity.

The loss of estrogen leads to vaginal atrophy. Using vaginal moisturizers and/or vaginal estrogen helps to restore tissue health. In turn, healthy tissue responds well to the use of vaginal dilators for comfortable intercourse!

It helps to understand the varied effects of a reduction in hormones. You can read the whole story on our website in what we call “the recipe” for continued sexual health!

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