Archive for September, 2016

You say you’ve had painful intercourse for a few years, and were hoping it would pass. You tend not to want to have sex because the perception of pain outweighs the perception of pleasure. No surprise! And you’re not at all alone, for whatever comfort that gives you.

Once a woman transitions through menopause, she will be postmenopausal for the rest of her life. That means there is no source of estrogen, which results in what we call chronic and progressive vaginal atrophy. The effects of this are increasing vaginal dryness and thinning and narrowing of the vagina. This is not something that will reverse itself over time; without treatment, it only progresses. (I know! This is not something our mothers prepared us to expect!)

You asked. Dr. Barb answered.The majority of postmenopausal women who want to continue to have intercourse need to compensate for the loss of estrogen. The Premarin vaginal cream you refer to using is one option for treatment; it’s a long-term treatment, not a “cure.” It replaces the estrogen your body used to produce, directly in the area where it can have positive effect. This localized hormone treatment is preferred for women whose only issue is painful intercourse. There are fewer risks associated with it than with systemic hormone therapy (called HT or HRT, for hormone replacement therapy), which introduces hormones to more systems in your body.

If your painful intercourse isn’t adequately treated with the Premarin cream, there may be a secondary cause of pain, like vaginismus or vulvodynia. It is important to give feedback to your health care provider to be sure that the sources of pain are properly identified and treated.

It may be that your tissues are now healthy, but because you’ve avoided intercourse you could now benefit from vaginal dilators. Regular use of dilators will gradually stretch your vaginal tissues so that intercourse is comfortable again.

Alas, the sexual enjoyment that came so easily, with so little effort, is now a different story. But I hope you find the efforts of regaining sexual comfort worth the time and energy! I’m privileged to hear from patients about their successes, so I know it can happen!

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You asked. Dr. Barb answered.Yes, exercise helps libido in a number of ways, both directly and indirectly. It improves general health and energy levels. It improves sleep and blood supply. And it improves self-image, too, which can make us feel more desirable and more in touch with our sexual selves.

I recommend that women add Kegel exercises to their exercise habits. Increased muscle tone in the pelvic floor increases orgasm response, as well as keeping our organs where they belong and preventing or minimizing incontinence. It’s a complete win!

So yes, get active or stay active. Your body will thank you.

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You asked. Dr. Barb answered.There are a variety of reasons that sex can be painful after birth. It may be pelvic floor muscles that are still too taut, injured, or spasmed. There may be some nerve damage that is still healing. In those cases, allow time for recovery–and do be in touch with your health care provider if you have questions or don’t think you’re progressing.

If the mother is breastfeeding, there’s can be a reduction in estrogen that contributes to vaginal dryness. In those cases, a silicone lubricant (Pink Silicone is our most popular in this category) can be very helpful.

In any case, I encourage new mothers to be forthcoming in their follow-up medical visits: Returning to a comfortable sex life is, ideally, a part of the new family “normal”! Whether or not your health care provider asks about your sexual health, please bring up your questions or concerns.

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It’s likely that a urinary tract infection (UTI) is coincident with, but not necessarily caused by oral stimulation. Menopause includes the loss of estrogen, which leads to the thinning of urogenital tissues–which include the vagina, vulva, and urethra. Because those tissues are thinner, they can be more fragile and susceptible to “trauma.”

We don’t think of sex as “traumatic,” but the activity can cause minor tissue damage. And sex can introduce bacteria to the bladder via the urethra, which can lead to bladder infections. That bacteria may come from hands, saliva, toys… anything that comes into contact with fragile urogenital tissues during sex.

You asked. Dr. Barb answered.And note that UTIs are often more frequent for women after menopause, whether they’re sexually active or not. You can reduce the chances by using a lubricant during intimacy to minimize “trauma” to tissues. Empty your bladder soon after sex; that may flush out bacteria before they proliferate and become an infection. Therapies like localized estrogen and Osphena, which improve vaginal tissue health (with proper pH and increasing cell layers), also benefit the urethra. And, if you’re prone to UTIs, you may find it helpful to take a dose of oral antibiotic with sexual activity.

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You asked. Dr. Barb answered.The primary reason for loss of the genitals, which includes the clitoris and also the labia minora and majora too, is the loss of estrogen. Levels of this hormone decline with menopause, whether it occurs naturally or because of surgery or other medical treatment. It’s estimated through clinical scanning and imaging that women lose up 80 percent of the volume of the genitals in menopause over time.

Stimulation helps somewhat to maintain the blood supply that’s a contributing factor so the “use it or lose it” phenomenon comes into play here as well as in vaginal comfort. But the primary factor is hormonal. Localized estrogen can also be helpful to maintaining the health of genital tissues.

This is another aspect of menopause that doesn’t get a lot of attention, so it’s not surprising that you’ve been surprised!

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You say you have not been sexually active for several years, and that recently a Pap test was painful to endure. Your doctor diagnosed vaginal atrophy. For reasons of your own health history and your family’s, you’re reluctant to use HRT (systemic hormone replacement, now called HT for hormone therapy).

Vaginal atrophy is a condition we characterize as chronic and progressive. It will not improve on its own and will get more uncomfortable over time. Initiating treatment sooner than later is usually advisable. Many treatments (like vaginal moisturizers) that maintain vaginal health are not effective at restoring vaginal tissues.

If you want to try a vaginal moisturizer as a first step, I’d recommend Lubrigyn Cream as a good option. It contains hyaluronic acid and elastin to maintain and support the tissue structure. We have other options in our shop if you’d like to experiment.

You had to ask. Dr. Barb answered.Localized estrogen–applied vaginally–is among the most effective ways to restore the integrity of an atrophic vulva/vagina. I do understand your hesitation about systemic hormones, but localized hormones don’t carry the same risk factors (it’s an option for breast cancer survivors, for example). And if your only menopause symptom is vulva/vagina-related then a localized treatment option is usually a great choice.

Osphena, a non-estrogen oral, daily treatment, is another prescription option that has been effective for my patients in restoring vaginal comfort. Here’s a blog post I published when it was first approved, and I’ve been using it successfully in my practice since.

You also asked about the MonaLisa Touch treatment, which uses laser treatment to stimulate the vagina to make collagen and develop a new layer of vaginal tissue. I don’t have direct personal experience with it, but have investigated it for my practice and find the research compelling. Pain and side effects are minimal, and the treatment appears to provide relief to 85 to 90 percent of women who have it. Definitely worth discussing with your health care provider!

Your age seems to be young to consider never experiencing a normal sex life again! (I admit that my threshold for expectation rises with my own age, but more treatment options are available each year.) With some effort, I’m quite certain you can revive that part of your life.

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I think the Prevaleaf products are likely a good option for you. The Oasis Natural Daily Vaginal Moisturizer is paraben- and fragrance-free, as well as pH-balanced for the vaginal environment. Regular use is key to healthy tissues, which typically means less irritation.

Because you mention burning sensations after application, you might also like Soothe Natural Vaginal Soothing Cream. Like the moisturizer, it’s made with natural ingredients; it’s formulated for rapid absorption.

You asked. Dr. Barb answered.Your complaint of burning suggests the possibility of vulvodynia, a condition that results in burning pain with intercourse; anything that comes in contact with the area (near the opening of the vagina) can be experienced as burning or irritating. A careful pelvic exam can help  determine if you have “simple” vaginal (or “urogenital”) atrophy or vulvodynia. If the former, the Prevaleaf products should be helpful and well-tolerated; other options might be explored if it’s the latter.


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