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You say that you have that sensation even though you’ve had Mona Lisa treatments [a procedure for restoring vaginal tissue] and use Uberlube, and that sensation continues for a couple of days after intercourse.

It’s possible you could have one of three conditions: atrophic vaginitis, vulvodynia, or a urinary tract infection (UTI) caused by intercourse.

The Mona Lisa Touch therapy doesn’t completely take care of atrophy for some women, and you might be one of them. If so, there are safe and effective prescription therapies available, and it may be helpful to add one of those.

Vulvodynia happens when the entrance of the vagina becomes inflamed, causing burning pain during and after intercourse.

Finally, in some women intercourse itself actually causes a UTI, a bladder infection that causes the symptoms you describe.

Those are the most likely possibilities, but please talk to your provider about what’s going on. She or he can determine the cause and recommend the best course of treatment for you–and there is treatment for each option.

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This is your life—you deserve to get what you need from your doctor. If you aren’t getting your questions answered when you go for an appointment, what’s the point of being there? Right? Your physical and emotional well-being are important, and if both of those needs are not being met at your doctor’s office, you may need to speak up or make some drastic changes—maybe even both.

Women need to feel entitled to care for themselves.

Think of it this way: If your car needed repair, you wouldn’t take it to just any random mechanic to be fixed: You’d ask your friends for referrals, you’d check online reviews, and you’d have a conversation with the mechanic to be sure he or she can communicate with you about what repairs are required and why.

You should expect at least as much from your health care provider as you do your mechanic. When you leave your appointment, you should honestly feel that you were able to discuss your concerns openly and get your questions answered. If not,  you can empower yourself to get what you need from your current provider or find a new one.

So, here are eight signs that you may not be getting what you need from your current health care provider and might need to start shopping around:

  1. You are being treated like a man. It’s no secret that, in the past, medicine has been dominated by men. Drug trials using animals were typically done with all-male specimens, and clinical trials were done using—you guessed it—all male candidates. So it’s no surprise that dosage amounts for drugs have been based on the “average male.” The good news is that researchers are now changing gears and looking at how both men and women react to various drugs, treatments, diseases, and side effects. The bad news is that the gender divide lingers. If you don’t feel like you are being heard, and your doctor is talking to you like a bowling buddy or a fragile flower, he or she is probably not sensitive to your needs as a woman.
  2. You wait weeks (maybe even months) to get an appointment. While this may mean that he or she is an excellent physician, it really doesn’t do you any good if you can’t get in the door. If she or he has such an extensive patient list and you aren’t a priority, it will be in your best interest to look for someone else. The same is true if you have to wait an hour (or two) every time you see the doctor or you have to call five times to get your test results.
  3. Your doctor is uncomfortable talking about certain topics. If you have questions about topics like sexual intimacy, bowel movements, or sex toys, and your doctor is reluctant to discuss any of them, your appointment may be a waste of your time. If you can’t be honest with your physician, your level of care may be compromised. You may be reluctant to name over-the-counter supplements your doctor’s implied are foolish, which could mean your doctor can’t fully assess interactions with your prescribed meds. If you find yourself leaving your appointments with too many unanswered questions, it might be time to make a change.
  4. Your doctor writes you a prescription before you finish your first sentence. If you are in the examining room for only two minutes and the doctor already has paper and pen in hand, beware! Sometimes, in the press of time and the desire to provide a solution, a doctor will short-change the conversation that leads to a confident diagnosis.
  5. Something just doesn’t feel right. It can be something as simple as a personality conflict or a communication style. It’s okay to trust a feeling of discomfort you have. If you’re not comfortable in the relationship, you’re less likely to be as open and honest as you need to be to forge a strong patient-physician partnership for managing your health.
  6. The office staff makes your life difficult. Are you on hold for 20 minutes (or more) when you call the office? Is the office staff rude when you finally get through? You deserve to be treated better than that! First, describe your experience to your provider; he or she can’t solve the problem if it’s invisible to them. If things don’t improve, decide whether dealing with the office is making you avoid addressing health issues—and if it is, consider alternatives.
  7. Your doctor talks down to you. Your questions are valid and important. The last thing you need when seeking care for a problem is condescension. If it’s implied that you’re not likely to understand your own issues and treatment, assert yourself and remind your doctor that you are ultimately your own health manager.
  8. Your doctor likes to work alone. Especially if you are a complicated case, your doctor may need to coordinate with your other health care providers. If he or she is reluctant or won’t communicate with others involved with your care, it may be time to make a switch.

Going to your doctor may never be “fun,” but it doesn’t need to cause you added stress and anxiety. If you don’t feel like you’re getting the care you need—including for symptoms of menopause— from your health care provider, ask yourself if you need to make a change. It may be the best thing you could do for yourself—and you do deserve care!

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There aren’t surgical options to restore genital sensation.

Exercise is a critical component of overall wellness (see this blog post on the topic). Exercise improves energy and self-esteem, releases helpful hormones, and does more that translates into improved sexual health and function.

Hormone therapy absolutely improves loss of sensation. The genitals have more estrogen receptors than any other area of the body, which means that the impact of estrogen is greater in the genitals than in any other area of the body! So especially in menopause (or other times of low estrogen), hormones are a big ingredient of sexual function. Testosterone is an important hormone for arousal and orgasm as well. You asked whether estrogen or testosterone “matters most”; while it’s hard for me to choose, I incline toward estrogen. I usually start patients with estrogen and add testosterone if it seems necessary or appropriate.

That said, we know a loss of sensation is a natural part of aging, as well as with chronic diseases such as heart disease or diabetes, and it can be a side effect of medications. That means for each individual, countering that loss is a bit more complex than a single simple answer. For many women, vibrators work wonderfully to heighten sensation. Warming lubricants also increase sensation; they have minty or peppery ingredients that stimulate circulation.

It’s worth trying a few options to see what works for you!

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You say that penetration is becoming increasingly difficult, although you’re using lubricants. This is normal progression: In the absence of estrogen due to menopause, our genitals atrophy. The vulva and vagina get smaller, the vagina narrows, there’s a significant loss of volume of the genital tissues, including the clitoris. There are fewer folds in the vagina (I’ve talked about a transition from a pleated skirt to a pencil skirt to give an idea of the change in elasticity). The tissues become thin, pale, dry, and fragile, and the pH level changes.

Vibrators

These changes are what we in medicine consider to be “chronic and progressive,” so without treatment, there’s no question that the changes will continue. The most basic “treatment” is regular sex or external and internal use of a vibrator (if you don’t have an available and willing partner), which improves blood supply to the area and restores some comfort and tissue health. Using a vaginal moisturizer daily or at least twice a week can also help somewhat to keep tissues healthy.

There are also prescription therapies that are designed to really reverse the atrophy. They are all very effective. They include localized estrogens, the oral non-estrogen Osphena, and now, the newest, the non-estrogen daily vaginal insert Intrarosa. A discussion with your health care provider would be very helpful to determine next steps.

Sometimes the use of dilators can be helpful to stretch the vaginal tissues to maintain capacity. But without prescription treatments like those listed above or, possibly, systemic hormone therapy, the tissues are not very elastic, which limits the degree of stretch you can obtain.

With some investigation and follow-through, you can “keep the shop open”!

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Many of the intravaginal moisturizers (like the Lubrigyn you mention) will correct or “normalize” the vaginal pH. (An atrophic vagina has a more “basic” pH, and a healthy vagina is more acidic.) Use of a moisturizer will cause a transition of the pH to a more health status, which is a shift of bacteria; you’ll end up with more lactobacilli, which is a good thing.

Vaginal moisurizersBut whenever we make a shift, the time of transition is a bit of risk for a yeast infection. This is not an adverse effect of the product, but more likely indicates that it is making a difference. Go ahead and treat the yeast infection, and I’d recommend continued use of Lubrigyn. This shouldn’t be a recurrent event once tissues are healthier.

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If the title of this post pulled you in, you’re likely part of the almost 50 percent of women aged 40 to 64 who have sleep problems. I’m sorry you’re a part of this club, but welcome! Sleep has been in the news a lot since—well, for as long as I can remember. It affects everything from mood and willpower to productivity and relationships. We all know how hard it is to gin up enthusiasm for romance when we’re sleep deprived.

Sleep also has implications for long-term health. Research shows that not getting enough sleep can lead to serious issues like diabetes and cardiovascular disease and a weakened immune system.

The evidence that we should make sleep a priority is pretty compelling. Perhaps you took the advice of our recent post on good sleep hygiene, and you have been going to bed at the same time every night, avoiding food, exercise, and alcohol several hours before bed, and keeping your bedroom cool and dark. Well done!

But if you’re still reading, those good habits may not be paying off for you. There are few things more frustrating to my patients than knowing all the reasons good sleep is important, following all the advice—and still not getting good sleep.

If you’ve tried all the normal ways to fix your sleep problems, and you don’t want to try medication, you might want to experiment with natural remedies.

As I’ve said before, herbal supplements are generally considered foodstuffs in the U.S., so manufacturers don’t have to conduct clinical studies about their efficacy or side effects. I can’t necessarily vouch for them, but few are known to be harmful. Some patients report one supplement or another has worked for them, and maybe one of them will work for you, too.

If you do want to try one, first consult with your doctor to make sure it’s safe for you, given your health and the medications you’re taking. I also recommend that you keep a sleep journal for a week before you begin and for 12 weeks after. Make a note of sleep hygiene factors, too, like when you ate and exercised and put away screens for the night.

Melatonin is a hormone that regulates when we sleep. When melatonin levels rise at night, body temperature falls and we feel sleepy. Melatonin seems to be most effective at helping people fall asleep rather than stay asleep. Calcium aids in the production of melatonin, which may be why some people find that drinking a glass of warm milk before bed makes them sleepy.

L-theanine is an amino acid that increases brain chemicals that are calming and reduces brain chemicals linked to stress and anxiety. Rather than acting as a sedative, L-theanine can improve the quality of sleep by lowering anxiety. It’s most often found in tea but can be bought in the form of supplements.

Valerian is an herb. Valerian root is thought to reduce anxiety by acting as a sedative, but research results on that have been mixed. It may help you fall asleep more quickly and improve the quality of your sleep, but you might need to use it every day for up to four weeks before it starts to help.

Magnesium is a mineral. Most adults get enough of it through their diets (leafy green vegetables, nuts, and whole grains are good sources), but it might affect the sleep of those who don’t; magnesium deficiency has been linked to higher levels of anxiety, which interferes with sleep. If you suspect you are low on magnesium, eat more of the above. Magnesium supplements often don’t play nicely with medications.

Lavender

Lavender is a popular natural sleep remedy. Many people say just the smell of it relaxes them and makes it easier to sleep. There is some research that shows that taking lavender oil by mouth for 6 to 10 weeks reduces anxiety and improves sleep.

Lavender—or any of the natural remedies above—may really work for some people. Or perhaps it’s just the placebo effect. If something is safe and it helps a patient get better sleep, I don’t care much about whether it’s “real” or placebo. And I suspect that you don’t, either.

Have you tried any of these or another that we haven’t included? I’d love to hear what’s working for you!

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You say you’re using a vaginal suppository for vaginal moisturizing; the product you’re using contains illipe butter, coconut oil, vitamin E oil, apricot oil, meadowfoam plant wax, and carnauba plant wax. If you’re tolerating this product well, and it’s working for you, great!

Vaginal moisturizers

It’s hard to determine in advance which products will work for which women. For some women, oils can be somewhat occlusive and cause tissue breakdown. For others, oils increase risk of vaginal yeast infections. Other women can be sensitive to specific ingredients, like coconut and certain fragrances.

Feel comfortable with what works for you, and keep in mind that your body changes over time, too—which may mean you’ll need to rethink your routine.

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