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Archive for the ‘Questions…and answers’ Category

The Intensity Pelvic Tone Vibrator works in two ways: It has electrodes that stimulate the muscles of the pelvic floor, causing them to contract and therefore strengthen. The vibration feature of the Intensity, which you can control separately, improves pelvic floor muscle tone the same way any vibrator does: They all help the user to experience orgasm, which is intense contractions of the pelvic floor. Those contractions, whether from the electric pulses or orgasm, improve muscle tone, just like flexing your bicep does. The contractions also increase blood supply to the pelvis, which improves function and sensation, too.

Yes, orgasm is good for muscle tone! And improved muscle tone can strengthen future orgasms, as well as holding organs in place and preventing or minimizing incontinence. I guess I’d call that a virtuous cycle.

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You asked. Dr. Barb answered.There are plenty of bioidentical pharmaceutical hormone options to treat menopausal symptoms. Over 90 percent of my hormone therapy patients use these, and most physicians who treat menopause are familiar with the options. There are brand name and generic products available; to list some of them: Estrace, Vivelle, Minivelle, transdermal estradiol, Prometrium, micronized progesterone.

You also mention weight gain. I hope you know you’re not alone! We had a series on this topic this summer that may be of interest to you: an overview of the reality, how you can respond with diet alterations, and how exercise can play a part.

If you need a provider who focuses on menopausal treatments you can find one on the NAMS website (North American Menopause Society) at this link. Enter your zip code and a list of nearby providers will be listed.

Good luck!

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You ask whether there’s effect on your pH level from swimming several times a week in a chlorinated pool and whether inserting a tampon would provide some protection. The vagina is, in its natural state, not an open space but collapsed, that is, the walls are lying next to each other. Imagine a balloon before it is blown up. We refer to the vagina as a “potential space,” because space is made there only when needed—for a tampon, childbirth, or sex.

The vaginal pH isn’t disrupted with a relatively brief swim or tub bath. Inserting a tampon actually would be more likely to act as a wick, introducing more chlorinated water because of its absorbency.

Chlorinated water certainly can affect the vulva and surrounding skin; I do hear that from a number of patients. In that case, be sure to rinse thoroughly after swimming, and then apply a product like Lubrigyn Lotion (available in wipes, which you can put in your bag to take to the pool) to soothe by moisturizing.

 

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There are many reasons women may have pain with sex, so I can’t be certain of the specific cause for your wife. A pelvic examination by her health care provider is needed to determine the cause and therefore the proper treatment.

That being said, the most common cause of painful intercourse in perimenopause (the phase before menopause) or post-menopause (beyond the year after the last menstrual period that marks menopause) is due to the reduction or loss of estrogen and the atrophy or dryness that result.

You asked. Dr. Barb answered.Using a vaginal moisturizer regularly, two to three times a week, is a great place to start; if the atrophy is not advanced, restoring moisture to the tissues may help. Using a silicone lubricant with sex may help, too. I recommend Pink, which is very slippery and, because it has Vitamin E and aloe, it’s soothing, too. If there’s been some vaginal narrowing in the process of atrophy, vaginal dilators can be helpful, too, by gently stretching the vaginal tissues.

I hope this is helpful, and encourage you and your wife to pursue a medical evaluation to enhance her chances of regaining comfort! There may be a physical issue that needs addressing, and there are also prescription-only products available to address her symptoms. For a practitioner focusing on menopause care, I recommend the North American Menopause Society’s practitioner finder.

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You say you’re four years past menopause, and in addition to hot flashes and other symptoms, you have dryness and have had vaginal atrophy—a decrease in the size of your vaginal opening. This is a classic symptom of genitourinary syndrome of menopause (GSM, earlier called vulvovaginal atrophy). Without estrogen, the vaginal tissues become thin and fragile, and the vagina can shorten and narrow.

Vaginal moisturizers, which you say you’re using, are of some benefit. They’re better at prevention, though, started during perimenopause or early in menopause; once atrophy is advanced, they’re less helpful and may be irritating, as you’ve experienced.

You asked. Dr. Barb answered.The most likely effective treatment is localized estrogens (cream, ring, or tablet) or something like Osphena (oral and non-estrogen) or Intrarosa. You say you like to avoid chemicals, and I understand that; estrogen is a natural chemical, and the local application is to replace what your body used to produce naturally in the way that has the fewest side effects. Osphena and Intrarosa work like a hormone, even though they aren’t one. These are all prescription therapies, and a necessary component of your plan to counter the effects of vulvovaginal atrophy, which is chronic and progressive.

Once the tissues are healthier, you may need to use vaginal dilators to regain increased “capacity” (patency, in medical terms) of the vagina.

Whenever there is pain involved, that problem needs to be addressed first; once you’ve achieved physical comfort, you may find a sex therapist helpful if issues remain, as your gynecologist suggested. In the meantime, no one should blame you for not wanting to have painful sex!

A number of the things you say are very familiar to me: you’ve had plenty of natural lubrication and you’ve never had issues with intercourse. The unfortunate reality is that menopause changes the game, more dramatically for some of us than others. What was true for the younger you is no longer the case (ask me about menopausal weight gain!). But! I know how important intimacy is to relationships, and if you’re willing to make the effort, it’s almost always possible to regain function and comfort again.

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You say your wife has lichen sclerosis and uses Estring, a ring placed in the vagina to provide localized hormones; she has difficulty doing Kegel exercises correctly.

You asked. Dr. Barb answered.The Intensity is very effective at contracting the pelvic floor muscles, which is does with electrical stimulation through specially designed electrodes. Contracting the muscles builds muscle tone, and it sounds like you and she are aware of the benefits of pelvic floor strength: keeping organs in their places, preventing incontinence, and strengthening orgasm.

The lichen sclerosis should not be a limitation in using the Intensity. Because the electrical stimulation works best if the Intensity is expanded for full contact with the walls of the vagina, it would work best if she slips the Estring ring out before using the Intensity, and reinserts it after. Otherwise the ring will prevent full contact and limit the effectiveness of Intensity use.

I hope this is helpful!

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You asked. Dr. Barb answered.You say you’re looking for clitoral stimulation, and options you’ve tried are either too intense or have too small a surface–or both. My personal favorite and a top seller for MiddlesexMD is the Siri2, which is rechargeable. It has patterns as low as a soft flutter but a range wide enough for most midlife women. (I’ll admit I got mine before Lelo added the option to sync to the beat of nearby music.) A less expensive option is the Kiri, which is battery operated but still plenty powerful. It has 16 different speeds and six patterns.

Both of these options are shaped specifically for clitoral stimulation, with broad curved surfaces that I suspect you and your partner will find more satisfying than the shape you described.

Enjoy

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