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Archive for the ‘Questions…and answers’ Category

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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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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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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Yes, shortening of the vagina is a possible consequence of a hysterectomy, and that is clearly what you are describing. You say you were previously using an Estring vaginal ring to address menopausal symptoms; the Estring won’t work for you now, since having it inserted is uncomfortable. Oral HT isn’t an option for you because you’re a breast cancer survivor.

Please don’t lose heart. I’d recommend you consider using Intrarosa, a newer, very effective treatment for postmenopausal atrophy. It is a nightly vaginal insert, non-estrogen. Osphena is another non-estrogen oral option, or you could use a cream form of vaginal estrogen. Any of these is likely to be an effective treatment option, and all of them are considered safe for breast cancer survivors.

Amielle vaginal dilator setAfter restoring health to the vagina, you may then need to use vaginal dilators. Dilators are designed to increase vaginal “capacity,” whether in width or (as in your case) length. A healthy or “estrogenized” vagina should be distensible and elastic to get back the necessary length. Most women are very successful in regaining this function.

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What you describe is an unpleasant (you said “putrid”) odor, almost like ammonia. The odor is worse after intercourse. You wonder if it could be related to an ablation you had over a year ago. Tests for yeast infections and trichinosis have been negative.

Your symptoms don’t sound consistent with an effect of the ablation. A much more rare possibility might be an intrauterine infection following the surgery that is chronic and causing these symptoms, but I rule it out because it would most likely lead to other physical symptoms. An endometrial biopsy would be needed to assess that possibility.

What it sounds like is bacterial vaginosis (BV), which is an overgrowth of bacteria in the vagina resulting in a discharge and odor. It is treated with antibiotics (oral or vaginal). Some women are prone to recurrences; if you are one of them, you may be helped by a product like Balance Moisturizing Personal Wash. You could also consider using ProB, a daily oral probiotic for vaginal health, available over the counter. It contains lactobacilli which are important in maintaining a healthy bacterial balance.

Here’s an overview of vaginal health, which you could consider when you’ve recovered for other ways to keep your pH in balance: Vaginal Health Begins with Bugs.

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