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Archive for the ‘Questions…and answers’ Category

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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The Intensity, which we call a “pelvic tone vibrator,” would certainly not be harmful in any way. There is some clinical evidence that increasing pelvic floor muscle strength and tone may improve prolapse a bit, and it is very possible it may reduce the progression or the prolapse to some extent.

The Intensity adjusts for a perfect fit and then uses electrodes to stimulate muscle contractions to increase tone. It has an additional vibration function, because that, too, increases circulation in surrounding tissues and orgasm is, in itself, great pelvic floor muscle development. (Read more here about how to use the Intensity.) The makers of the Intensity recommend that you be able to insert the Intensity shaft at least four inches for effective use.

Good luck!

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Re-engaging in intimacy is a bit different for each individual, just as everyone’s first experience of intercourse is unique. Some of the “preparation” can depend on the partner, the scenario, the amount of foreplay, and so on, so it’s a bit tough to know exactly when “you are ready.” I hope you can move into this slowly and gently to determine your readiness as you move forward.

An exam by your provider can tell a great deal. How comfortable was your last pelvic exam with speculum placement? I tell women that when I do a pelvic exam and place two fingertips into the vagina comfortably, it is quite likely they will be comfortable with intercourse. Because there are variations in male size and female elasticity, that may not always be 100 percent accurate.

Vaginal lubricantsYou say you’re taking vaginal estrogen, and that should be very helpful to your tissue health. This is a time using an intravaginal vibrator (like the Liv2 or Celesse) may be helpful. Can you insert and use these without discomfort? Having a good lubricant is very important as well. Most menopausal women benefit from a silicone or hybrid lubricant (and this article describes the variety of lubes and how you might select and use one). Some women need to use vaginal dilators to do some stretching of the vagina in advance of intercourse.

I’m so glad to hear you have found someone special to share intimacy!

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You describe two issues, one of which is painful sex and the other is embarrassing sound effects when your partner withdraws. You’re wondering why that happens and whether you can change it.

Vaginal DilatorsI don’t have an absolute solution for your dilemma, but I do have a suggestion that I hope will be helpful. We consider the vagina to be a “potential space”; in other words, the walls of the vagina are usually collapsed but can create “space” when needed – when you insert a tampon, for example, or during intercourse. When the space is created, air can, as you describe, enter and be trapped; the entering object (a penis, during intercourse) forces the air out. If the space is tight, there’s likely to be that sound effect you’ve noticed.

You may consider using vaginal dilators, which gently stretch the vagina, giving it greater capacity in both width and depth. This should both reduce the painful sensation of tightness you experience and the likelihood that air escaping will cause the embarrassing sounds.

I think this is definitely worth trying. Good luck! And in the meantime, remember that sex for everyone includes at least some messiness or awkwardness – and one of the joys of midlife intimacy can be the playfulness of laughing together.

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You say you’ve tested negative for herpes 1 and 2 antibodies, while your partner has tested positive for the herpes 2 virus, though he has not shown symptoms. I don’t find your situation unusual, and it does pose a bit of a conundrum. The reality is that using condoms is the most reliable way to prevent transmission, but in a long-term relationship, I understand that it’s not desirable.

I find that the most up to date and reliable information regarding HSV (and other STIs) is the Centers for Disease Control and Prevention (CDC), which is what I use to counsel patients:

  • HSV can be transmitted when lesions are not present.
  • Anyone with a HSV diagnosis is encouraged to inform current and future intimate partners, and to abstain from sex when lesions or their precursor symptoms are present.
  • Correct and consistent use of latex condoms might reduce the risk of transmission.
  • “Daily treatment with valacyclovir 500 mg decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences. Episodic therapy does not reduce the risk for transmission and its use should be discouraged for this purpose among persons whose partners might be at risk for HSV-2 acquisition.”

What that last point means is that ongoing daily treatment with a prescription for an antiviral therapy by the affected partner can be effective protection to reduce the chances of transmission; “episodic therapy,” meaning the antiviral is taken only in cases of an outbreak of lesions, will not provide that protection.

I hope this is clear! You can have intimacy confidently, and I’m glad you’re researching the steps to take!

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