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Posts Tagged ‘vulvodynia’

The dryness, discomfort, and frequent infections you describe are consistent with vulvovaginal atrophy (now sometimes called “genitourinary syndrome of menopause”) and, possibly, vulvodynia. The mainstay of treatment for these conditions is to “estrogenize”–add estrogen to–the vagina.

It was once thought that all estrogen posed some vascular risk, so I understand the hesitation about continued use for you after a blood clot. More recently, though, localized (placed directly in the vagina rather than taken orally) estrogen has been shown not to raise the risk of thrombosis. Estrogen products still carry the “black box warning,” regardless of the method of administration. About a month ago, though, additional data were presented to the FDA asking them to remove that “class labeling,” since the means of administering makes such a difference. We’ll see what happens, but you can ask your health care provider to reconsider.

In addition to continuing the use of a vaginal moisturizer, you might also use a silicone lubricant (Pink is a favorite at MiddlesexMD). That type of lubricant reduces friction and gives more glide or slipperiness. And you could ask your health care provider to prescribe a topical xylocaine, an anesthetic that you can apply to the area to make you more comfortable during and after intercourse.

Have another discussion with your health care provider, and try all your options! Comfortable sex is possible for you.

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Ouch! That’s a description I hear more often than you think. You’re not alone. Other women also describe the sensation as sandpaper, cutting, burning, or ripping.

When a woman describes that sensation, it’s usually caused by vaginal atrophy, or more likely vestibulodynia/vulvodynia. A careful msmd-features-368x368_yesexam is needed to determine exactly what’s happening; proper treatment can make sex comfortable again.

It’s likely that vaginal estrogen is necessary to make those tissues healthier; that alone may solve the issue. If that doesn’t completely resolve the pain, treatment options for vestibulodynia or vulvodynia should be explored.

The good news is that there is nearly always successful treatment! You can regain the intimacy you’re missing in your relationship.

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The pain that you describe sounds like vulvovaginal atrophy, and possibly vulvodynia (vestibulodynia). These conditions can both be treated, but need the attention of a physician for an accurate diagnosis and treatment plan. Estriol and progesterone, which you say you’re trying, aren’t likely to be of great benefit to you, but localized estradiol is likely to help.

It’s sad at any age to put this important aspect of a marriage aside. And, because, unfortunately, the longer it goes on, the worse these conditions get, I’d recommend a visit to your physician sooner than later. If you’re unsure of your physician’s ability to adequately manage this part of your health, find a Certified Menopausal Provider in your area.

In the meantime, make sure you are using a good lubricant; a silicone lube like Pink is probably going to be most effective for this condition. It’s also important to use a vaginal moisturizer like Emerita.

I’m sure you feel discouraged. Know that I have had patients who have regained the sex lives they wanted! They’ve felt it was worth the effort. Good luck!

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A burning pain upon penetration is a classic symptom of vulvodynia (also known as vestibulodynia). The cause is not well understood, but it’s more common in low-estrogen states–like menopause. The diagnosis is made by a careful examination of the area near the opening of the vagina or hymen; the area appears somewhat reddened and even touching lightly with a Q-Tip will cause discomfort.

I have seen significant improvement with “re-estrogenizing” the vagina, which is done with prescription localized estrogen that is absorbed only in the tissues in that area and does not circulate in significant levels throughout the body. Another successful option has been a compounded (custom-formulated by a pharmacist) topical combination of estrogen and testosterone, applied to the area twice a day for 12 weeks. These two options can also be beneficial in combination.

Finding the right practitioner who is familiar with this condition is critical. A gynecologist will be most helpful, and I recommend finding one who is NAMS (North American Menopause Society) certified and in your area by searching their website by zip code.

It is highly likely that this can be successfully treated and sex will be comfortable again!

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Your description of pain with the vaginal opening makes me think a really careful exam is your next step. It sounds like vulvodynia (also called vestibulodynia) should be considered. This condition results in pain with penetration, usually described as a burning or tearing sensation.

A lubricant can make penetration less uncomfortable, but it doesn’t make it comfortable.

Another possibility is that the absence of estrogen has led to atrophy, resulting in the loss of caliber (size of the opening) of the vagina. If that’s the case, using vaginal dilators may restore size and comfort.

In either case, I’d encourage you to see your healthcare practitioner. Stick with it! I know you can be comfortable and revive your sex life!

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