You say your baby was born two-and-a-half years ago, and you still get some soreness in the vicinity of your episiotomy. It would be very unusual this long after a birth for the scar to be an issue. A somewhat common cause of pain, vulvodynia, is often blamed on an old episiotomy scar. It just happens to cause pain near the site of an episiotomy.  Please see a women’s health specialist for a careful history and physical exam to help determine what might be the cause of pain. You don’t need to just live with it ..read more

You’re young and premenopausal, yet you’ve lost genital sensation and some libido. This could be related to medications such as starting a birth control pill, using SSRI/SNRIs (antidepressants), beta blockers, pain meds, or other medications. It would be very helpful to have an exam to make sure this is normal; measuring hormones may be helpful to discern what might be going on. Imaging the lower spine/pelvis can be helpful in a case like yours, as well. A visit to your primary care provider or gynecologist will help you understand and respond to what’s happening! I encourage you to schedule t ..read more

You say your doctor has recommended Premarin vaginal cream (conjugated estrogens) as part of a treatment approach for a prolapsed uterus. You’re hesitant to use a cream with hormones. There are no risks in using a topical estrogen—none. And there are no substitutes, per se. We use localized estrogens in our breast cancer survivors and see no risks of using these products. There is no significant absorption into the blood stream delivering the estrogen anywhere else other than the local tissues it is applied to. I’m not sure of the goal in using the topical hormone cream. It is certainly indica ..read more

You say you “can hardly fit a finger” in your vagina and recognize other signs of vaginal atrophy. This is a very common condition, affecting the majority of postmenopausal women. Unfortunately, this condition is what we call “chronic and progressive,” meaning it will only get worse. You wonder whether you could achieve the same results with lubricants and dilators as with the localized estrogen cream that your doctor recommends. Lubricants typically can help a woman feel more comfortable during intimacy, but they don’t contribute to tissue health (beyond minimizing friction). The use of moist ..read more

You say you’re twelve years past menopause (a full year without menstruating). In menopause the changes to the vulva and vagina are significant, and they are what we call “chronic and progressive,” meaning they get worse over time. The condition is called genitourinary syndrome of menopause (GSM), with impact to the vulva, vagina, and lower urinary tract. This can lead to painful intercourse, the vulvar irritation you describe, and, for some women recurrent bladder infections and urinary frequency and urgency.  If infections and vulvar skin conditions have been ruled out, it’s likely you ..read more

It’s not typical that use of a lube causes a UTI. What is much more likely is the activity of intercourse itself causes UTIs.  Women have a very short urethra, from the outer skin up to the lower bladder, and bacteria can quite easily access the bladder. When you add the changes of menopause—less blood supply and thinner, more fragile tissues—it is a set up for recurrent UTIs in women (with or without intercourse). We refer to this condition as the genitourinary syndrome of menopause, because the changes impact the vulva, vagina, and the bladder; it is directly related to t ..read more

You say you’re 60+ and experiencing vaginal dryness and painful sex. Usually the solution at this point includes localized estrogen. You mention a family history of breast cancer, which is not a contraindication for localized estrogen; we actually use it with breast cancer patients themselves. There are also two very effective non-estrogen prescription options: Intrarosa and Osphena. The laser treatment offered with Mona Lisa Touch is quite effective as well.  Once there is pronounced atrophy and pain, which it sounds like where you are, the use of moisturizers, lubricants, and vibrators ..read more

You say you’re two years past your last menstrual period. You’re healthy and active, and you run, cycle, and swim. You haven’t had hot flashes or other menopausal symptoms of note, other than occasional insomnia and muscle and joint pain after exercise.  You read Estrogen Matters (which I highly recommend; listen to my conversation with the authors here), and you’ve been interested in some of the content here about hormone therapy (HT). You’re considering HT for the protective benefits it offers; in fact, you’ve obtained a prescription but haven’t started the therapy yet. I really support ..read more

You say intercourse is “less than stellar” and suspect that pelvic floor muscle tone may be an issue. The pelvic floor does play a number of important roles in our overall health, as well as our sexual health. A good place to start is with your gynecologist, because a thorough pelvic exam would be helpful. Other factors beyond pelvic floor muscle function can affect intercourse, including your comfort and satisfaction. Other issues can be identified and addressed through that exam. Gynecologists typically have close relationships with pelvic floor physical therapists they can recommend and ref ..read more

Great question. I wish I had a succinct answer for you, but there are a number of factors unique to each individual.  The biggest factor is whether you are pre- or post-menopausal. If you’ve passed menopause (one year without a menstrual period) since last being sexually active, then you may be in a completely “new ball game.” If you are still premenopausal, then you have likely lost nearly nothing in the intervening 12 years.  Any idea on the status of things based on a recent pelvic exam? (Here’s why it’s important to maintain a regular check-in with your primary care provider [PCP ..read more