September 23, 2016


Q: Is there an alternative to HRT to combat vaginal atrophy?

You say you have not been sexually active for several years, and that recently a Pap test was painful to endure. Your doctor diagnosed vaginal atrophy. For reasons of your own health history and your family’s, you’re reluctant to use HRT (systemic hormone replacement, now called HT for hormone therapy).

Vaginal atrophy is a condition we characterize as chronic and progressive. It will not improve on its own and will get more uncomfortable over time. Initiating treatment sooner than later is usually advisable. Many treatments (like vaginal moisturizers) that maintain vaginal health are not effective at restoring vaginal tissues.

If you want to try a vaginal moisturizer as a first step, I’d recommend Lubrigyn Cream as a good option. It contains hyaluronic acid and elastin to maintain and support the tissue structure. We have other options in our shop if you’d like to experiment.

You had to ask. Dr. Barb answered.Localized estrogen--applied vaginally--is among the most effective ways to restore the integrity of an atrophic vulva/vagina. I do understand your hesitation about systemic hormones, but localized hormones don’t carry the same risk factors (it’s an option for breast cancer survivors, for example). And if your only menopause symptom is vulva/vagina-related then a localized treatment option is usually a great choice.

Osphena, a non-estrogen oral, daily treatment, is another prescription option that has been effective for my patients in restoring vaginal comfort. Here’s a blog post I published when it was first approved, and I’ve been using it successfully in my practice since.

You also asked about the MonaLisa Touch treatment, which uses laser treatment to stimulate the vagina to make collagen and develop a new layer of vaginal tissue. I don’t have direct personal experience with it, but have investigated it for my practice and find the research compelling. Pain and side effects are minimal, and the treatment appears to provide relief to 85 to 90 percent of women who have it. Definitely worth discussing with your health care provider!

Your age seems to be young to consider never experiencing a normal sex life again! (I admit that my threshold for expectation rises with my own age, but more treatment options are available each year.) With some effort, I’m quite certain you can revive that part of your life.

September 19, 2016


Q: What moisturizer would you recommend if ingredient sensitivities?

I think the Prevaleaf products are likely a good option for you. The Oasis Natural Daily Vaginal Moisturizer is paraben- and fragrance-free, as well as pH-balanced for the vaginal environment. Regular use is key to healthy tissues, which typically means less irritation.

Because you mention burning sensations after application, you might also like Soothe Natural Vaginal Soothing Cream. Like the moisturizer, it’s made with natural ingredients; it’s formulated for rapid absorption.

You asked. Dr. Barb answered.Your complaint of burning suggests the possibility of vulvodynia, a condition that results in burning pain with intercourse; anything that comes in contact with the area (near the opening of the vagina) can be experienced as burning or irritating. A careful pelvic exam can help  determine if you have “simple” vaginal (or “urogenital”) atrophy or vulvodynia. If the former, the Prevaleaf products should be helpful and well-tolerated; other options might be explored if it’s the latter.


September 15, 2016


Q: How can I boost my desire and arousal?

You asked. Dr. Barb answered.You say you find your partner attractive, you have a good relationship, and your gynecologist gives you a clean bill of health. And yet, you’re having trouble getting aroused. This is the exact situation for which the Fiera Arouser for Her was designed. It’s not a vibrator; you use it as “before-play”; the gentle suction and vibrations increase blood flow to your genitals, which increases responsiveness--and lubrication, as well.  

Another consideration may be Stronvivo, a nutritional supplement that has been shown to improve sexual function for women (and men), including improved libido/desire and ability to arouse and orgasm.

Some women with libido concerns benefit from supplementing testosterone. This requires an assessment and monitoring from your physician or nurse practitioner, since it’s prescription only. Use of testosterone in women is considered “off label”, or non-FDA approved, and not all practitioners are willing to prescribe it for their patients.

At the same time, you say you’re experiencing less moisture. This is critical to address, because painful intercourse is, of course, not an incentive to desire! There are varieties of lubricants that can add playfulness as well as immediate increased comfort; regular use of a vaginal moisturizer can help you through perimenopause.

The Fiera may be your best bet. I do know this issue can test relationships, and wish you the very best in finding a way forward! Be assured it’s possible.

September 12, 2016


Q: How can I enhance intimacy with my partner?

You asked. Dr. Barb answered.You describe your partner’s penis as “smaller than most,” and wonder how to enhance your intimacy--especially intercourse. A reminder, first, that foreplay, which is helpful to both your arousal and lubrication, is an often undervalued part of intimacy. Assuming that you’re taking full advantage of what that “warm-up” has to offer, there are additional things you can try. The We-Vibe is a “couple’s vibrator” that was designed specifically to help in this kind of situation. It nestles in place to provide additional stimulation (both clitoral and internal) during intercourse.

You can also try using an internal vibrator, which you or he can use as part of your play together to provide the feeling of fullness some women prefer to experience orgasm. Both the Celesse and the Gigi2 are specially shaped for G-spot stimulation, if that’s an issue for you.

And I do hope that both you and your partner are open to the reality that for humans, sexual pleasure takes many forms! With some exploration, I’m sure you can assure that you’re both satisfied--and comfortable with yourselves.



September 08, 2016


Q: Is it normal to have cramping after intercourse?

While this isn’t common, it does happen. It’s usually attributed to semen. Semen contains prostaglandins (PGs), and PGs cause uterine contractions or cramping.

You asked. Dr. Barb answered. You can test this theory by using a condom with intercourse a couple of times to see if you still experience the cramping. The condom keeps the semen from the cervix, which should reduce reaction. You can also use withdrawal, removing the penis before ejaculation.

You can also try taking ibuprofen or Aleve before intercourse; these are anti-prostaglandin medications that can ease the cramping as well.

I hope one of these approaches works!



September 06, 2016


Q: What vibrator do you recommend for a first-time user?

You say you don't currently have a partner, and were diagnosed with premature menopause before your last relationship ended. I’m with you on hoping for another romance in your future!

You asked. Dr. Barb answered.In the situation you describe, the best vibrator is one you can use internally (place inside the vagina). This will improve blood supply to the vagina and surrounding tissues and keep the vagina patent (medical term for open) and more elastic, until you have a partner. Probably the best designed vibrator for this would be the Liv2 or the Raya. The Liv2 is rechargeable and has a bit more intensity in its vibration (important for post-menopausal women), but either could work well. These vibrators can also be used externally, in direct contact with the clitoris, as well as internally.

Along with these you’ll want to use a water based lubricant. Any of these could work well for you; our most popular are Yes WB and Almost Naked.  

You mentioned that you’re also using Vagifem as a localized estrogen. It’s a good idea to continue that for vaginal tissue health. And I’m so glad you’re putting the effort into maintaining and regaining sexual health! 

August 29, 2016


A Promising New Treatment for Vaginal Dryness

There may be a Santa Claus after all, Virginia.

Of all the menopausal afflictions, vaginal dryness (or genitourinary syndrome of menopause—GSM—in medicalese) is the most pervasive. Virtually all of us will experience GSM to one degree or another, either due to menopause, hysterectomy, breast cancer, or some other hormone-disrupting event. Some of us will suffer from GSM to such an extent that sex or even a gynecological exam is impossible.

Yes, lubes and creams help. Estrogen replacement helps a lot, but not all women can or want to use hormones (especially if they’re breast cancer survivors, although localized estrogen has been confirmed safe). And there’s Osphena, a new nonhormonal drug that has proven effective. Still, nothing beats that firm, moist tissue we took for granted at 30.

Enter the MonaLisa Touch. With a name like that, you might hazard a guess that it was developed in Italy, and you’d be right. (I’ll never view that enigmatic smile in the same way again.) The procedure has been available in Europe and South America for a while and was recently approved for use in the US by the Food and Drug Administration.

The MonaLisa Touch is the same type of laser abrasion used to rejuvenate facial skin but repurposed for vaginal tissue. (This should not be equated with cosmetic surgery, however.) It’s a laser treatment that creates small lesions and removes a surface layer of dry vaginal cells. This causes the vagina to make collagen and stimulates the mucus membranes. A new, moist, healthy layer of tissue then develops.

Voilá!  A 30-year-old vagina.

Wait a minute, I can hear you say: What about side effects? What about risks? Is this procedure appropriate for everyone?

Dr. Barb DePreeWell, that’s the thing. The procedure appears to be safe and appropriate for women suffering from GSM, painful sex, mild urinary incontinence, and/or frequent urinary tract infections. Pain and side effects are slight—maybe one or two days of redness or soreness. It’s an outpatient procedure done with no or very little anesthetic.  Results have been promising with 85 to 90 percent of women experiencing relief, sometimes almost immediately and sometimes significantly. “This is as close to the best result a medical treatment can achieve,” says Dr. Cynthia Krause, ob/gyn and assistant professor at the Icahn School of Medicine in New York City.

The procedure is straightforward, involving three laser treatments performed at six-week intervals. While many women experience relief quickly, the full effect may take up to six weeks after the final treatment. Laser treatment of vulvar and external vaginal tissue may also help with urinary incontinence and UTIs. Following that, an annual “touchup” may be required.

So, what’s the catch?

Well, for one thing, the procedure is new. While short-term studies are very positive, long-term data on side-effects or efficacy simply isn’t available. For another, it’s the cash. Since the procedure is new, most insurance companies won’t cover it, although that may change as the treatment becomes more mainstream. Cost varies depending on the region, but ranges from around $1500 to almost $2000 for the three required treatments.

Still, many women are thrilled with the chance to enjoy pain-free sex with their honey again, not to mention the freedom from a painful, burning, itching bottom. Like any treatment, however, there are no guarantees. Not every woman experiences the same result.

Still, for many women who suffer from the sexual difficulties and pain of GSM, the MonaLisa Touch is definitely worth looking into.  




August 15, 2016


Never Gonna Say Goodbye (to Sexuality)

You eat right. You exercise. You meditate. You read interesting books.

But if you’re neglecting your sexuality, you’re not as healthy as you could be. Plus you’re missing out on plenty of fun–and perhaps even a little taste of heaven.

Yes, sex can be good for you–even if it’s alone. Here’s why:

Sex is great exercise.It helps you relax. With sex, important hormones and neurotransmitters rise and fall, especially dopamine and oxytocin. There’s research showing sexual intercourse can lower blood pressure for women. And having an orgasm could even improve your sleep, thanks to the hormone prolactin.

It sparks your libido. Sex is a use-it-or-lose-it proposition. Having sex increases vaginal lubrication, blood flow and the elasticity of your vagina, all of which adds up to craving more of the same. On the other hand, women who don’t have sex can lose their vaginal patency.

It perks up your immune system. Yup. A study from Wilkes University in Pennsylvania said college students who had sex once or twice a week had higher antibodies than their peers. Okay, maybe you’re past your college years, but it’s worth a try, right?

It could improve bladder control. Kegel exercises give your pelvic floor muscles a workout, but so do orgasms. I recommend both.

It’s great exercise. Not only will you burn calories (calculate how many), but sex also raises your heart rate, and it keeps your estrogen and testosterone levels balanced, all of which helps to ward off heart attacks and osteoporosis.

So here’s the question: What if you haven’t had sex for weeks, month or even years? Is it too late to reap the benefits?

No. It’s not too late, even at our age.

Recently I wrote about a patient I’ll call “Sue,” who was in a new relationship after nearly 20 years of celibacy.

No. It's not too late.“My body had definitely changed since 1997,” wrote Sue. “I would encourage anyone facing any type of sexual challenge… don’t give in to the shame that would try and make you hide from your issue. Sexual intimacy is so precious and valuable to a marriage that it’s worth the discomfort (physical and emotional) it takes to press through.”

If, like Sue, you’re ready to “wake up” sexually, start by finding a supportive, experienced menopause specialist who can help you get on the right path. You’ll find that hormones (systemic or localized), moisturizers, vaginal dilators, and personal vibrators are all helpful on this journey.

To make it easier to get your hands on helpful products to revive your sexuality, we've sought out high-quality, effective products for our shop. It’s a confidential, reliable way for you to experiment (and have fun) while improving your overall health.

What could be better?



August 12, 2016


Patience. Persistence. Prayer. And Passion!

I’ve been writing about the use-it-or-lose-it phenomenon and the fact that sexually inactive women are in danger of losing their ability to enjoy a physical relationship after menopause if they take a long break from sex, whether it’s with a partner or from self-stimulation.

Now, I’d like to introduce you to Sue (not her real name), a patient of mine who had a hysterectomy in her 20s, was widowed in her early 40s, and had the good fortune to fall in love again at age 59.

A petite, attractive woman, Sue had no idea how much her genitals suffered from lack of attention for nearly 20 years. During her first office visit, I could barely insert a Q-tip® in her vagina, yet I wanted her to know there was hope for her future if she was willing to do the work needed to “wake up” again sexually.

Intercourse isn't the only way to create intimacy with your partner.Sue wrote: It was a very difficult thing to tell my future husband, but he responded with such understanding and compassion. Instead of feeling embarrassment and shame, I was comforted and strengthened by his assuring me that no matter the outcome, it didn't change his feelings for me or his intentions for our relationship. If anything, the whole process has only served to deepen and strengthen it. Being believers, we trusted that just as God had miraculously brought us together, He would see us through to a satisfying and pleasurable sex life.

I prescribed Osphena and vaginal dilators for Sue, then saw her several times as she prepared to consummate her marriage. Her condition didn’t change overnight, so although she and her new husband were physically affectionate as newlyweds, they were unable to actually have intercourse until several months after their wedding.

Sue’s husband Bill (also not his real name) wrote: What did happen during our first 7 months of marriage was truly a miracle… we connected emotionally, physically, spiritually…. I would not trade that time of growth and intimacy for anything. We will have this deep and priceless quality of sexual intimacy the rest of our married lives. It has been the foundation of our love, our joy, our story.

I especially appreciate Bill’s emphasis on intimacy. And it’s a good reminder that intercourse isn’t the only way to create intimacy with your partner.

Thankfully, Sue and Bill had the right mix of patience, persistence and prayer to create the passionate relationship they both desired.

Bill added: We now have a fully pleasurable and intimate marriage bed and it’s terrific. Sue is an amazing, wonderful, fabulous lover. But more importantly, she is truly my dearest friend and confidant. I love her with all my heart.

Be persistent. Have patience. Pray or meditate.Here’s my advice: If physical symptoms are keeping you from being your sexual self, find a menopause specialist who can help you again enjoy the pleasure and other benefits of sex. Know that it will take time. Be persistent. Have patience. Pray or meditate, remembering that spirituality can help keep you balanced. And keep your sense of humor because, yes, there will be awkward moments.  

Will it be worth your time and effort? You bet. In my next blog post I’ll talk about the health benefits of being sexually active.



August 09, 2016


Getting Your Groove Back after a ‘Dry Spell’

There are many reasons that women may go months, or even years, without engaging in any kind of sexual activity. She may be without a partner. Or she may be in a relationship where the sizzle has fizzled–her husband or partner is more like a roommate than a lover.

You may be in a relationship where the sizzle has fizzledAs a side note, I think there’s an epidemic of peri-menopausal and menopausal women who have given up on sex as their bodies change and their priorities shift. Sadly, losing intimacy in a marriage can lead to or exacerbate the distance between two people. I suspect that a number of late-in-life divorces happen because of that loss. 

As a friend recently said, “In many relationships, sex is the glue that binds a relationship together.”

I often remind my patients about the use-it-or-lose-it fact of life: If you’re sexually inactive, your body can have some unpleasant surprises for you when you try to be sexual again. Doctors call that losing vaginal patency. (Patent means “open” in the medical world.)

This can happen especially quickly after surgical menopause as your hormone levels decrease, making the tissues of your vagina thinner and more fragile, with less circulation to those tissues. And if your vagina isn’t having any stimulation, those changes will happen more rapidly.

Don’t give up!

Most women can get their “groove” back with the right regimen of vaginal treatments along with patience and persistence.

Last year, I saw a patient (I’ll call her Sue) who had a hysterectomy in her late 20s, then was widowed at a young age and not in any sexual relationships for nearly 20 years. At age 59, a spark was kindled and she fell in love again. I asked Sue if she’d be willing to have us share her story, and am very grateful that she not only agreed, but provided correspondence from her husband as well as herself.

Most women can get their groove backWhen Sue first came to see me, the situation in her nether region was pretty grim. I could barely insert a Q-tip® into her vagina. Her vaginal moisture was non-existent and while she thought she had entirely lost her sex drive, the new romance had revived it. Yet she knew that if her relationship moved to marriage, she would want to revive her interest in–and ability to have–sex.

Each situation is different. For Sue, I began by prescribing Osphena, and I encouraging her to use vaginal dilators to stretch her vaginal walls, making them spacious enough to do their job.

If you’re in a situation where you haven’t been “using it” for a long time, I’d encourage you to seek out a gynecologist who has the expertise to help you bring your sexuality back to life for a relationship with a partner or for the health benefits of self-stimulation.

You can read more about Sue’s story in my next blog post, but I’ll give you a sneak preview: It took several months of “work,” with more than a few ups and downs, but Sue and her new husband are now enjoying a pleasurable and intimate marriage bed.

The lesson is this: With the right help, combined with persistence and patience, you can make a come-back and enjoy the benefits of a healthy sex life again.



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