Q: How, beyond the Vagifem my doctor prescribed, do I work back to sexual activity?

Vagifem will have some influence on tissues within four to six weeks; I hope it won't be long before you note some benefit.

Beyond tissue health and lubrication, having comfortable sex depends on vaginal "capacity." I've recommended vaginal dilators to a number of women who've found them helpful; dilators are smooth cylinders of graduated sizes used to gradually, gently stretch the vaginal opening and depth.

If it really is just dryness (did I say "just dryness"?) making intercourse painful, the Vagifem and a good lubricant should get you back on track. And, of course, remembering to take the time you need for arousal!