You ask about lifestyle changes, medications, and over-the-counter options. I appreciate your sensitivity to this issue on behalf of your wife, and your desire to be supportive.
Vulvar Herpes Simplex Virus (HSV) is actually a quite common condition but feels very isolating to women; they don’t share this with others. It feels like they’re alone, but that’s far from the truth: about about one in five women has HSV. It remains, though, a difficult diagnosis for many.
Menopause is typically not a time women experience more herpes outbreaks; often the outbreaks even become less prevalent. It is, though, a time that the changes related to menopause (namely the loss of estrogen) have a big impact on the genitals. Fifty to eighty percent of women will experience some degree of discomfort, possibly with day-to-day activities and for some pain with intercourse.
It’s not clear to me based on your description whether her increased discomfort is from the HSV or the more likely results of menopause; therapies therefore should probably be directed to that. Avoiding pool chemicals may be less of an irritant to the vulvar skin. Applying vulvar soothing products may be helpful as well. Epigyn is a great product that I have seen helpful for many menopausal women. Lubrigyn is a great vaginal moisturizer.
Using a localized estrogen therapy is ultimately the best outcome for some women, an important issue for her to discuss with her health care provider.
None of these suggestions will affect the likelihood of herpes outbreaks, and remaining on an antiviral like valacyclovir will be important to use either with outbreaks or daily as prevention.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.