Q: What can make penetration less painful?

Oooh! "Less painful" is a difficult goal; I'd like penetration to be pleasurable for you!

I'd like you to start with a thorough exam by a gynecologist or someone who specializes in women's health. If the problem is vaginal/vulvar atrophy, then localized estrogen may help to restore some moisture and elasticity. What you describe could also be caused by vulvodynia, which can cause burning sensations and pain with penetration. Again, a healthcare provider experienced in treating mid-life women can help you evaluate options.

If atrophy is profound and longstanding, you may find vaginal dilators helpful, too, in regaining caliber--the size of the vaginal opening.

I do hope you'll investigate--and raise your expectations. The minimum you deserve is no pain; I know you can have enjoyable sex again!

Q: Would a vaginal moisturizer help with bladder function?

No, I'm afraid a moisturizer won't help with bladder function. Moisturizers really only improve the tissue condition in the vagina where they're applied.

The vagina and the base of the bladder and urethra do have some tissue characteristics in common--they have the same embryonic origin. They both, for example, have estrogen receptors. That means that localized estrogen in the vagina can influence bladder function like frequency and urgency. Estrogen for localized application comes in several forms, but moisturizers don't contain estrogen.

If you are bothered by urinary urgency or frequency, I'd encourage you to see your medical practitioner; there can be multiple causes and there are solutions for each!

What Do Breasts Do for Us?

Recently I treated a patient who’d had elective breast reduction surgery. Nerve damage during the procedure had caused her to lose all sensation in her nipples. She found herself unable to have an orgasm without the extra stimulation those nerves had provided. That was a consequence she hadn't thought to ask about!

Changes in nipple sensation are possible side effects of any type of breast surgery, including elective surgery to increase or reduce breast size. Sometimes the effects are temporary, but they can be permanent. It’s important to understand these risks -- and the role your breasts play in sexual arousal and satisfaction -- when choosing breast surgery for cosmetic reasons. I don't know if my patient would have made a different choice, but she may have.

How do breasts contribute to orgasm? Some women (not most) can reach orgasm through nipple stimulation alone. Others rely on intense breast and nipple fondling to “put them over the top” during oral sex or vaginal penetration.

Like the clitoris, nipples are bundles of nerve endings that respond to touch by releasing certain hormones in the brain. One of these hormones, oxytocin, is sometimes referred to as the “cuddle hormone”: It makes us feel warm and open toward the person whose touch initiated its release in our bodies. Other hormones, including testosterone and endorphins, combine to create a surge of sexual arousal that increases blood flow to the clitoris and stimulates vaginal lubrication.

For most women, sexual foreplay is essential to getting us interested in and ready for intercourse or penetration. And for most women (82 percent in one study) breast and nipple stimulation are an essential ingredient of foreplay.  We talk a lot about clitoral stimulation and vaginal maintenance for maintaining our sexual satisfaction, but other parts of our bodies also play a part in arousal and orgasm, though.

For those of us fortunate enough to retain the pleasant sensations our breasts can provide, remembering these important sites of arousal during foreplay and intercourse (warming and massage oils can work wonders here) will enhance our readiness for and enjoyment of sex -- at any age. Let's not forget to raise our focus -- to our breasts.

Q: Can I get an over-the-counter estrogen cream for vaginal dryness?

Estrogen-containing vaginal preparations are prescription only. If you haven't tried lubricants and moisturizers, which are available over the counter, you might try those first.

Lubricants are designed for short-term effect, to make intercourse immediately more comfortable. They can be water-based, silicon-based, or a hybrid of the two.

Vaginal moisturizers are designed for longer-term maintenance of your vaginal tissues. They don't contain hormones, so don't require a prescription. They're typically used every several days.

Localized estrogen, which is available as a ring or vaginal tablet in addition to cream, helps to increase blood flow and elasticity in genital tissues. If you've tried lubricants and moisturizers and haven't yet been comfortable during sex, consider talking to your health care provider to see if localized estrogen or another hormone therapy might be right for you.

Q: I quit the pill and tested mid-menopause in one month; now sex hurts. Suggestions?

Isn’t it amazing how quickly things can change? You say you were tested as being mid-menopause. Blood work is accurate at assessing ovarian function on the day you're tested, but it is miserable in predicting what may happen in the next weeks or months. An FSH level may come back 40 (suggesting menopause) on one day, but you may ovulate 6 weeks from now at have an FSH at 8. It's really only over time that you really can better understand if this is the ‘new norm’ or transient. Perimenopause is known to have fluctuating symptoms; once in menopause, most women's symptoms are more predictable.

To make sex comfortable again, I would start with a lubricant. I would try a water-based lube like Carrageenan or Yes. If using a lube makes you comfortable and doesn't irritate the area, that can be a great, simple solution for now.

A warming lube can add some additional sensation for arousal and make orgasm somewhat stronger. Try Oceanus G Stimulating or Sliquid Sensations. Occasionally the warming lubes can be irritating if the area is sensitive, which is why I'd start with a non-stimulating water-based lube; then test a small amount of the warming lube to see if it works for you!

Good luck! I know you can have satisfying sex again.

Q: My libido is higher than ever! Will it last? Should I be concerned?

When you're in perimenopause, we say that your hormone levels are, in general, declining. While they are declining "in general," it's likely that your levels of estrogen and progesterone are fluctuating erratically from day to day. Testosterone is usually more steady, not particularly fluctuating day to day or month to month. As a result, the mix of hormones changes, and for some women testosterone seems to play a more dominant role; one effect of testosterone is enhanced libido (it's sometimes considered as part of therapy to restore sexual function).

This may explain what you are experiencing. You asked whether you should be tested for hormone levels. While it's possible to measure hormone levels, and those measurements are accurate, the levels are accurate only for that hour or day and are not particularly helpful to predict what to plan on in the upcoming days or months.

I would say, enjoy the current state! I hope this is your ‘new norm.’

July 01, 2010

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estrogen ›   hormones ›   maintenance ›  


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I surely don't miss the troublesome little egg sacs. The havoc they played with my system when they were there made my life miserable, to say the least. The new freedoms I have without them are well worth the maintenance work of not having them. View full article →

Q: Is weight gain a side effect of the estrogen ring?

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