Let's Get Specific

Like you, I feel the pull of the New Year, the impulse to fresh determination and resolve. (It partly comes, I think, from the satisfaction of packing away the Christmas decorations—much as I love them during the holidays!) I see the January magazine covers with headlines that offer a more organized, less stressed, healthier life.

And I see evidence of the season in the order trends here at MiddlesexMD. There are clearly a number of us who are making resolutions, and our fresh-start, new-focus impulse includes our sexual health.

As we’ve said before, being specific helps when making resolutions. So I dug into the data to see what other women have been choosing during this season of self-improvement. Here are the most popular choices, consistent over the past three years, and the reasons why I’d guess they land at the top of the list:

Vaginal moisturizer: I love that this lands at the top of the list. Moisturizers are used regularly (we put lotion on other body parts daily!) to strengthen vaginal tissues and keep them healthy. They supplement the moisture that we lose as our estrogen levels decline. Yes Water-Based moisturizer is our most popular, but we offer other options as well.

Lubricant: Lubricants are the very easiest defense against uncomfortable sex, which many of us experience with vaginal dryness. The most popular resolution purchase is the Personal Lubricant Selection Kit, and for good reason, I think. With the kit, you can sample seven different varieties, and then receive a full-size bottle of your favorite. If lubricants are new to you, this is especially helpful: The drugstore options are overwhelming, and I hate to buy a full-size bottle of something I end up not liking! All of our lubricants are selected for safety, efficacy, and fit for the needs of midlife women.

Kegel tools: I’m also happy to see these among the most-purchased at this time of year. Our upper arms are more visible, so we get a visual prompt to add them to our tone-up list. Our pelvic floors are out of sight and often out of mind—until we’ve lost enough muscle tone to experience incontinence or diminished orgasm. Strong pelvic floors do so much for us! And Kegel tools help us focus on the right muscles to flex, as well as reminding us to do those pesky flexes. Luna Beads Vaginal Weights are among the products most purchased at this time of year (and are actually the most popular of our Kegel tools throughout the year).

Just because these have been popular, of course, doesn’t mean they’re right for you; take some time to think about your own starting point and priorities. But you can also take some comfort in knowing there are simple steps you can take, and you’re not alone in the journey!

Q: Is there an over-the-counter product for elasticity?

You ask whether there's an over-the-counter hormonal cream to restore vaginal elasticity. You're finding intercourse painful and experiencing dryness.

Vaginal moisturizers will help to retain some moisture, but none of them will reverse the process—which is, medically speaking, atrophy given the loss of estrogen. The combination of moisturizers and lubricants will keep things comfortable for a while, but most women eventually need more.

Localized estrogen or the new pharmaceutical Osphena are effective; either requires a consultation with your health care provider. I'm not aware of any hormone-based medication available over the counter and, in fact, encourage a consideration of your medical history and current factors before use.

Q: How does Sjogren's Syndrome affect my moisturizer and lube choices?

Sjogren's is an immune system disorder most commonly identified by dry eyes and dry mouth, but vaginal dryness is among the additional symptoms. For a vaginal moisturizer, be sure you're starting with a product designed to be effective for that purpose (and Yes and Emerita are among the favorites we offer). Normally moisturizers are used twice a week, but with a condition like Sjogren's, you may increase that frequency.

For a lubricant, I'd recommend a hybrid (like Sliquids Organic Silk) or a silicone (like Pink). The silicone lubricant will last longer and feel more slippery, which usually means less discomfort. The hybrid, which has some of the benefits of both water-based and silicone, may be your choice if you use a silicone vibrator. If you want to experiment to compare lubricants that are water-based, hybrid, and silicone, we offer a Personal Selection Kit so you don't need to invest in a full-size bottle just for a test!

You have plenty of options in managing your comfort and Sjogren's! I wish you the best of luck.

Q: What can I do for dryness after sex?

The best option for what you describe is a regular routine of vaginal moisturizer use; use it consistently at least two times a week. Add a lubricant at the time of intercourse to assure your comfort.

Yes is the most popular product at MiddlesexMD for this condition; it's an organic vaginal moisturizer that can also be used as a lubricant. Emerita is another moisturizer option that works well.

Lubricants come in a number of formulations, so you might want to use our personal selection kit to try out a few and find the one that's most effective for you and your partner.

Q: Do I need a moisturizer or estrogen?

When women in my practice have vaginal dryness or atrophy, I typically start by recommending a vaginal moisturizer. The key is to be faithful, using the moisturizer at least two times each week. Yes is the most popular vaginal moisturizer at MiddlesexMD; the fact that it's available in pre-filled applicators is definitely a plus for women who don't like the mess of other options!

If the dryness or atrophy is not effectively managed with a moisturizer (which can happen over time), then I add a vaginal (localized) estrogen product.

I should also mention that a new oral medication for vaginal dryness or pain was approved by the FDA this summer. Non-hormonal, it's called Osphena and is available by prescription. Because it's oral, there's no mess! But you do need to make the consistent commitment, again, to regular use.

Q: How can I apply moisturizer more conveniently?

Like a number of my patients, you'd like to avoid the disposable applicator that often comes with vaginal moisturizers—whether for environmental or cost reasons (or both!). I know many women prefer to use an applicator: no muss, no fuss. I can't help but encourage women to reconsider the simplest approach: Wash your hands, apply moisturizer to your finger, and insert it in your vagina. This has a number of advantages—you're experienced in washing your hands, your finger is warm and able to curve with your vagina, and you'll know your body better. If you've used tampons without applicators or menstrual sponges or cups, you may be entirely comfortable with this method.

But I know our instinctive preferences are hard to retrain. Another alternative that's worked for patients is to go to the drugstore and check out the syringes for one of appropriate size and cleanability. Note that these are typically designed for single use, so you'll need to develop your own approach for washing and storing the syringe between uses.

Find a method that works for you! Vaginal moisturizer makes a difference with regular use.

Q: Could fibroids cause tenderness during and after intercourse?

You say you were diagnosed five years ago with fibroids, and you've reached menopause (one year without periods) quite recently. The good news is that fibroids tend to shrink in menopause, so they're unlikely to be causing the soreness you describe after deep intercourse.

The less good news is that your symptoms sound most consistent with vaginal atrophy, the typical consequence of the absence of estrogen in the vagina. I'd recommend that you start using a vaginal moisturizer or vaginal estrogen as soon as possible. The moisturizers are readily available; you'll need a prescription for the estrogen, which comes in a variety of forms for local application.

What you're experiencing is normal and easily treated—more good news!

Q: Would a vibrator be less irritating than manual stimulation?

If you're experiencing some irritation with clitoral stimulation, you might start with a hybrid (Sliquid Organics) or a silicone lubricant (Pink or Pjur). They provide more slipperiness for longer than their water-based counterparts.

And I would recommend that you try a vibrator. You can vary the intensity of the vibration, the pattern of vibration (continuous or pulsed, for example), and the pressure you (or your partner) apply--all helpful to finding what you need *now* for arousal. I'd recommend the Fin as an external options that is versatile, have nice soft surfaces, and can be recharged. The Kiri is a battery-operated, waterproof option with similar features.

Finally, if you're using a localized hormone like Premarin internally, with an applicator, there may be no added benefit from using a vaginal moisturizer. There's no harm in trying it, though, and I encourage moisturizer use among women who are not using localized hormones. If you choose to, Yes is the preferred product for many women who come to MiddlesexMD.

Q: Are the changes I see in my vaginal skin normal?

You say the skin is becoming lighter and sometimes is dry, sometimes moist or itchy. That sounds completely consistent with the changes of vulvovaginal atrophy (VVA), which results from the absence of estrogen. It's a gradual progression; it may not be particularly bothersome at first but may be more noticeable in the months and years to come.

The consequences of lost estrogen are often most noted in the vulva or vaginal tissues. Our bodies have lots of estrogen receptors, meaning estrogen plays a role there--from head to toe. But there are more estrogen receptors concentrated in the vagina and the vulva than in any other part of the body. \In and of itself, VVA doesn't require treatment. If you have uncomfortable symptoms, there are treatment options, including localized estrogenvaginal moisturizers, and more.

You might also be aware that natural vaginal pH levels rise in the absence of estrogen, which means a woman can be more susceptible to infections. Symptoms to watch for are discharge, irritation, and/or odor.

Q: Can I use a moisturizer with my localized hormone cream?

Absolutely you can, and I often recommend that women use both. Both vaginal estrogen creams--like Estrace--and vaginal moisturizers--like Prevaleaf--are typically used twice a week. Because each needs to be absorbed and, frankly, because it might otherwise be a little messy, I recommend that you alternate application. You might, for example, use the Estrace on Monday and Thursday and the Prevaleaf on Tuesday and Friday.

Glad you're taking care of yourself!