Q: Is it possible that my vaginal dilators are too long?

Dilators are not intended to fit all the way inside your vagina. The extra length gives you some space to hold on to and to apply gentle upward pressure. The pressure gently stretches the tissues to achieve additional length or depth in your vagina.

The graduated diameters of the dilators in the set are intended to address narrowing of the vagina. Use the smallest one until it's comfortable, and then move to the next-larger size. We offer a more complete description of how to use dilators on our website.

I also encourage the consideration of vaginal moisturizers and localized estrogen to help keep the tissues healthier and more supple. That in combination with the dilators can give you more comfortable, faster, more lasting results.

Moist is Good

In the last post, we talked about how pH levels affect the vagina. The second part of good vaginal health has to do with moisture. As we say at MiddlesexMD, moist tissues are strong tissues.

Normally, your vagina moisturizes and cleanses itself by secreting a clear fluid that seeps from blood vessels in the vaginal wall. When you become sexually aroused, blood flow increases, and so does the lubrication. Unfortunately, this process is regulated by estrogen, and we all know what’s been happening to that hormone lately.

With decreasing estrogen levels and circulation, vaginal tissue becomes thin and dry. Maybe you’ve noticed that you don’t lubricate as easily during sex so that penetration is difficult or painful, or maybe you’ve experienced vaginal dryness and discomfort at other times as well.

The good news is that this condition is easy to fix. You moisturize your skin regularly; you should do the same with the vagina. First, a little refresher on the difference between vaginal moisturizers and lubricants. Lubricants may be used in the vagina and on the penis or toys during intercourse to help with penetration and to make sex more pleasurable. Lubricants come in water- or silicone-based varieties or a hybrid of the two, and in various viscosities (thick to thin). Choice of lubricant is a highly personal preference and may depend on the activity you have in mind. Because it’s helpful to try different kinds, we’ve compiled a sampler kit of our favorites.

Lubricants last several hours, and the only rule of thumb related to vaginal health is that no oil-based product, including petroleum jelly, should be used in the vagina. They’re hard for the vagina to flush out; they tend to disrupt pH balance; and they also tend to deteriorate condoms. Lubricants can be used in addition to a moisturizer.

The sole purpose of vaginal moisturizers, on the other hand, is to keep vaginal tissue moist and healthy. Moisturizers last two or three days and should be used regularly, just like facial products. And just like anything you use on your body, you want your vaginal moisturizer to contain natural, high-quality ingredients. A few common ingredients in vaginal moisturizers (that are also present in lubricants) bear some examination:

  • Glycerin. Widely used in moisturizers and lubricants, glycerin is a colorless, sweet-tasting substance that can exacerbate a yeast infection by giving the organisms sugars to feed on. If you’re susceptible to yeast infections, find a glycerin-free moisturizer.
  • Parabens. In all their hyphenated mutations (methyl-, ethyl-, butyl, and propyl-) parabens are a widely used preservative and anti-microbial agent. While some contamination-fighting ingredient is a good idea in these personal products, a few recent studies have found very slight health issues that may be linked to parabens. A bigger problem is the potential for an allergic reaction that could be related to parabens or other ingredients in moisturizers.
  • Propylene glycol. Used as a fragrance and to control viscosity, propylene glycol has also been linked to skin irritations and allergies.
While none of these substances present major health risks, it’s a good idea to make an informed decision about your personal care products. Read the ingredient list in your moisturizer; the fewer unpronounceable names, the better. If you can find a product that uses natural ingredients and that works for you, wouldn’t that be your first choice?

Q: Could my husband's medical treatment affect me in oral sex?

You say that your husband had a tumor removed from his lip, and you've experienced some discomfort since then after oral sex. The only possibility I can imagine that's specific to your situation is if he's using topical chemotherapy, a scant amount of which could be transferred to you.

It's more likely that the saliva is an irritant. As our vulvar skin becomes more thin and fragile, it can be irritated by enzymes in the saliva. You can use warm water--you don't need soap--to rinse after oral-genital contact. And you may find more comfort by using a lubricant like LiquidSilk or Yes (which is also a moisturizer) at the opening of the vagina and surrounding area.

Q: Is my vaginal moisturizer safe for oral sex?

Vaginal moisturizers for comfort

Both Replens and Yes, the vaginal moisturizers we offer at MiddlesexMD, are perfectly safe for oral sex. In fact, all of the products we offer are chosen with safety in mind.

Your partner may have personal reactions to a taste or texture of either product, or to personal lubricants. Feedback through our personal lubricant selection kit proves just how individual those reactions are!

If you or your partner isn't happy with a moisturizer or lubricant, don't think you've got to give it up! Just check out some other options to find one that works for both of you.

Q: Could I have injured myself during sex?

You say you don't have issues with vaginal dryness, but you did feel discomfort--difficult to sit comfortably, spasms of pain--for at least a week after intercourse. It does sound as though you experienced some trauma.

It's likely that though you're still experiencing your own lubrication when stimulated, you're experiencing some atrophy, too. I'd suggest that you start using a vaginal moisturizer (like Yes or Replens) or a localized estrogen to maintain moisture all of the time--not just when you're aroused.

If you and your partner aren't able to be intimate often (and I'm afraid the definition of "often" varies from woman to woman), you might think about some of the additional options I talked about in a blog post about "Staying Ready for Sex." It's easier to maintain your sexuality than to restore it!

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!

Q: How do I apply a vaginal moisturizer?

Vaginal moisturizers can typically be applied in two ways: either with your fingertip in the vagina and externally as needed, or with an applicator in the vagina. Applicators often come pre-filled (like the Yes product offered at MiddlesexMD) for one use, but, in general, the amount to use is an individual decision based on the degree of dryness or discomfort.

Manufacturers of vaginal moisturizers generally recommend application every 3 or 4 days, but, again, it's you who will need to find the frequency that works best for you.

Women I talk to often like the pre-filled applicators for "maintenance" application, and then to use a bulk bottle when they need lubricant for sexual intimacy. And, of course, you might find that a personal lubricant in addition to regular moisturizing is what you like best.

Q: Should I have secretions when I orgasm?

Most of a woman’s genital lubrication comes during arousal, not with orgasm (unless you're wondering about female ejaculation; there isn't agreement about whether this occurs for women, and if it does occur, most women aren't aware of it). And remember, most women can only achieve orgasm with direct clitoral stimulation; few women experience orgasm with penetration alone.

The amount of secretion--or vaginal lubrication--is most dependent on the time and energy and technique put into foreplay or arousal. After menopause, both arousal and lubrication are affected by the absence of estrogen in the genital tissues, which also decreases blood circulation.

Using a vaginal estrogen product (by prescription only) can allow a woman to produce more secretions on her own, which many women prefer. Talk to your health care provider about considering that as an option.

Non-hormonal (and non-prescription) options include vaginal moisturizers and lubricants. Moisturizers (like Replens or Yes) are used every few days and keep the vagina moist and supple; lubes are used at the time of sex to add comfort. The hybrid (Liquid Silk and Sliquid Silk) and silicone (Pink and Oceanus) lubes last somewhat longer than the water-based; water-based lubes may require re-application during a sexual encounter (which can itself be intimate).

Sharing with your partner what feels best to you will be helpful. Let your partner know that a lube is beneficial for your pleasure and find a way, together, to incorporate it in a tasteful, non-embarrassing--even arousing!--way.