I’m Not Dead Down There………Yet

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Cathy, a 45-year-old marketing professional came to see me in my clinical practice.  A striking women, she appeared the picture of health, but sadly she was not. Recently divorced she had met a new man five years younger. Cathy’s problem was that she could no longer experience orgasm although she was wildly attracted to this new man.   Having been together for nine months now, she was tired of painful sex and the need to fake her orgasms with her new hot man. She did not understand her problem with orgasming because when she was married to her husband, although the marriage was in trouble and her sexual desire low, she still managed to experience orgasms with him.

I inquired about her vaginal health and asked her if she was using anything for the painful sex. Menopause had hit her hard and early with hot flashes and night sweats, heart palpitations and vaginal dryness.  Initial penetration was painful and it was hard to hide that from her new lover, but she guided him and he was smooth.  “I’m not dead down there....yet, she quipped.”

Her doctor had prescribed estrogen systemically and progesterone to help with her vasomotor menopausal symptoms and a low dose localized estrogen for her vagina in the form of a tablet. Her vasomotor symptoms of hot flashes and night sweats all but disappeared, but her vaginal dryness remained and was now impacting her sexual experience - something that is not uncommon. In addition to this, Cathy was getting urinary tract infections, also common when vaginal estrogen diminishes.

I explained to Cathy that the estrogen tablet she was prescribed to insert into her vagina was a very low dose. The tablet was previously 25 mcg and was to be taken twice weekly for a total weekly dose of 50 mcg. Now the tablet that is marketed and prescribed is 10 mcg and is to be taken twice weekly for a total of 20 mcg per week. This weekly dose is 5 mcg lower per dose than the previous daily dose that was available for women. This new lower dose of vaginal estrogen is often too low for many women.

I suggested that Cathy speak with her doctor about increasing the dose of her localized estrogen tablet as it clearly was not working. Many women who experience vaginal dryness may also have problems with the female sexual response cycle such as desire (no one wants to do anything that hurts), arousal, excitement, engorgement (poor blood flow results when vaginal estrogen is low) and/or orgasm. Women may also experience issues with sexual sensation as well.

I also suggested something Cathy could do immediately to help with the dryness. I suggested she use a personal moisturizer on opposite days of her low dose localized estrogen tablet. She could try RepaGyn, an ovule that is inserted into the vagina or Gynatrof or JoyGel, a gel and a cream, respectively, that she could use on her labia.  RepaGyn, Gynatrof and JoyGel are over the counter medications that do not require a prescription. That said, you may have to ask the pharmacist for it because it is kept behind the counter at many pharmacies.

Cathy did not know that as the hormone regular of the vagina, estrogen and personal moisturizers are important in order for women to experience orgasms. That said she had no idea that it is just as important to moisturize your vagina as it is your face. Now she knows and she is looking forward to getting back to the bedroom with her new man!

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