HRT, K-Y and frequency can help

Dear Dr. Gott: I repeatedly read about the devastating problem of male impotence, but what about vaginal atrophy in middle-aged women? Believe me, no doctors in my area seem to care. All they want to do is prescribe hormones and hormone creams, even when this remedy doesn’t produce good results. Changing physicians isn’t the answer, either, as I’ve done that. It’s the same old story.

Dear Reader: After menopause, when the levels of estrogen fall, women notice profound changes in their bodies. These changes include vaso-motor instability (hot flashes), emotional upset (especially depression) and vaginal atrophy (shrinkage and dryness of the reproductive tract). This last consequence of menopause may make normal sexual relations difficult or impossible. You’re right. This is a serious problem that is, unfortunately, often dismissed by male physicians.

I’m glad to be able to inform you that there are three solutions to the problem, all of which are effective – and, in combination, universally successful.

First, hormone replacement will – if given enough time – reverse vaginal atrophy and “recondition” the reproductive tissues. When administered as a cream (or a ring) applied daily to the vaginal wall, estrogen usually produces miraculous results. But it must be used regularly and in sufficient quantity. Because it is not absorbed in appreciable amounts into the body, it won’t affect the other symptoms of menopause, however. Nonetheless, this is one of its strengths, too, because it is not generally associated with vaginal bleeding and uterine cancer, as may be the estrogen patches or pills. Ask your gynecologist about this prescription therapy.

Second, a water-soluble lubricant, such as K-Y Jelly, will reduce friction and pain during intercourse. Many older couples in my practice use this product regularly, especially until the full effects of the estrogen cream become apparent. These lubricants are available without a prescription.

Third, frequent sexual relations (at least once a week, if possible) will help stretch and revitalize the vaginal tissues. Women often discover that a lack of sexual stimulation is a major factor in their dyspareunia (painful intercourse); by the time they want to start having relations, their bodies are not prepared.

Thus, in summary, I suggest that you utilize a lubricant while you attempt gentle intercourse, and apply estrogen cream daily. (Don’t use the cream at the same time you have relations, as it may be absorbed into your partner’s body and cause impotence.)

Finally, review my strategy with your gynecologist; if he or she seems disinterested, you should probably find a gynecologist more sympathetic to your plight.

To give you related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.