Oh lord, people. I hear this from patients all the time. They have been in pain and discomfort, sometimes for years, to the point that they can no longer enjoy any part of an intimate relationship or ever feel comfortable in the hinterlands. I am now understanding that this is being told to women by both male and female physicians. What the? I can sort of see it coming from male physicians because they have no personal perspective to relate to but female physicians saying this too? Shame on you ladies! You know better. I am willing to bet that you are just not willling to spend the time dealing with it. I am not sure why though.

Well, I am here to tell you that you don’t have to just accept that….from any physician. Is it true that our vaginas become drier with age? Well, yes they do, but there in fact is all kinds of stuff we can do about it! It is not just something you have to deal with and suffer. I am hollering bullshit over hear when I hear that.

I know we are always going around telling ourselves that sex isn’t everything and it is not the key to a relationship. I am not saying it is either, but we are kidding ourselves if we think that depriving ourselves of that level of intimacy with a person that we really care about, or lust after as the case may be..lol has no consequences.

So, let’ s first talk about why the vagina changes so much as we age. It is time now to bring out the hormone blame. As the hormone levels drop or lose their equilibrium, the vaginal tissue becomes thinner, more friable, more delicate, looser, and unable to self-lubricate. The PH also gets off and leads to increase risk of infections. In fact, the angle of the vagina also changes to the point that hitting that magic g spot becomes almost impossible at times. On top of that, as our testosterone levels drop as well, our libido goes down the toilet. How’s that for abject chicanery? We are dry, we hurt, we don’t want to do it in the first place or we don’t want to do it because we know it will hurt.

I have good news coming! All of this can be addressed and the pain can resolve and the pleasurable sexual functioning can be restored! There are all kinds of creative and safe options that can be individually tailored to the specific woman.

First let’s address the dryness. I said that the vagina gets thinned out and irritated right? So, we need ways to plump it up and relubricate it. I have several. One is to do it with hormones, either orally or directly into the vagina. Usually estrogen is the key here and testosterone too.This is a potentially awesome option with relatively quick positive effects. There are several things to consider before entertaining this option though. You have to know your patient’s entire history. Women are not a candidate for these hormonal options if they have a history of certain cancers or blood clots. Women who have these conditions are not a candidate for hormonal therapy. Also, you have to keep in mind that if they still have their uterus, you cannot give them estrogen only because it could overstimulate the uterus and potentially lead to endometrial hyperplasia or cancer. But, no problem there, just balance it with some progesterone too and you are all good.

The good news is that there are plenty of alternatives for the patients that cannot take hormones. You wouldn’t think of this first but regular fresh out of the kitchen extra virgin olive oil is an excellent lubricant. So is coconut oil. My personal favorite is olive oil because you need less of it and it tends to be less greasy and get everywhere. All of those amazing feminine lubrication products out there tend to be the devil in my opinion. If you read the fine print there, there are all kinds of those things in those products that actually irritate the vagina more than they lubricate it. All that scented stuff that makes us think we have to smell like flowers, cake or pie? I say run in the other direction. The vagina has it’s own smell and no one is going to swoon away by letting it have its own natural odor. But, I have to admit that the packaging is very attractive. They also tend to be expensive too. I say forget it and just go with the olive oil or the coconut oil. Or, at least pick a water-based lubricant like astroglide. It seems to be the safest.

I have another good option for those that cannot do hormone therapy, the forma V intimate rejuvenation treatment. It is a radiofrequency treatment that involves inserting a wand into the vagina multiple times for a ten minute or so, in-office treatment, that replumps the vaginal tissue, relubricates the vaginal tissue, tightens the muscles, resets the vaginal angle and tightens the skin as well. It has no significant risks. You can even get it done if you have had a history of cancer or a previous sling or anything like that. We are using this awesome procedure lately to even return 80 plus year old patients back to the bedroom. There really has been no significant discomfort with this procedure so far in the last several years of doing it besides some pressure at the time of treatment only. The catch is that insurance does not cover it so there is an upfront charge, but every patient I have treated with this procedure has thought it was very effective.

There are other reasons to develop vaginal and vulvar pain as well. The most concerning ones are something called vulvodynia with or without vaginismus. Vulvodynia is a condition when there develops certain pain trigger points around the clitoral hood, around the urethral opening or at the bottom entrances (the vestibule) of the vagina. This trigger points become so inflamed that any attempt at penetration causes an extreme pain response. This can sometimes lead to an intense spasm of the muscles called vaginismus. Sometimes you get lucky and can determine a specific lesion or area of irritated skin that is causing the pain and you can treat that and the pain goes away. More often that not, there are just these trigger points with no set lesion. If this is the case, temporarily treat these areas with topical hormone cream for a month or so and then convert to a long-term topical combination anti-spasm, analgesia, anti-pain medication that the patient may have to use daily for the rest of her life. But these options do really work well and can even help return these patients to an intimate relationship. The other thing i do with these patients is that we take a deep dive into their cleansing regimens and use of certain detergents, soaps, and toilet paper and make any changes to their routine that could be contributing to any inflammation or irritation. I call it my be kind to your vulva tip sheet. You would be surprised at how many things you could be doing to harm yourself without realizing it.

Let’s talk lastly about libido and its relationship to intimate relationships. If you have no desire to have sex because you are afraid it is going to hurt, then you treat as above and once you eliminate the fear of pain, libido will usually return. If your lack of libido is due to a testosterone deficiency, you can either treat with oral micronized testosterone or local vaginal testosterone with great results. If you are not a candidate for hormone therapy, there are a variety of excellent herbal alternatives like schizandra or argin max or even yohimbe that can be very helpful.

The bottom line is that all is not lost. Ask for help. Seek a physician who is actually willing to take the time to get to the bottom of your particular issues. It will be worth it. The bedroom is calling!

Dr. Katz