Part Two Of A Three, Maybe A Four Part Series – (Let’s Just See How This One Goes)

We last left our heroine in the dire trap of “How Can I Avoid Having Sex. Ever. Again.” Perhaps not an unfamiliar situation to a few of you out there. No one here is suggesting that certain people may pretend to be asleep when they’re not, or have a headache when they don’t or have to practice their tuba lessons without benefit of actually owning a tuba. But, I’m going to guess that if you’ve crossed the half-century mark (yes I said it, get over it), then you have probably come up with some excuse at some point to avoid having sex, as sad, pathetic and 1950’s as that may sound.

Let’s unpack the who, what, when, where and why of choosing chocolate over sex, starting with my previous post.

Issue One: Sex Hurts

Why on earth would you want to have sex if you are in pain? You wouldn’t. You literally would never want to have sex if it resulted in massive pain. Let’s look at why sex would hurt.

I am of course assuming that your partner has some clue as to what they are doing down there and that you are not the masochist end of a sado-masochistic couple. We will save that for another post.

It’s the Sahara down there, but drier…

Vaginal dryness is a very common problem and can impact women of any age. It is common in women after age 40, and definitely after 100. But if you are giving it the old college try after 100 years-old — You’ve certainly got my admiration!

Symptoms

• Burning vagina
• Itching and irritation
• Feeling dry
• Sex hurts and burns
• Touch can feel sharp and painful.
• reduced natural lubrication.

Causes of Vaginal Dryness

• Low or no estrogen is by far the biggest cause of vaginal dryness. Lack of estrogen leads to a thinning or “atrophy” of the vaginal and vulvar tissue. Collagen and elastin levels drop leading to a lack of stretchiness. Blood flow to the tissue also drops which can mean so-long orgasm and bye-bye natural lubrication.
• Much less likely causes include: vaginal infections, chemical irritants (suddenly that over the counter “odor-away” douche wasn’t such a grand idea), sexually transmitted disease, and certain skin conditions like lichen sclerosis, lichen planus and other dermitis’ associated conditions. More on this later.
• Medications can also create dryness and lack of lubrication: Birth control pills, anti-histamines, decongestants, diuretics and anti-estrogen medications used to treat breast cancer (Evista, Arimidex and Tamoxifen.

What to do next?

This is the easy part. First of all, get checked out.

• Have someone with experience examine your vagina. Please don’t go to urgent care for this. Nobody there really wants to look at your vagina. Also the dentist won’t want to do that either. So, skip them. Your friendly neighborhood gynecologist can see if the tissue looks like it is suffering from lack of estrogen versus an infection or vaginal skin condition. You can check the pH (acid content) of the vagina and do cultures.
• See about getting off of drying medications if possible. Obviously, check with your doctor before changing up medications.

Treatment

Assuming that medications and infections are not involved, let’s talk about ways to address vaginal dryness.

Level One: I’m slightly uncomfortable

Lubricants: During sex, making things a little “slipperier” to use the medical terminology may be just what the doctor ordered. I recommend using lubricants that don’t contain toxic chemicals and ingredients you can’t pronounce. Tragically I’ve seen a few vaginas fall out as a result of using the wrong lubricant. Not a particularly pleasant sight at the check out line in Stop & Shop. Check out my previous post for more detailed information about treating vaginal dryness.

Here are a few of my favorite lubricants: Organic Glide, Aloe Cadabra, Sliquid H20, and UberLube (if this name doesn’t grab you I don’t know what will). As an aside, you can use Uberlube as a hair oil, a lubricant and to help with chafing. How’s that for multipurpose??

Vaginal Moisturizers: It may be helpful to moisturize your vagina on a consistent basis. This is NOT a lubricant. So don’t use this during sex. Moisturizers make the tissue stretchier, more supple and pliable if used consistently. Sounds like I’m describing a sensible pair of jeans, but no, I speak of the vagina. Look for vitamin E, hyaluronic acid, beeswax, coconut oil and aloe as part of the ingredients. Also makes for a nice veggie dip. Again, avoid the toxic chemical assault.

Here are some non-hormonal options to consider: Carlson Key E suppositories, and Bezwecken Hydration pearls.

Level 2: This is not “uncomfortable” — this hurts!

Here is where the rubber meets the road. Seriously, what does that even mean? I’m assuming it means, let’s get serious!

Vaginal Estrogen or DHEA: Replacing what is missing is a very helpful intervention. Use either of these topical hormones for six weeks to see a significant improvement in pain, sensation, lubrication and even odor. You do need a prescription for vaginal estrogen and DHEA, however there is an over the counter option called Renewed DHEA vaginal suppositories that are very helpful for many patients. Check out my post for details. What are the downsides?

• If you are not interested in or need to avoid any hormonal exposure, this is not for you. Although there is minimal absorption, it does in fact absorb into your bloodstream.
• If you will not consistently use a vaginal treatment (at least 2 to 3 times/week), this is not for you.
• If you have an estrogen-associated cancer, this is not for you.

Vaginal C02 Laser — The Femilift: CO2 lasers traditionally used for facial rejuvenation and wrinkle reduction are now used to build collagen and elastin in the vaginal tissue. This non-invasive outpatient option can tighten the vaginal walls, restore tissue elasticity, bring back your natural lubrication and improve blood flow to improve sensation. In addition, if you are dealing with some urinary incontinence, the laser can help with that as well. It may fold your laundry if you ask it nicely.

Each treatment lasts about 5-10 minutes each. You need a total of three treatments spaced 4 to 6 weeks apart initially. You will need one touch-up session after a year to maintain the benefit.

This is a great option for patients who:

• don’t want to use estrogen hormone therapy
• have breast or other estrogen-associated cancers
• have no time to or don’t want to constantly put medication in the vagina a few times a week
• have not improved on standard therapy
• want to get an optional vaginal tightening benefit as well
• want to reduce urinary incontinence symptoms
• have battled with recurrent vaginal or bladder infections

Oral Estrogen Receptor Modulators (ERMs) — This is an FDA approved non-hormonal oral drug for painful intercourse due to estrogen deficiency. This could appeal to women who wish to avoid using any estrogen therapy at all or wish to avoid using vaginal treatments. Ospemifene or Osphena (brand name) is an estrogen agonist/antagonist. Similar to other drugs in the same family like tamoxifen and evista, this drug acts like estrogen on some tissues (such as the vagina and uterus) and like anti-estrogen in others (such as the brain and breast). You need to take one pill daily for 12 weeks to see an improvement in symptoms.

Why I’m not a fan…..

• Similar to hormone replacement therapy, Osphena will stimulate the lining of the uterus and could lead to precancerous or cancerous changes.
• Although the risk is low, Osphena can result in an increased risk of blood clots, heart attack and stroke.
• You may experience an increased risk of hot flashes.
• Osphena was not studied head to head against vaginal estrogen therapy which is the standard of care for treating vaginal dryness due to estrogen deficiency. It is unclear whether or not Osphena performs as well, better or worse than vaginal estrogen therapy.
• There currently are no long term studies to confirm safety with long term use.

My Opinion:

Osphena should not be used as first-line therapy. Until more studies are available, the risks of Osphena seem to outweigh the benefits. According to the drug-developers sponsored study, after 12 weeks of treatment only 14% of women using Osphena reported improvements in symptoms compared to placebo users. A similar percentage had adverse effects, like infection.

Okay then! Next week we talk about other reasons it hurts to have sex. And which chocolate is the best.