Free Women's Health Advice

Please know that our general columns cannot take the place of a visit to a qualified professional who can determine your exact situation and needs.

Archived Questions and Answers from
Debra L. Hill-Busselle, MD
On Women's Health Issues

• I am past childbearing age, do I need an OBGYN or can a Family Practice Physician do my Pap smear?

• I am 67 years old and have gone off my HRT. It seems I have less sensation with sex and that my vagina does not seem as firm with intercourse. Is this from stopping my estrogen?

• I am 16 years old and have a problem. Sometimes I notice an abnormal discharge. It looks like raw egg white. It does not have an odor. It goes away for a while, and then comes back again. What is wrong with me? I am afraid to ask my mom.

• I’m 58 years old and haven’t had a period for 5 years. I have a few hot flashes, but they are mild. I’ve never taken hormone therapy and seem to be doing fine without it. Sex, however, has become uncomfortable and at times it really hurts. Is this normal for someone my age?

• I’ve been having hot flashes and night sweats. My cycles are changing, I don’t sleep as well as I used to and I can be pretty moody at times. I am 46 years old and think I am too young to be in menopause. My friend, who is 39 years old, just stopped taking birth control pills three months ago. She is having hot flashes daily and has not had a period yet. She told me her mom went through menopause in her early 40s. Is she in menopause? Am I?

• I am 43 years old and try to exercise regularly. When I go to my aerobics class and we do jumping jacks, I leak urine! I am so embarrassed! What’s wrong with me?

• Should my daughter get the new HPV vaccine?

Questions & Answers

Question:

I’m 58 years old and haven’t had a period for 5 years. I have a few hot flashes, but they are mild. I’ve never taken hormone therapy and seem to be doing fine without it. Sex, however, has become uncomfortable and at times it really hurts. Is this normal for someone my age?

Answer:

Painful sex is never ‘normal.’ Yet painful intercourse can occur at any age and as many as 35% of women complain of it at some point in their life. There are numerous reasons why sex can hurt. In your case, it is most likely due to estrogen deficiency.

Lack of estrogen causes the tissues to dry up, become thin, and crack and split with intercourse. The acidity gets off balance and bacterial overgrowth is common. Lack of estrogen also causes the tissues to become less sensitive to sexual stimulation. It becomes harder to achieve orgasm and women will notice their orgasms are less intense. Lubrication decreases tremendously and women complain of vaginal dryness. These changes cause sex to hurt!

Treatment Options:

• Regular sexual activity: “If you don’t use it, you lose it!’ Women who have sex regularly are less likely to develop these problems. The increased blood flow that occurs with sexual arousal keeps the tissues, blood vessels, and nerves healthier longer!
  
• Over the counter lubricants: Use a lubricant such as KY® jelly, Astroglide®, and many others with each act of intercourse. Lubricate your partner and yourself BEFORE penetration and sex will feel much more comfortable.
  
• Over the counter vaginal moisturizers: Products like Replens® are not lubricants, but moisturizers. They are not used with each act of intercourse but inserted into the vagina 2-3 times a week. Moisturizers adhere to vaginal walls and absorb 7 times their weight in water, coating the vagina with a moist layer. With regular use, the vaginal tissues actually become thicker, healthier, and the pH improves.
  
• Topical (local) estrogen: These prescription products are applied directly to the vulva and vagina. Even if you are already taking oral estrogen or using the patch, 20-30% of women on estrogen therapy still have discomfort with intercourse and may benefit from the addition of local estrogen. There are estrogen creams (such as Estrace® or Premarin®) that can be used 2-3 x a week and inserted into the vagina at bedtime. Within 4-6 weeks, tissues thicken, pinken and become more elastic; lubrication increases, acidity improves, and sensation increases. Estrogen cream is absorbed into the blood stream and this may concern some women. The insertable Estring® ring and Vagifem® tablets are local estrogen products that do not get absorbed.

There are many options available to treat painful intercourse due to estrogen deficiency. The most important thing is NOT to suffer in silence or start avoiding intercourse. Sex is good for your health so don’t be afraid to talk to your gynecologist about your concerns!