Phuli Cohan, MD
If you’re not enjoying sex and want to, if you’re not having mind blowing orgasms like you used to, but your healthy in every other way, I have good news for you. Your return to a full, lush, and exciting sex life is at hand. Read on.
The vagina can be mysterious- particularly in us women over 50.
As you age, estrogen and progesterone are no longer coursing through your veins and vaginal walls at high levels. Eventually the vaginal walls thin and bladder pipes become more easily irritated. Vaginitis, bleeding, itching, urinary frequency and infections can occur. Orgasms, if you’re lucky enough to have them, lose intensity.
There are a plethora of lubricants on the market, but none will actually improve the health of your vagina, and prevent infections. For that you need the bioidentical hormone, Estriol.
Estriol is a very weak, naturally occurring form of estrogen that any doctor can prescribe, using a compounding pharmacist. All women, including women who have had a history of breast cancer, can use vaginal Estriol safely- without increasing risks of cancer.
Estriol should be used instead of vaginal Estradiol (i.e. Premarin, E ring, or Estrace), because it won’t stimulate the lining of the uterus and cause bleeding or fibroids, and it won’t increase breast cancer. It has been prescribed safely for decades by physicians worldwide.
How do you get some? You will find Estriol over the counter as vaginal/facial creams (yes it lessens wrinkle too!) In general, these over the counter preparations can work, but the doses are usually too low. The typical dose is a 1 mg Estriol suppository, prepared by a compounding pharmacy.
Ask your doctor and, if your doctor is clueless, (1) find a compounding pharmacy in your area and ask them about it and which doctors in your area are prescribing it, or (2) ask your doctor to call the compounding pharmacy and prescribe it and (3) refer your doctor to my book, The Natural Hormone Makeover, (I have lots of references in it), or (4) give your doctor this article reference to read, (Menopause 2009: 16: 978-83).
Never heard of a compounding pharmacist? They are pharmacists, trained to prepare individualized medications. They can make creams, lotions, suppositories in what ever dose your doctor recommends. Compounding pharmacists are in all states. You can locate one in your area from this website: http://www.pccarx.com/contact-us/find-a-compounder
I recommend starting with 1 mg Estriol suppositories daily for 7 to 10 days. Once the vagina and sex is comfortable again, then maintain your vaginal lining by inserting a suppository every 2 to 3 days.
If you start using vaginal Estriol and orgasms are not as intense as they used to be explore DHEA. Have your doctor measure a DHEA-S blood level (any lab can do this). The level should be over 150 ug/dL. I’ve posted about DHEA before- but it is a hormone made by the adrenal glands and converts into testosterone. DHEA is available over the counter, but should be monitored by your doctor.
The great news is that DHEA can safely be used vaginally to enhance orgasm. I usually prescribe 25 to 50 mg in a vaginal suppository and have women use ½ to a full suppository before sex or once per week. It’s thicker than estriol so if it feels uncomfortably messy, use less, or ask the compounding pharmacist to make smaller doses and use it more often. Vaginal use won’t raise your blood level so prescribe both vaginal and oral DHEA if a woman has a low DHEA-S blood level. DHEA definitely improves sex drive and vitality if your levels are low.
So ladies don’t be scared to enter the world of bioidenticals vaginally. Educate your doctors and your friends and enjoy sex again!
We would love to hear from you….did you try this after reading Dr. Phuli Cohan’s article? How is it going for you? Is painful sex an issue for you? Are you willing to give this a try?