I get occasional questions about erotic use of various household objects. I am, after all, long trained as a physician, so safety and hygiene are among my first concerns. And, since starting MiddlesexMD, I’ve seen some very well designed vibrators, dilators, and dildos that I know are safe, easy to clean, and designed specifically for older women’s pleasure.
That said, I encourage women and their partners to be playful. These are the things I would look for to be safe: Are there sharp edges, seams that might pinch, protrusions that might surprise you? Can you clean the material thoroughly—before and after use? Is it compatible with any lubricants you might use? And, less clinical but just as important, will it make you feel like a valuable, sexually alive person?
Q: What help is available for difficulty penetrating?
Tightening of the vaginal opening is one of the effects women can experience from the loss of estrogen. The type of lubricants that offer the most “slipperiness” and the least resistance is silicone; Pink may be the most popular at MiddlesexMD in that category.
It is possible to gradually, gently, and comfortably stretch the vaginal opening by using vaginal dilators. These are available in a set of graduated sizes; start with the smallest (and plenty of lubricant) in daily exercises and, when comfortable, progress to the next-larger size.
Only rarely is surgical modification appropriate for addressing this condition. With patience, women can typically achieve comfort with dilators and lubricants.
Riding a Bike? Take Some Care
You know that we always encourage you to exercise. Keeping fit is excellent for your overall health, and it keeps you sexually tuned up as well. You have more energy; you have a better self-image; you probably have less pain in your joints and elsewhere; and you probably have better range of motion.
So, far be it from us to discourage any form of exercise. But, we have a teensy qualification for those of you who like to ride bicycles.
Take care of your bottom.
Turns out that the numbness and tingling you feel after a nice, long ride is an indication that the nerves and tissue on the pelvic floor may be affected, which means less sensation in the genital area. And lord knows we don’t want to compromise anything down there.
A few years ago, researchers found that policemen who rode bikes on the job had less sensation and some erectile dysfunction. Following the study, women cyclists began to suggest that this wasn’t just a guy thing.
Sure enough. A new study of female bike riders by researchers at Yale University confirms that women who ride at least 10 miles a week also lose sensation on their pelvic floor. This effect was particularly striking for women whose handlebars were lower than their seats and was even greater when riders lean forward onto the dropbars for a more aerodynamic effect. These positions put the most pressure on the perineum. “That part of the body was never meant to bear pressure,” Dr. Steven Schrader, lead researcher for the study on male riders. “Within a few minutes the blood oxygen levels go down by 80 percent.”
Granted, these gals were competitive bikers, so a maximal aerodynamic position isn’t likely to be your overriding concern, but if you tend to lean forward as you ride, or if you feel numbness, pain, or tingling in your pelvic floor, you should raise your handlebars to a more upright, granny-style position. This helps to distribute pressure to the anatomical part that’s meant to take it—your sit-bones.
And if you really, really like to ride, you could consider a no-nose bike saddle. A list of manufacturers is here. A cyclist’s discussion of the pros and cons are here.
The take-away? By all means continue with your regimen, and more power to you. With a few minor adjustments, you should be on the road and more comfortable than ever.
Q: Can I revive my sex drive and orgasm after a hysterectomy?
There are a number of pieces to this puzzle–we women are complicated! First, because your hysterectomy was “complete,” you no longer have ovaries, which are a major source of testosterone (up to 50 percent) for women. Losing that testosterone can be a major hit to women’s desire, arousal, and orgasm. Some women benefit from adding back testosterone, but it’s not FDA-approved in the U.S. and not all practitioners are familiar or comfortable with prescribing it for women.
If you’re taking oral estrogen, some complicated biochemistry is at play that can further decrease your testosterone. Replacing estrogen by a means other than oral–skin patch, spray, gel–is important.
If you’re not taking estrogen, orally or otherwise, that may be a contributing factor, too. Losing estrogen leads to less blood supply to the genitals, which makes arousal and orgasm more difficult. Localized vaginal estrogen works for many women, and it’s not absorbed system-wide.
Beyond the hormonal pieces of this puzzle, I often recommend warming lubricants or arousal oils, which use a stimulant to bring more blood supply to the genitals. Using a vibrator can also help; the more intense stimulation can make a difference. And I encourage women to explore self-stimulation: What you require now may be different from what it was, and the better you understand yourself, the more you can help your partner meet your needs.
Best of luck! It will be worth the time and effort to revive this part of yourself!
Q: Are the changes I see in my vaginal skin normal?
You say the skin is becoming lighter and sometimes is dry, sometimes moist or itchy. That sounds completely consistent with the changes of vulvovaginal atrophy (VVA), which results from the absence of estrogen. It’s a gradual progression; it may not be particularly bothersome at first but may be more noticeable in the months and years to come.
The consequences of lost estrogen are often most noted in the vulva or vaginal tissues. Our bodies have lots of estrogen receptors, meaning estrogen plays a role there–from head to toe. But there are more estrogen receptors concentrated in the vagina and the vulva than in any other part of the body.
In and of itself, VVA doesn’t require treatment. If you have uncomfortable symptoms, there are treatment options, including localized estrogen, Neogyn vulvar soothing cream, vaginal moisturizers, and more.
You might also be aware that natural vaginal pH levels rise in the absence of estrogen, which means a woman can be more susceptible to infections. Symptoms to watch for are discharge, irritation, and/or odor.
Q: Could my HPV diagnosis be behind pain after sex?
HPV is an unlikely cause for pain with or after intercourse. It’s associated with abnormal pap tests, which may require further investigation—like the biopsy you say you had. Much less commonly, it can cause genital warts. If the warts happen to be at the opening of the vagina, they can become irritated and cause discomfort, but that’s really very rare.
It’s more likely the discomfort is related to the atrophic changes of menopause, which you may not have been aware of between relationships. In the absence of estrogen, the tissues become thin and less distensible—meaning less stretchy and able to expand—and also more fragile and easily injured. This can happen even if you don’t perceive dryness.
You didn’t say how long you’ve been sexually active; this problem may resolve itself: It’s the opposite of “use it or lose it”! But because menopausal tissues don’t rejuvenate quite as well as younger, fully estrogenized tissues do, you might consider using a moisturizer or localized estrogen. But I wouldn’t worry about HPV being a cause.